NC lags in testing for COVID-19 in prisons. Experts say more will die unless that changes
North Carolina officials in early May responded to a judge’s order with a sheaf of documents outlining what the state is doing to stem the spread of COVID-19 in its prisons.
They described providing at least two masks to each inmate. In dorms packed with bunk beds, they are asking prisoners to sleep in a “head-to-toe” arrangement to maximize the space between their heads. And they are directing inmates in prison manufacturing plants to churn out face masks, gowns and thousands of gallons of disinfectant and non-alcoholic hand cleanser for use in the prisons.
But, some attorneys and experts say, what was most notable in the state’s response is what was left unsaid.
Neither the N.C. Department of Public Safety, which oversees state prisons, nor the governor, who has power to commute prison sentences, outlined any plans to release more inmates early — a step that some experts say is crucial to allow for more social distancing in currently crowded prison dorms.
Officials also didn’t announce any plan to test more adult inmates for COVID-19. So far, the state has tested about 4% of inmates — well below the national average for state prisons, according to data compiled by the COVID Prison Project.
“I think the necessary steps to limit the spread of disease include de-population and test, test, test,” said Dr. Brie Williams, who heads a team of medical experts at the University of California, San Francisco that focuses on the health of people who live and work in prisons and jails.
When little testing is done, undetected cases of COVID-19 are inevitable, said Alison O. Jordan, a nationally recognized public health consultant with expertise in jails and prisons.
“The consequence is that more people will spread the disease,” Jordan said. “More people will get sick. And more people will die.”
To evaluate how prison officials are attempting to curb the spread of COVID-19 in the prisons, reporters from six newsrooms across the state examined records from the May 8 court filing and interviewed inmates, experts and officials from other states.
COVID-19 thrives in the cramped quarters of prisons, and it endangers more than inmates and prison employees, experts say. That’s because employees can transport the virus to their families and communities.
“COVID-19… does not respect the boundaries of a prison wall or a jail wall,” Williams said.
‘If they test us, they’re going to find there’s COVID-19’
Limited testing makes the true scope of COVID-19 in state prisons impossible to know.
About a third of North Carolina’s prisons have yet to test a single inmate, state data as of Sunday night shows. And at 24 more state prisons, fewer than a dozen inmates have been tested.
Dr. Mandy Cohen, secretary for the N.C. Department of Health and Human Services, said Friday that more people now qualify to get a COVID-19 test. That includes people who live and work in congregate facilities, including prisons and county jails.
But when asked how inmates would gain access to a test, she said contact tracing will determine whether inmates get tests.
“The good news is we haven’t seen other outbreaks in other facilities,” Cohen said.
DHHS defines a COVID-19 outbreak as two or more laboratory-confirmed cases, which means that North Carolina has seen outbreaks in 11 of its prisons.
“As we ramp up testing on our staff, we know we are going to find more virus potentially. Then we’ll trace back to, ‘Where are those staff? Are they in a correctional facility that has not yet undergone more testing?’” she said. “Then we will take the necessary steps from a contact tracing perspective to ramp up testing.”
The state’s two largest outbreaks are at Neuse Correctional Institution, in Goldsboro, and the North Carolina Correctional Institution for Women, in Raleigh.
At Neuse, all the inmates were tested after medical staff saw a spike in confirmed cases in mid-April. More than 460 inmates — about 70% of the prison’s population — tested positive. At NCCIW, 230 inmates were tested. More than 90 of the women — about 40% of those tested — were found to be infected.
The lack of known outbreaks at more facilities may be due to limited testing.
“Given what we know about how quickly this disease spreads, the result of such limited testing is putting people in DPS’ care in grave danger,” said Leah Kang, a staff attorney for the ACLU of North Carolina who helped represent civil rights groups in a recent lawsuit aimed at reducing the state’s prison population in response to COVID-19.
Inmates at several prisons have told reporters over the last several weeks that prison officials are not testing people who show symptoms of COVID-19.
At the Wake County Correctional Center, in Raleigh, the state’s statistics show that just one inmate has been tested and that no one has tested positive.
But one inmate there, who asked not to be named because he fears retaliation, said that, based on what he sees, he thinks a number of inmates have contracted COVID-19.
“We see guys who don’t smoke but they cough for like a week,” the inmate said. “They don’t want to test us. Because you know what? If they test us, they’re going to find there’s COVID-19.”
On Saturday, DPS announced that it would test all youth at the Stonewall Jackson Youth Development Center in Concord after a staff member there tested positive for the coronavirus. But no other large-scale testing initiatives have been announced.
State prison officials say they’re simply following the recommendations of the Centers for Disease Control and Prevention and DHHS, which urge testing when people show symptoms.
“The stance has been that CDC guidelines don’t call for mass testing. DHHS guidelines don’t call for mass testing,” prison spokesman John Bull said on Friday. “Both call for symptom-based testing.”
Yet those guidelines are changing. On Friday, DHHS issued new guidance that recommends testing be available to people in correctional facilities, regardless of symptoms.
Some other states have taken a far more aggressive approach.
Tennessee was the first state to enact a plan to test all staff and people housed in state prisons on May 4, after seeing the results of mass-testing at four prisons.
On May 12, the Texas Department of Criminal Justice announced the mass-testing of inmates through self-administered tests after seeing a surge in illness and deaths among inmates and staff.
Michigan, a state with a prison population comparable to North Carolina’s, has already tested more than 16,000 inmates — about 12 times the number tested in North Carolina. The state’s goal is to test all 37,000 inmates, according to Michigan prison spokesman Chris Gautz.
