The rapid spread of new variants of the coronavirus, some of which seem to be more contagious than older versions, has experts in the US calling for stricter social distancing and better masking to avoid yet another big surge of new Covid-19 cases and deaths.

Health advocates and epidemiologists are particularly concerned about what will happen once the new variants find their way into prisons, jails, and immigration detention facilities.

Across the US, at least one in five incarcerated individuals has already been infected with Covid-19, and a disproportionate number of them have died. One study found that the 2.3 million Americans living behind bars have twice the risk of dying from Covid-19 as a similar person who is not.

Jaimie Meyer is an associate professor at Yale School of Medicine and a researcher and clinician who specializes in the spread of infectious diseases behind bars. The pandemic “has laid bare [and] exposed the issues around conditions in confinement,” she told Vox, including how difficult or impossible it is to truly safeguard those held behind bars. In its quest to survive, Covid-19 will find “all of the holes [in our public health strategy] … all of the weaknesses, and pressure test them” she added. “If facilities have not done something to keep people safe, a more highly transmissible strain will spread like wildfire.”

An epidemiological nightmare

Prisoners are at an increased risk of Covid-19 for a simple reason: how the virus spreads. Scientists now know that the illness is mostly passed from person to person through respiratory droplets and sometimes through the air, which is why being in sustained, close proximity to others is so risky — and why crowded prisons and jails are especially dangerous. Contagion also frequently happens even before someone has symptoms, making it impossible to know who to isolate without frequent, rapid, near-universal testing.

“Congregate settings in general, and prisons in particular, are places where physical distancing is impossible,” said Meyer. Moreover, she added, people in prisons are more likely to have certain medical conditions, including obesity and diabetes, that put them at greater risk of infectious diseases.

The epidemiological realities of Covid-19 have been exacerbated by the failures of elected officials and institutions whose job it is to protect those who are incarcerated. Chris Beyrer, a professor of public health and human rights at Johns Hopkins, has been a vocal critic of Maryland’s approach to managing the crisis. In December, cases of the virus in the state’s prisons more than doubled.

“The single most important thing you have to do to deal with Covid in prison is to [reduce] overcrowding,” he told Vox. “We failed at that.” Although prison and jail populations dropped at the outset of the pandemic — mostly because fewer people entered the system due to virus concerns, rather than early release pushes — these populations are now on the rise again.

The second most important thing is to implement policies that can stem the spread of the disease, including social distancing and giving prisoners and staff masks and other essential supplies. “That, too, has been slow, inadequate, and insufficient,” Beyrer said. The Maryland Department of Corrections, he told Vox, isn’t providing free, unlimited bars of soap to people locked up in the state, leaving prisoners unable to do something as fundamental as wash their hands.

And the concerns don’t stop there. In facilities across the country, incarcerated people have reported a range of serious safety issues during the pandemic: correctional officers who refuse, or are not required, to wear masks; insufficient or failed efforts to test staff and incarcerated people; and the creation of new outbreaks by transferring Covid-positive prisoners to new facilities.

Meanwhile, vaccination has not even begun in most of the country’s prisons and jails, while those in other congregate settings — including nursing homes and homeless shelters — have been among the first in line to receive the shot.

“We are living through the failure of the basics of Covid prevention,” said Beyrer.

With all of these systemic shortcomings, many are extremely worried prisons and jails will be even harder hit when more contagious strains breach their walls. Early research has indicated that people infected with the new strain may carry higher viral loads, meaning that engaging in the same conduct — spending extended periods of time indoors without distancing — poses an even greater risk of spreading the virus than it did previously. For prisoners, that means that the worst outbreaks may be yet to come.

“A more infectious virus is only going to infect more people,” Beyrer said. “If more people are going to get infected, more people are going to die.”

“Scared as hell”

With so few resources to protect themselves and, in most places, no vaccine in sight, many prisoners are worried about the future. Jabriel Lewis is incarcerated at Allenwood federal prison in Pennsylvania. “That new strain got everybody in here scared as hell,” he said. “[I]f it gets into the federal institutions it could possibly mean a death sentence.”

For Michelle Angelina, a woman locked up in New Jersey’s Edna Mann facility, the threat posed by the new variants isn’t limited to the virus. The steps the prison system has taken to protect prisoners — shutting down all visitation, ending academic and substance abuse programming, and canceling religious services — will only be extended even further. “It’s putting an immense strain on all of us.”

