By Lillien Waller
Since early 2020, our national consciousness has been focused on the coronavirus pandemic. COVID-19 has captured our attention but also our anxiety and grief: to date, more than half a million Americans and nearly three million people worldwide have died from the disease. But amid the lockdowns, quarantines, stimulus package battles, culture wars, a presidential election, and national vaccine rollout, we have begun, tentatively and imperfectly, to lumber to our collective feet.
A number of long-term public health crises have continued to roil in the background, however, often overlooked but nonetheless urgent—indeed, made more urgent by a pandemic that has intensified their effects. Commonwealth School alumni/ae Ezra Haber Glenn, Sonya Del Tredici, and Aaron Littman are advocates for some of the most vulnerable among us, who have felt the impacts of COVID even more acutely as they grapple with housing insecurity, opiate use disorder and life behind bars.
“Prison walls don’t keep the virus in or out”
There’s a lot we don’t know about what goes on in America’s jails and prisons. What we do know, and have for decades, is that the U.S. carceral system is a public health crisis marked by widespread violence, overcrowding, and inadequate sanitation, healthcare, and mental health resources. That was before the pandemic.
“It’s clear that the toll in prisons has been really staggering and that the infection rate has been multiple times higher than in the community at large. There are systems where half of people have been infected. And the age-adjusted death rate in U.S. prisons early in the pandemic—and before the most recent winter surge—was also multiple times higher than in the community,” said Aaron Littman ’06, Binder Clinical Teaching Fellow at UCLA School of Law and Deputy Director of the UCLA Law COVID-19 Behind Bars Data Project.
Begun by UCLA Law Professor Sharon Dolovich in March 2020, the data project started out as a simple spreadsheet to track policy changes in prisons and jails, particularly regarding in-person visitations, which had been stayed in the early days of the pandemic. More than a year later, the project has a full-time twelve-person staff, more than 100 volunteer researchers, and is the CDC’s official source of COVID data on prisons and jails.
There are a number of reasons the infection rate and death toll in prisons would be higher, Aaron notes, including the inability to socially distance, the constant movement of people between and within facilities, and an incarcerated population of disproportionately poor people and people of color with comorbidities that make COVID-19 more deadly.
What’s most surprising is that there is much we still wouldn’t know about the realities of the pandemic behind bars were it not for the project’s data collection to date. Reporting—on quarantine procedures, testing, how many have contracted the disease and how many have died from it, along with other crucial information—has been inconsistent, often unreliable and, in many cases, nonexistent.
“There are, roughly, three thousand jails in the country. At the beginning of the pandemic, the L.A. County Jail, where I live, had 17,000 people in it, which is bigger than a number of state prison systems. They reported data, as did Cook County Jail in Chicago and Rikers in New York,” Aaron explained.
“But well over 90 percent of jails have just reported nothing or issued a press release once or twice, rather than sharing data in any kind of consistent way. So, we just don’t know how many people died in those jails. In a few states there is decent data—for example, in Massachusetts—because the ACLU brought a lawsuit and has collected and reported some of that data. But in most states, we just don't know.”
Aaron emphasizes that the entities withholding information on incarcerated people during the pandemic may be doing so not only because they prefer to operate in obscurity but also to keep their jurisdictions’ infection rates artificially low in order to reopen local economies more quickly.”
Transparency is a primary objective of the data project during the pandemic and for the long run: A serious public conversation about the future of mass incarceration cannot happen without knowing what is really taking place in America’s jails and prisons.
“There’s real importance to having basic data about what’s happening in these carceral institutions so that the public can have an informed debate about what they should look like, how big they should be, and how people should be treated in them.”
Greater transparency also helps protect communities at large because of the multiple ways the coronavirus can be carried into, and out of, jails and prisons. “Prison walls don’t keep the virus in or out,” Aaron said. “If what you care about is that your grandmother not die of COVID, then you should want fewer infections being generated in that prison down the road so that fewer infections are coming out.”
