Prisons and jails have been primary sites of the spread of COVID-19 since the earliest days of the pandemic; this has not been limited to spread within these institutions, either. One study found that more than 10% of COVID-19 community infections during the summer of 2020 were traceable to mass incarceration. Last year, nine of the top 10 outbreaks in the United States were in jails and prisons, linked to surrounding communities as staff come and go daily.
Maryland has appropriately prioritized vaccination of staff and those incarcerated in prisons, but the process is slow and many individuals have refused the vaccine. Thus, for the foreseeable future, the state must implement proactive testing immediately to avoid further preventable tragedies.
The public health community has known since the beginning that prisons, jails, and detention facilities — congregate care settings, like nursing homes — are incredibly vulnerable. They are indoors, densely populated and mitigation tactics like social distancing are virtually impossible; COVID-19 thrives in these conditions, especially where personal protective equipment (PPE) is unavailable. And like nursing homes, carceral facilities have many people over age 65 who have significant chronic and underlying health conditions, making them particularly vulnerable.
One of the most effective weapons in the battle to control the spread of COVID-19 is testing. But it is too late to test people once they are symptomatic. Facilities must proactively test, taking samples of asymptomatic people, to stay on top of the viral spread. An effective testing mitigation strategy allows for rapid identification of viral hot spots, so staff can initiate appropriate quarantine and treatment protocol. Public health experts look for a positive rate far below 5% percent to indicate an environment where the viral spread is under control.
This is why Gov. Larry Hogan issued an executive order in April 2020 to test all nursing home residents and staff. We applauded the Department of Public Safety and Correctional Services (DPSCS) when it took similar steps to test all staff and incarcerated individuals in state prisons. Unfortunately, after completing its initial round of tests, DPSCS appears to have abandoned proactive testing. Thus, predictably, the uncontrolled spread of the virus began in several Maryland prisons.
In the first eight months after the pandemic shut down Maryland in March, 1,139 incarcerated people in state prisons tested positive. In the three months since then, 2,928 incarcerated individuals have tested positive. That translates to one in five people in Maryland prisons testing positive since March. The number of staff who tested positive during the same period more than doubled to 2,073 people. Prisons such as the North Branch Correctional Institution and Eastern Correctional Institutions routinely reported positivity rates well above 50% — in some reporting periods, 100% of tests came back positive.
These infection rates indicate a system that is only testing symptomatic individuals and suggest that little is being done to stem the spread of COVID-19 as increasing numbers of infection and death among staff and incarcerated people should be ringing alarm bells.
How many of the 22 incarcerated people and four staff members who have died of this virus could have been saved with proactive testing? And how much of the spread throughout Maryland communities can be traced to staff’s day-to-day travel in and out of facilities? The implications of the state’s failure to effectively test its prison population and staff spread far beyond the institutional walls. They can be measured in lives lost and families torn apart.
Maryland must take immediate action to redouble testing in prisons and jails, and to offer vaccines to everyone who wants one. Maryland must also finally take the steps necessary to make PPE, soap, and disinfectant readily available to everyone inside prisons, jails, and detention facilities. The state has wasted precious time, and lives have been lost. It is past time to take these simple steps before we see more preventable deaths.
Chris Beyrer (email@example.com) is the Desmond M. Tutu Professor of Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. Ryan King (firstname.lastname@example.org) is director of policy at the Justice Policy Institute.