Her concerns were echoed by Shebri Dillon, a woman incarcerated at Fluvanna Correctional Center at Virginia, who described the difficulty of spending “hours upon hours in a concrete cage, without seeing or hugging our children and family.”

“This new variant means an extension of all that pains us,” Dillon told Vox. “It is not a matter of if it will get in, but when.”

A matter of equity and public health

There are basic ways, however, to protect this large, vulnerable segment of the population — and the rest of the public at the same time.

For epidemiologists, advocates, and incarcerated people, the answer is to implement the policies they’ve recommended all along. “The implications of a more rapidly spreading Covid-19 variant in jails are clear,” said Robert Cohen, a physician who previously worked on Rikers Island and now serves on the Board of Corrections that oversees New York City’s jails. In addition to providing better access to basic PPE, sanitizing supplies, and testing, as many people as possible need to be released from prisons, jails, and other detention facilities, stressed Cohen, and all remaining incarcerated people and staff must be inoculated against the virus sooner rather than later.

In a handful of states, including Massachusetts and California, the vaccinations of prisoners have already begun — but in many places, including New York, they aren’t being prioritized for the vaccine.

Advocates say this reality is just another example of the inequitable impact of the virus on poor people and people of color, given that Black and Latinx individuals are locked up at many times the rate of their white peers. “Despite calling for equity in vaccine distribution, [New York’s] Gov. Cuomo has neglected incarcerated people even while rolling out vaccines to other congregate settings,” including homeless shelters, said Katie Schaffer, director of advocacy and organizing at Center for Community Alternatives, which provides programming and policy work to reduce incarceration across New York state.

While many incarcerated individuals are eager to be inoculated, vaccine hesitancy does exist inside prisons and jails, in no small part due to the long history of medical experimentation inside these facilities. Some agencies are providing incentives to encourage prisoners to participate, including video visits with family members and slightly shortened sentences, while outside initiatives have sought to educate prisoners about the vaccine and its safety. Since the two coronavirus vaccines in the US currently only have emergency approval from the FDA, it’s likely unlawful for correctional authorities to mandate that prisoners or staff receive the shot.

Releasing more prisoners and accelerating the vaccination of those left inside is not only a matter of human rights, say public health officials — it’s also a necessary step to protect the public at large.

There are indications that widespread infection inside these sorts of facilities easily spreads to the community and beyond. One study found that the March outbreak in Chicago’s Cook County jail contributed to about one in seven of the state’s total cases in the following month. Prisons have also incubated especially deadly variants of other illnesses, including strains of multi-drug-resistant tuberculosis.

“This is part of our public health,” said Meyer. “We should all want people who are in any congregate setting to have the best chance of preventing exposure and infection” — for their own health and safety as well as that of everyone else in the country.

Aviva Stahl is an award-winning investigative reporter who writes about how health care policy and scientific debates play out in the prison context. She’s written for a variety of outlets including Vox, the Guardian, and the New York Times, and can be followed at @stahlidarity.

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It’s been nearly a year since Julie Horowitz-Jackson’s mother, Arlene, died of Covid-19 in a nursing facility in Philadelphia. “What hit me recently is that the world is opening back up, and my mom’s still dead,” Horowitz-Jackson says.

At this point in the Covid-19 pandemic, as vaccines get rolled out in the United States and around the globe, there is a glimmer of hope that life will safely start shifting back to “normal” in the coming months. But so many people, like Horowitz-Jackson, are still working through their grief, and it won’t just disappear when the virus does. Horowitz-Jackson, 51, says she was coping well with the loss of her mom until recently, when, in Chicago, where she lives, she saw many people out and about, celebrating St. Patrick’s Day in large crowds. “I get angry,” she says. “I get angry that people aren’t taking it seriously.”

With over 550,000 reported Covid-19 deaths in the US and 2.8 million worldwide, a massive grief crisis is upon us — with large, unaddressed mental health and economic implications.

“For a large share of people, these [losses] lead to bouts of prolonged grief disorder and depression,” says Ashton Verdery, a Penn State sociologist who studies the societal costs of bereavement. “But also they have huge impacts on their finances, on their employment, on their relationships, and on all kinds of aspects of thriving in the world.”

And new research here provides a broad window onto the lasting scope of our national tragedy.

