Beyond the curve: Dr. Peter Lurie's COVID-19 blog

The largest single cluster of COVID-19 cases for most of this summer didn’t occur in a nursing home or in a meat-packing plant, although those places have surely been hit hard by the virus.

No, the summer’s number one cluster—cases closely grouped in time and place—apparently began May 30 when buses carrying 120 prisoners from the California Institution for Men at Chino pulled up in front of San Quentin State Prison across the Bay from San Francisco.

The facility at Chino was experiencing an outbreak of coronavirus infections and officials were trying to contain the outbreak by moving healthy prisoners who were at high risk for adverse outcomes to COVID-19 to San Quentin, which had no known cases of COVID-19 at the time.

The plan was to test the inmates for COVID-19 before they left Chino to make sure they weren’t carrying the disease. But somehow the testing never took place and some of those who boarded the buses—it could have been prisoners, guards, or drivers—were already infected with the virus.

Within days of the prisoners’ arrival, the novel coronavirus started burning through San Quentin, eventually infecting more than 2,500 men and killing at least 29. Prison officials later conceded that they could have done a better job of transferring the men. Ya think?

San Quentin, however, is far from an anomaly. The 17 biggest clusters—in fact, 46 of the 50 largest clusters of COVID-19 infections in the United States—have occurred in prisons and correctional institutions. (The other four: three meat-processing plants and one Navy aircraft carrier.)

Yet, the 55,838 cases in these 46 clusters are less than half the cases that have occurred in U.S. penal institutions. By October 15, more than 148,000 incarcerated people in the United States had tested positive for COVID-19 and 1,224 had died. In addition, more than 29,000 staff working in prisons contracted the virus and 70 perished.

To be sure, the toll in nursing homes—more than 346,000 confirmed and suspected cases and 53,000 deaths—has been much greater, despite the fact that there are a little over half as many people in nursing homes as in the penal system. Of course, nursing home residents are older and more vulnerable.

Still, the sheer magnitude of the prison system in the U.S. makes the challenge of controlling outbreaks in these facilities daunting. The United States has the highest incarceration rate in the world, with only Russia rivalling us. On any given day, almost 2.3 million people are held in more than 7,000 state and federal prisons, jails, and other correctional facilities.

It’s not hard to understand why people in prisons and jails are so vulnerable to the spread of the coronavirus. Inmates are packed closely together indoors, often without masks, usually in overcrowded conditions where it’s difficult, if not impossible, to socially distance. Many sleep not in two-person cells like in the movies, but in bunkbeds or on cots or mattresses in large dormitories. They’re so close to each other that "when the men lie down, they can smell one another's breath," The New Yorker reported about an overcrowded prison in southeast Arkansas where the nation's 14th largest cluster of COVID-19 cases broke out.

Isolating the sick is a challenge, protective equipment can be scarce, access to soap and paper towels restricted, alcohol-containing sanitizers prohibited.

Making matters tougher, the average age of prisoners is higher now than ever as a result of longer prison sentences. In federal prisons, those 51 and older outnumber young adults aged 18-30 years and more than half of the older prisoners have a least one chronic medical condition that could make them more vulnerable to COVID-19.

The coronavirus has many opportunities to enter penal institutions from the outside world through staff, visiting families and legal representatives, and a high turnover of prisoners, especially in jails. And similarly, the virus can spread from prisons to outside communities carried by released prisoners and staff who return to their homes each day.

How have the states responded to the pandemic challenge in their prisons and jails? The Prison Policy Initiative, a nonprofit advocacy group, and the American Civil Liberties Union evaluated and graded all 50 states on their efforts. Their report’s conclusion, issued on June 25:

“State responses ranged from disorganized or ineffective, at best, to callously nonexistent at worst.” Most states, the report found, “ignored the pleas of incarcerated people and the warnings of medical experts and refused to implement widespread testing, provide protective equipment, and reduce prison and jail populations.” The results “have been as tragic as they were predictable.”

Jail populations nationwide did drop by about 25 percent between March and June, apparently because of fewer arrests, but have started increasing again. Federal prisons released more than 7,700 inmates to home confinement, but this constituted only five percent of prisoners and wasn’t enough to prevent overcrowding. Comparable data on state institutions are not available.

Our prisons and correctional facilities, like many other institutions, were not prepared for this pandemic, even though at the very beginning of the outbreak it should have been obvious that prisoners would suffer a disproportionate toll. Apparently, these institutions did not have the knowledge, the resources and, for some, the will to adequately take on the virus. Any blueprint for dealing with a future pandemic must include protecting the incarcerated and the staff responsible for them.

This post was written in collaboration with former CSPI senior scientist David Schardt.

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