Aaron explained that the pandemic has exposed deep crises that were there all along.
“I think it could potentially catalyze change. Our courts, which have been so hostile to prisoners’ rights claims, are not going to fix this problem. We need to have other avenues of reform, and if [the pandemic] exposes strategies that are fruitful, that are not the ones we normally employ, that’s sort of a glimmer of hope in what’s otherwise a pretty bleak picture.”
“The pandemic has been bad for addiction”
“My biggest concern for my patients is that they’ll die,” said internist and addiction specialist Dr. Sonya Del Tredici ’94 of WellSpan Internal Medicine – Apple Hill in York, Pennsylvania. Speaking candidly about her specialty in opiate use disorder (OUD), Sonya explained: “Opiate addiction is a deadly disease, and the destabilization of the pandemic has made treatment a lot more difficult for my patients. They already didn’t have a lot of extra resources at their disposal, so when they get thrown into a hole it’s that much harder for them to dig out of it.”
The opioid epidemic is commonly understood to be one of the greatest public health crises in U.S. history. So, what happens when one historic crisis coincides with another?
According to the CDC, the year ending in September 2020 saw a record number of fatal overdoses in the United States—more than 87,000—the most ever recorded in a single twelve-month period. The largest increase occurred during the first three months of the coronavirus pandemic from March to May, amid national lockdowns and mitigation measures.
“The pandemic has been bad for addiction,” Sonya said, explaining that pandemic conditions responsible for isolation, financial hardship, and joblessness among the general population have been that much more challenging for people suffering from OUD and other substance abuse disorders.
“The residential treatment centers had to close or reduce their numbers, and the mutual support groups like AA had to move online, which was less effective for many people. Therapy had to go to telemedicine, which was also hard,” said Sonya. “and there was a lot of job loss among my patients, who often work at places without job protection. Many were also not given adequate protection against COVID at their workplaces and ended up getting sick.”
Sonya noted that the pandemic’s restrictions chipped away at the system of accountability that she and her colleagues had worked to build with their patients. “We keep very close tabs on them, and when we weren’t able to do that, people started to relapse.”
Such accountability points to the deep connection between patients suffering with OUD and the medical care they receive for recovery, especially as a lot of patients began taking opiates in a medical setting. Since doctors have been some of the drivers of the opioid epidemic, they are uniquely positioned to help reverse it, said Sonya. And effective medications exist to treat OUD, which isn’t the case for most other drug disorders.
WellSpan in Pennsylvania has expanded its addiction services within the last year making it possible for patients there to access services through their primary care physicians rather than through a separate addiction specialist or clinic. Sonya, who is also Associate Director of the residency at York Hospital, is heartened by the model the health system uses to support recovery. Each patient sees a doctor regarding their medications and a Recovery Support Specialist regarding other life issues.
“The Recovery Support Specialists are all people who have also experienced addiction in some way, so they can empathize with our patients. We do the visits together: I talk about medication, and mental and physical health, and the Recovery Support Specialist helps with all the other aspects of treatment, like arranging for counseling, job training, child care resources, or even Christmas presents for their kids. We do it together.”
It’s a promising treatment strategy designed to address all aspects of the disease, which is at once biochemical, psychological, and social—meaning it can, and does, decimate a person’s life from the inside out.
Sonya remains passionate about her practice and her mission, especially during a pandemic that has not yet begun to abate. “I’m very interested in the mind-body connection, and addiction medicine is an interesting example of how biochemistry interacts with behavior. And I love working with this group of people. They’re young, energetic, positive, and really eager to get help.”
“It’s not just a housing crisis. It’s a community development crisis.”
For months they appeared on our TVs, phones, and tablets. Large families and small, parents and kids, low income and new to financial hardship: the global pandemic threw millions of American renters—many of whom were already on the brink—into financial chaos and, quite literally, the streets, compounding a pandemic crisis with an eviction crisis.