“These losses that are felt now will be felt for some time to come — even individuals who aren’t born yet will potentially be missing these relatives who might have been alive during their formative years,” says Mallika Snyder, a graduate researcher at UC Berkeley who is also working on estimates with colleagues of the “excess bereavement” felt in the United States and other countries this year.

There’s no exact figure on the amount of “excess bereavement,” but it’s likely very large, and very devastating.

So many more people are grieving this year than normal

Lately, I’ve been trying to understand the long-term consequences of the Covid-related death — the blank spaces and shadows it leaves behind. Death is not a one-dimensional statistic. It ripples across time, leaving holes in people’s present and future where their loved ones would have been. So, so many people are sensing these holes in their lives right now.

Recently, Verdery and colleagues estimated that, roughly, every person who dies from Covid-19 in the United States leaves nine grieving people behind. Since more than 550,000 people have died of Covid-19 here, then there are nearly 5 million people who’ve suffered the loss of someone close to them.

Verdery’s work is based on a statistical model of the personal connections people typically have. The Centers for Disease Control and Prevention collects data on who is dying of Covid-19, but not the survivors they leave behind.

That said, Verdery says his team’s work suggests a huge swath of people are dealing with loss. “Each death [regardless of their age at death] is going to leave a 4-year-old, a 50-year-old, a 60-year-old, a 10-year-old bereaved, on average,” he says.

And researchers know from past disasters that those losses can leave a lasting mark.

Meghan Zacher, a sociology researcher at Brown, has recently re-analyzed some mental health and wellness data collected from survivors of Hurricane Katrina, in an attempt to predict some of the long-term consequences of the pandemic. “Katrina and Covid are different in really important ways,” she stresses. “This isn’t an apples-to-apples comparison. But there really isn’t an apples-to-apples comparison to the pandemic, at least in modern history.”

She and her co-authors found that the experience of losing a relative or a friend during the storm and its aftermath had the “largest effects on mental and physical health, one year after the storm,” she says. “Also things like fearing for your loved ones’ safety had sizable impacts, as did unmet medical needs. And those are all things that people have experienced during the pandemic.”

Many people experiencing loss from death could benefit from counseling. Covid-19 swells their numbers.

The loss of a loved one is really hard, and not everyone copes in the same way. But there’s some research into the broad buckets of need grieving people fall into. And that helps us understand the immediate impact this bereavement crisis is having in the country — and around the world.

Survey research suggests that, at least in Western contexts, around 60 percent of people dealing with a loss cope by relying on friends and family to support them. “They handle it in their own way,” says Catriona Mayland, a physician and researcher at the University of Sheffield who studies end-of-life issues. It’s not necessarily easy for this group to deal with loss. But they manage.

A further 30 percent might need some more structured help. “So that might be group bereavement support from a faith-based or community-based group,” Mayland says.

And then around 10 percent of those who lose someone close to them experience symptoms qualifying them for a prolonged grief disorder, a diagnosis that soon will be included in the DSM (the psychology/psychiatry official diagnostic manual).

The diagnosis recognizes that sometimes grief rises to the level of severely interfering with the normal function of life, and that people experiencing prolonged grief could benefit from mental health care.

That 10 percent figure is both small and large. It means that, yes, most people cope with loss in their own time. But it’s also not uncommon for someone to need extra help.

And then consider the Covid-19 pandemic. Again, there could be 5 million people grieving losses due to the pandemic. If 10 percent of those people qualify for this diagnosis, that’s half a million people.

There’s even some limited research from the Netherlands suggesting losses due to Covid-19 are harder to take, resulting in more grief, compared to deaths from more typical natural causes.

Talking with people who have experienced loss, it’s easy to see why. Horowitz-Jackson’s family is Jewish, and it’s custom for the family and surrounding community of the deceased to hold a week-long open house “shiva” period, where there’s near-constant company in the home.

“Shiva Zoom was about the worst thing I’ve ever experienced,” she says. Particularly, she remembers how her father, hard of hearing, struggled with the technology. “The ritual of seeing each other and leaning on one another,” she says, just couldn’t be facilitated as well over the internet.

Mayland worries, too, that “there actually could be an upward shift” in the number of people needing more than informal support after a loss, since due to the social distancing restrictions of the pandemic, “normal support” from family and friends may be limited.

Which is all to say: More people than usual may need support to deal with their loss.

