Carlos Franco-Paredes, a doctor and associate professor of medicine at the University of Colorado Anschutz Medical Campus, worries the worst is yet to come for coronavirus outbreaks in Colorado’s state prisons and county jails.
“We are entering these new waves, and I don’t think we’ve seen half of what is going to happen,” said Franco-Paredes, who’s been an infectious disease doctor for 23 years. “I hope I’m completely wrong. But from the very beginning, we knew this was going to be bad in correctional facilities.”
Nine months into the pandemic, seven of the 10 largest active outbreaks in the state are within state prisons. A total of 3,481 inmates and 722 staff members have tested positive for the virus since the beginning of the pandemic and seven people have died, according to the Colorado Department of Corrections COVID-19 dashboard.
The DOC’s pandemic strategy has focused primarily on limiting inmates’ movement within the facilities, providing masks, and conducting targeted testing of inmates who exhibit symptoms or have been in contact with someone who has tested positive. As of Nov. 23, 84,044 tests have been administered between DOC’s 23 facilities over the last nine months — an average of about five tests per inmate.
“We really need layered strategies for outbreaks in all types and that absolutely applies to outbreaks occurring in correctional settings, whether that’s jails or prisons,” Rachel Herlihy, Colorado’s state epidemiologist, said during a media briefing on Tuesday.
“Certainly testing is going to be an important component of limiting introduction of the virus into the facility, and then quickly identifying when virus is present in the facility, whether that’s in staff or among residents of the facility,” Herlihy said. “But also using infection control practices, cohorting strategies … all of these things are really important strategies that facilities need to have in place to ensure that transmission is limited as much as possible.”
Herlihy did not respond to a media question about how the state health department is providing oversight to facilities that have struggled to get their outbreaks under control and stop transmission.
Testing only some inmates
Franco-Paredes, who also works with Denver Health’s Human Rights Clinic to conduct medical evaluations inside the Aurora ICE facility, said that testing only some of the inmate population is not an effective approach from an infectious disease perspective.
“The numbers vary, but I would say that about 40% to 50% of transmission happens by people who have no symptoms,” he said. “If you’re not testing everybody or not testing the majority of people, it’s not an effective strategy. You’re only going to be detecting a few cases and it’s only the tip of the iceberg.”
Throughout the pandemic, Franco-Paredes has conducted numerous jail inspections across the country as part of ongoing lawsuits related to conditions within correctional facilities. In April, he conducted two inspections of Weld County Jail, where 62 inmates and 22 staff members have tested positive for the virus and one inmate has died from it. In addition to scattered testing, he’s found that poor ventilation systems, overcrowding, delayed medical care and intake procedures are some of the biggest factors contributing to the skyrocketing case numbers in correctional facilities.
Last week, the Arkansas Valley Correctional Facility in southeast Colorado, which houses close to 1,000 inmates, saw a 740% increase in cases compared to the previous week, according to state outbreak data.
The facility tested all of the prison inmates for the first time on Nov. 3, according to Annie Skinner, a DOC spokeswoman. Prior to that date, inmates had been tested if they demonstrated symptoms, had potentially been exposed, or if they were being transported for a medical appointment or release.
A Colorado Department of Public Health and Environment spokesperson said that since April, the state lab has supplied the DOC with 170,000 testing swabs, along with PPE, for staff to conduct testing.
Franco-Paredes said intake procedures in county jails are also hampering efforts to slow the spread of the virus. In an ideal situation, new inmates should undergo a 14-day isolation period. If any symptoms developed, the clock should reset, Franco-Paredes said.
“But testing at the time of intake is not done routinely,” he added. “There’s some places that do it, but not everywhere.”
At Denver’s city jail, where there are currently 699 positive cases and 476 probable ones, new inmates are placed in intake housing while they wait to be tested by Denver Health staff, according to a Sheriff’s Department spokeswoman. Those who test positive are isolated for 10 days then are screened by staff before entering the general jail population.
Local public health agencies are charged with managing outbreaks in county jails and detention centers, but CDPHE overseas outbreaks in state prisons. The CDPHE spokesperson, who would not provide their name, did not provide specifics on how the state health department is enforcing public health orders and best practices to slow the spread of the outbreaks.
“Anyone living in a congregate setting is at higher risk of contracting COVID-19,” the spokesperson said in an email. “It’s important to conduct widespread testing, enforce mask wearing, and frequent hand washing — as well as to cohort those who have tested positive and have symptoms from those who are not ill.”
At the Weld County Jail, where Franco-Paredes conducted two inspections earlier in the pandemic, inmates were being shuffled around without being tested, he said.
“There was evidence of asymptomatic transmission, but it wasn’t widely reported,” he said. “When they saw that they had a few cases in an area, the rest of the people were transferred after a few days to another ward because they didn’t develop symptoms, and they started moving those that were with symptoms to another ward. So, that created a spread of the outbreak to other pods.”
Other concerns: Poor ventilation, high touch areas and lidless toilets
One of Franco-Paredes biggest concerns — and what he considers to be one of the largest contributors to the spread of the virus in jail and prison environments — is poor ventilation systems.
“Many of these air ducts have never been cleaned or the filters have never been changed, and they’re very old systems,” he said. “There’s no windows, there’s nothing. And in many places there’s only one vent. One for a unit that has like 400 people.”
In the overcrowded facilities, it’s almost impossible to keep surfaces and frequent touch areas such as door knobs, tables and telephones clean, he said.
“One thing that I’ve observed in multiple facilities is that they have one hour or two hours a day to go out, to take a shower or whatever it is, and the first thing they do because they’ve been in isolation is to call their families or their loved ones,” he said. “In some places there were some protocols to clean the telephones, but not in every place and it’s very hard because sometimes they run out of disinfectants.”
The bathrooms are also an area of concern. In most facilities, the toilets are close together with no doors or toilet lids, Franco-Paredes said. “There is likely some transmission by aerosolization when you flush the toilet,” he added.
He says the only way to get the outbreaks under control and to slow the spread of the virus within congregate environments is to conduct mass testing of all inmates and reduce the number of people within the facilities by releasing those with significant risk factors or who are in pretrial detention.
In March, Gov. Jared Polis issued an executive order that allowed the DOC to release at-risk and nonviolent inmates, but the order has since expired. While it was in place, 61 people earned time credits, 165 were released on “special needs” parole and 84 were released through the DOC’s Intensive Supervision Program, according to the DOC website. The number of inmates released is less than 2% of the state’s prison population.
Franco-Paredes said the number of people who have died from COVID-19 while incarcerated in the past nine months is comparable to the number of people who have died under the death penalty since the 1970s. There have been 1,452 reported coronavirus-related deaths in United States prisons, according to the Marshall Project and the Associated Press. 1,527 men and women have been executed in the United States since the 1970s, according to the Death Penalty Information Center.
“These people are on death row with COVID-19,” he said. “Some of them are just waiting to die in the next few weeks or months because of the lack of attention to them.”