Last month, I spent nearly five days at Mount Sinai Hospital in Manhattan with severe Covid-19. Because I’m immunocompromised, having Covid—or any viral infection that damages the tissues—makes me more susceptible to developing bacterial pneumonia. My doctor was taking no chances.

For the first two days, I lay in my hospital bed too weak to even look at my phone which lay next to me. I spiked fevers every day; each fever prompted Tylenol, large IV bags of fluids to prevent dehydration, and yet another blood draw to determine whether I had an infection. I started taking Paxlovid to decrease the chances of more severe Covid.

My appetite plummeted to nothing. On the third day, I started to feel well enough to drink some soup broth, which I promptly vomited. That was the fate of other food and drink I attempted to put into my body.

An X-ray and a CT scan of my chest both showed no signs of pneumonia. I was given Paxlovid and bags of intravenous hydration to prevent dehydration. By day four, I had enough energy to sit upright in a chair to look out the window and read a novel. I could keep food down, though my appetite remained tiny and I got most of my nutrients through protein shakes.

As terrible as my experience was, I know I am fortunate. Although the city has shuttered free testing sites and stopped distributing free Covid tests, medical professionals continue to take Covid seriously. While the federal Food and Drug Administration restricted the latest Covid vaccine only to people whose medical conditions place them at high risk and those age 65 and older, New York continues to make vaccines available for all.

That’s not the case in many states, where governors and medical officials have used the latest FDA restriction to limit vaccinations. It’s also not the case behind bars, where viruses can—and do—spread like wildfire. That’s what happened at the start of the Covid pandemic, as I document in my book, Corridors of Contagion.

Thousands of people were packed, often without access to masks, into cellblocks and dormitories. Public health officials recommended that jails and prisons release people to avoid outbreaks. Some states did. But with hundreds of thousands still held behind bars and staff coming in and out each day, that was not enough to avoid outbreaks and preventable deaths. Although the number of people behind bars decreased, the prison mortality rate jumped 77 percent in 2020 compared to 2019, or 3.4 times the rate of the general public. Not every state distinguishes Covid from other causes of death, but in the 19 states that did, Covid was seen to have caused nearly one-third of prison deaths. When vaccinations became available, prison staff were prioritized over incarcerated people.

With Covid rates rising and vaccination rates and mask wearing nearly nonexistent, incarcerated people are facing yet another spike in cases. Now they also must contend with years of hostility toward basic protective precautions, such as masking or attempts at social distancing. They continue to face substandard medical care, with many providers emboldened by the FDA’s restrictions and the federal government’s anti-science ideology to justify their refusal to administer vaccines and boosters or even take Covid symptoms seriously.

Kwaneta Harris in Texas is one of the incarcerated women whom I interviewed extensively for Corridors. She told me in September that, unsurprisingly, women in her housing unit had been showing symptoms consistent with the latest strain of Covid. But medical staff told them that they simply had a bad summer cold or allergies. No one was tested and, even if they had been, there’s no way to tell how many people are affected because the Texas prison system stopped tracking Covid rates in May 2023. The year before, prison rules had changed to prohibit masking; masks were confiscated and anyone caught with a makeshift mask was threatened with a ticket, which could jeopardize their program participation, time out of their cell, visits, or parole possibility.

People at Oklahoma’s largest women’s prison report a similar pattern. “[Covid] is undoubtedly here, but there’s no testing or isolating going on that I’m aware of,” one woman, who asked to remain anonymous to avoid retaliation, told me. “And no booster [shots] available that I know of, either.” In an e-mail to The Nation, Kay Thompson, public relations chief for the Oklahoma Department of Corrections, wrote that prisons no longer isolate or quarantine those who test positive. Instead, they are encouraged to wear a mask for five days. She also wrote that incarcerated people can request vaccines and boosters from medical staff.

In Texas, Kwaneta has repeatedly asked about getting the latest Covid booster. Although the state allows adults to get the vaccine or booster, prison nurses have given her conflicting answers. One told her that the CDC had said it wasn’t necessary. Another said that they weren’t paying “for that rip-off.” A third told her that she did not qualify. In mid-October, a nurse told her, “We don’t even got none. I don’t think we getting none. All that is over.”

When Kwaneta pointed out that Covid is currently spreading, she said that the nurse told her, “It ain’t killing nobody.” (The Texas Department of Criminal Justice did not respond to queries about its Covid policies.)

As I found when researching Corridors, this fits with the pattern when the vaccine first became available to the general public. Kwaneta had to advocate repeatedly to get her first shots. When she was finally allowed to do so, months after they had become available, the guards escorting her to the medical clinic asked why she was doing so, repeating popular misinformation. While Kwaneta succeeded in getting fully vaccinated, she was the only one in her unit to do so. The guards’ fearmongering dissuaded the other women.

Malakki, who asked that we withhold his full name to prevent retaliation, told me that his housing unit in Pennsylvania has been offered the latest Covid booster. This was a relief after most of them fell ill with Covid-related symptoms last year. He had been hit hard—he spent three days in bed, largely unable to move. Two men had to help him out of bed, into his wheelchair, and to the bathroom down the hall. He was unable to get to the chow hall, but no staff noticed that something was wrong. It was only when most of the housing unit fell ill—and some men asked to be tested—that staff quarantined their unit. Those who tested positive were not offered Paxlovid or other treatment.

Even when I was at my most debilitated in the hospital, I knew how lucky I was compared to the millions of people behind bars. I knew that, despite the early ravages of and outrage about the pandemic behind bars, prevention measures were short-lived. Prison abolitionist Mariame Kaba has long called prisons “death-making institutions.” Now, the rise in incarceration (and a skyrocketing of immigrant detention), coupled with the nation’s lax approach to Covid-19 and health care behind bars, makes her characterization (yet again) a frighteningly accurate prophecy.