Bereavement can impact health and well-being differently at different ages

A person older than 65 who loses a spouse has a “shockingly elevated” increased risk of dying over the next year, Verdery says — estimates range from 15 to 30 percent higher risk of dying. There are many reasons: Our loved ones take care of us when we’re sick, they prod us to get checked out by a doctor, they provide emotional and sometimes financial support. When a loved one gets taken out of the picture, so many cracks can form in the foundations of our lives.

There is, quite literally, a condition called “broken heart syndrome,” or takotsubo cardiomyopathy. It’s when, in reaction to a sudden surge in stress, the heart’s left ventricle weakens.

The experience of loss can be particularly impactful on the trajectory of a life when it comes to young people: When a person under the age of 18 loses a parent, they become less likely to finish high school or college. “Because we know that education is so strongly linked to all manner of life course outcomes — like involvement in the prison system, socioeconomic status in adulthood, unemployment spells, early pregnancy, all sorts of stuff — this does suggest that some of these bereavement events might be really derailing,” Verdery says.

The impact of these deaths is so powerful that bereavement is thought to be a source of racial disparities in health and education in America. By age 20, a Black child is twice as likely to experience the death of a mother and 50 percent more likely to experience the death of a father. The pandemic is likely to make this trend worse — as we know Covid-19 has been taking minorities at younger ages than white people dying from it.

And American society doesn’t do well to protect these grieving kids. It’s estimated that less than 50 percent of children who experience the loss of a parent receive Social Security survivors benefits (which they may be entitled to). “This is one of the most staggering statistics that I found,” Verdery says. “The kids are already dealing with so much. And we’re not even getting them in touch with the benefits they’re entitled to.”

What should we do about this?

After experiencing the loss of her child, Joyal Mulheron, a former adviser to Michelle Obama’s “Let’s Move” campaign, felt the extreme, life-altering pain bereavement can bring. “I basically drove to work every day for 18 months and cried to and from work,” she says. And it wasn’t just her personal pain that was horrible — she also realized that society often overlooks bereavement issues.

Now Mulheron runs Evermore, a bereavement-focused nonprofit, and hopes the pandemic will be a wake-up call for the country to start paying closer attention to the societal strain bereavement puts on the country. “The challenge is no one is thinking about it as an event that can change the course of an individual’s life,” she says.

For instance, she points out that “bereavement is not part of the FMLA” — the Family and Medical Leave Act, which provides time off for those caring for sick family members, but not to cope with their loss. She calls for better housing protections for those who lose financial support after losing a loved one, more transparent funeral pricing, and better Social Security assistance for kids who lose parents.

She also simply would like to see this issue be studied more thoroughly. “We’ve not had the data to really contextualize this,” Mulheron says. “We’ve really thought of a death event as a personal tragedy, rather than a family or a community experience.” At the very least, Mulheron would like to see the White House establish an Office of Bereavement Care, to set a national agenda on this issue.

On a smaller scale, Mayland, the physician who studies end-of-life issues, says it can be helpful just to find spaces to talk about grief, and more helpful still if friends and family reach out with an ear to listen. “Sometimes it’s therapeutic to be able to tell a story,” she says.

“Each time I talk about it, I feel like I’m honoring her memory,” Horowitz-Jackson, the Chicago woman who lost her mother, says.

And don’t forget, Mayland stresses, “Individual kindness can have an impact. It often is the small things that actually can make a difference.”

If you’re reading this, having lost someone to Covid-19, know that you are not alone. So many people are experiencing loss in the country right now, and the pain might not go away when life appears to return to normal.

For some additional resources on bereavement, check out Refuge in Grief, a website and online community with worksheets and courses for processing grief. And you can read more about therapies designed to help people with complicated grief here.

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July 4 this year could also be America’s Independence Day from Covid-19.

At current rates, America is administering nearly 2.8 million Covid-19 vaccine doses a day — roughly enough to vaccinate every adult (18 and older) in the country by July 4.

That would mean 80 percent of the population would be able to get a vaccine. We don’t know for certain if that’s enough for herd immunity, when enough of the population is immune to the disease, through vaccines or natural infection, that the virus can no longer sustain its spread. But it’s in the range that experts typically mention.

Since a vaccine isn’t yet approved for children younger than 16, this is also close to the highest level of vaccination we can expect for the time being. (The estimates in this story don’t include 16- and 17-year-olds who are eligible for vaccines.)