They’ve accomplished this mass testing with the help of 75 National Guard troops.
Each test costs about $50. But Gautz said prison officials have found that it’s worth the cost.
“You can’t solve a problem if you don’t know you have one,” he said. “And you can’t solve a problem if you don’t know where it is.”
‘It’s a breeding ground’
Those who live and work in prisons are particularly vulnerable to COVID-19 because inmates live so closely together.
In interviews over the past month, more than a dozen inmates described cramped conditions: Bunk beds so close together that prisoners can reach out and touch their neighbors. Inmates who line up right next to each other for food and medication. Prisoners who crowd around televisions in prison day rooms, sometimes without masks.
Carl McMillian, an inmate at Carteret Correctional Center, near coastal Morehead City, is serving time for a low-level drug charge and is scheduled to be released from prison in August.
He said the state’s measures to prevent the spread of COVID-19 are hardly being followed. The prison set down markers on the ground to keep people apart while they line up for meals or for medicine, but the markers are ignored, he said, by both staff and inmates.
“I ain’t come to get a death sentence, because I don’t know if this thing will get me,” McMillian said last week. “I got 84 days left.”
Pamela Humphrey, an inmate at the NCCIW in Raleigh, said that in her dorm, the bunk beds are still no more than about 2 feet apart — even after the death of 67-year-old fellow inmate Faye Brown on May 6.
Brown was one of more than 640 state prison inmates who tested positive for COVID-19 — and one of five state prison inmates who died from the disease.
“It’s a breeding ground, is what it is,” said Humphrey, 58. “It’s literally putting our lives in danger.”
In some prisons, as many as 80 people are packed into a single room, said Kang, of the ACLU.
Prison officials acknowledge that the cramped conditions make social distancing difficult.
“All bunks in all dorms in all facilities are already spaced as far apart as possible, and at a minimum three feet apart,” state prisons commissioner Todd Ishee said in an affidavit filed in response to the ACLU lawsuit.
“However, due to limited square footage, the bunks cannot be spaced out any further than they already are positioned.”
To compensate, prison officials are now telling inmates at some prisons to sleep head-to-foot, a recommendation from the CDC.
This suggestion has been greeted with some skepticism by infectious disease doctors.
"I don’t know if it helps,” said Williams, the professor of medicine at the University of California, San Francisco. “...I would count that as a very small step that may or may not have efficacy."
Dr. Sandra Springer, an associate professor at the Yale School of Medicine, said having inmates sleep head-to-foot in dormitories isn’t enough. The bunks should be spaced at least six feet apart, she said, but that’s a problem “because not every facility has space.”
One of the ways to create adequate space, she said, is to release inmates.
Experts: Releasing more inmates early would help
Given the cramped conditions inside many prisons, some experts believe corrections officials need to consider releasing as many inmates as they can, provided they can do it in a way that doesn’t pose a significant risk to public safety.
In North Carolina, about 700 inmates — a little over 2% of the total — have been released early due to COVID-19. Some of them are completing their sentences in the community, under the supervision of probation and parole officers.
Unless those inmates were released from just a few prisons, “it seems unlikely that releasing 2% of the population will have a discernible impact,” said Dave Rosen, a UNC epidemiologist who studies infectious diseases in prisons and jails.
In Connecticut, Springer noted, the state has reduced the prison and jail population from 13,000 inmates to fewer than 10,000.
And in Kentucky, Gov. Andy Beshear has commuted the sentences of more than 1,200 inmates convicted of nonviolent and nonsexual crimes. The commutations will help protect both inmates and staff members, said J. Michael Brown, secretary of Beshear’s executive cabinet.
“This is lightening the load on our corrections system and at the same time protecting some of the most vulnerable individuals who are in the corrections system,” Brown said at a recent press conference.
But in their statements to the court, North Carolina’s top prison officials asserted that they’re hamstrung by inadequate resources to monitor and aid recently released inmates once they get back to their communities.
“In my professional opinion, there is simply no way to accomplish a mass release of offenders into the community at one time without sacrificing either the services that in our opinion are essential to reentry success, or the interests of public safety,” Nicole Sullivan, DPS director for Reentry Programs and Services, wrote in an affidavit on May 8.
Do inmates have enough protective gear?
Prison officials say they’ve taken multiple steps to protect the health of inmates and staff. They have suspended in-person visitation and sharply limited prison-to-prison transfers. They’ve begun taking the temperatures of all staff members before they enter prisons each day.
And they’ve retooled prison manufacturing plants, instructing inmates to make enough masks, disinfectant and non-alcoholic hand cleanser for all inmates and staff.
But until several weeks ago, many inmates said they had no masks.
Even now, some still say they have no access to some of the supplies they need to protect themselves.
In addition to Brown who died at NCCIW, there have been four other COVID-19 deaths at state prisons. At Neuse, three people died. The first death was of a man housed at Pender Correctional Institution, where at the time only three people had been tested for the disease.
Gloria Estes, 68, an inmate at the women’s prison in Raleigh who suffers from a variety of health problems, said inmates in her dorm still have no access to hand sanitizer. And she says the phones that inmates share still aren’t disinfected between uses.
“I’m an endangered species,” she said. “I’m pretty brave, but I’m fearful.”
This story was jointly reported and edited by Kate Martin, Jordan Wilkie and Frank Taylor, of Carolina Public Press; Gavin Off, Ames Alexander and Doug Miller, of The Charlotte Observer; Dan Kane and Jordan Schrader, of The News & Observer; Nick Ochsner, of WBTV; Emily Featherston, of WECT; and Tyler Dukes of WRAL.
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