Halfway through 2020, and prior to the CDC’s most recent moratorium on evictions, the National Low Income Housing Coalition (NLIHC) estimated that as many as 40 million renters were at risk of eviction—not least because, prior to the pandemic, nearly half of all American renters were already cost burdened by their rental payments.
“Housing affordability in this country has been a complete mess for decades. It’s never worked well. It’s never worked fairly. It’s never been clear. We have a huge amount of confusion and inequality,” says Ezra Haber Glenn ’87, who teaches in MIT's Department of Urban Studies and Planning and works to help communities across the state build more housing. “COVID has really revealed the depth of housing insecurity and the kind of housing disparity that exists between the haves and the have-nots.”
According to Ezra, beyond the interrelated job-loss and eviction crises, there’s the problem of additional financial burden for property owners who, because of rental payments in arrears, can’t afford their own mortgages, property taxes, and maintenance. And behind all of this, there has always been a fundamental disparity in the United States between the quality of housing in different neighborhoods and the different options available for owners and renters. When you own a house, you’re saving money and paying yourself, Ezra notes, and when you rent, you’re not.
But the benefits of home ownership, the pandemic has demonstrated, extend far beyond the economic when where you live determines how you live.
“Because some people have been able to pay so much more for housing, they’re able to live in places that are less dense,” Ezra explained. “They’re living in houses that are much more comfortable, that allow you to work at home, and that provide private access and outdoor space. COVID made it clear that this wasn’t just about comfort but safety.”
It’s a fact of American life that may have been illuminated by the pandemic but, at least in terms of housing policy, we’ve accepted for decades. And it’s also why America’s crisis in housing insecurity will likely persist. The current moratorium on evictions remains in place through June 2021. But how well will ongoing government relief play among the American public outside of a historic national emergency?
“If you just cancel the rent, that passes the burden back to the landlord,” Ezra said. “We like to think of landlords as evil people, but often they’re just struggling small business people or homeowners, too. So, you don’t want to have the eviction crisis turn into a rent forgiveness crisis, which turns into a foreclosure crisis.”
On the positive side, the revelations of the pandemic may offer a unique opportunity to reimagine affordable housing.
Simply building more affordable houses or units is a great start, but it’s unlikely to deliver enough to truly solve the problem because the supply can never meet a demand that, even before the pandemic, numbered in the tens of millions. And it’s as much a problem of location as it is about supply: unlike other consumer goods, you can’t move houses around. The problem isn’t really about the number of houses but the number of houses in places people want to live, Ezra notes.
“People want to live in places where there are good jobs, good transportation, good parks, good schools and clean air and water. Unfortunately, we only have so many places like that. One option is to build more houses in these neighborhoods—which we are trying to do—but it’s really expensive, and slow, and there’s only so much you can do there. But the other option is to make more places like that.
“Viewed that way,” Ezra added, “our housing crisis is actually a community development crisis. We need to make more places that offer the same opportunities as the ones that everyone seems to want to be in.”
Nonprofit organizations like Boston’s Dudley Street Neighborhood Initiative or Urban Edge have already been doing the groundwork to empower residents to build affordable, vibrant, and thriving neighborhoods. Such groups are part of a broader patchwork of organizations across the country working to alleviate the cluster of crises around housing—not at the city or state level but at the neighborhood level.
“Part of community development is the actual community developing things,” Ezra said. “Instead of just the government developing affordable housing, the community does. Instead of a private company making jobs, the community will help make jobs.”
Lillien Waller is a poet, essayist, and editor. Her poems have been nominated for the Pushcart Prize and Best New Poets, and she is editor of the anthology American Ghost: Poets on Life after Industry (Stockport Flats). Lillien is a Cave Canem Fellow and a Kresge Artist Fellow in the Literary Arts. She lives in Detroit.
This article was first published in the Summer 2021 issue of Commonwealth Magazine.