Testing sparse at many large jails

Testing at Colorado’s largest jails remains limited and sporadic even as an increasing number of the facilities are added to the state’s list of confirmed outbreaks.

With the exception of Denver, testing numbers at the state’s 10 largest jails remain in the double or single digits despite populations in the hundreds and daily churn of people booking in and out of the facilities. At least five of the facilities — Arapahoe, Pueblo, Mesa, Larimer and Boulder — had tested fewer than 10 inmates as of earlier this week. For example, the Arapahoe County Detention Center currently houses about 600 inmates and has conducted six tests over the past two months, which all came back negative.

The jails are following Centers for Disease Control and Prevention guidelines that suggest screening inmates by asking them about symptoms and taking their temperatures. Workers at some of the jails said they were first stymied by a lack of available tests, although they have been able to acquire more tests recently. The jails have been able to better spread inmates out because of a precipitous drop in population — all of the largest jails in the state have seen their daily populations drop 40% to 50%, data provided by the jails show.

But quarantine and social distancing policies are nearly useless without frequent testing to know who is sick, said Dr. Carlos Franco-Paredes, an associate professor at the University of Colorado School of Medicine and infectious-disease specialist. And the CDC-recommended symptom screenings used by the jails are ineffective against those with COVID-19 who are asymptomatic, he said.

“If you don’t do testing, you’re flying blind,” he said. “You’re following guidelines that are insufficient.”

Total testing numbers for the El Paso County and Adams County jails were not available because the facilities’ contracted health care provider, Wellpath, did not return emails or phone calls requesting the numbers.

In the past month, the virus has crept into correctional facilities across the state, infecting at least 750 inmates and 33 workers in jails, prisons and halfway houses, according to outbreak data released Wednesday by the Colorado Department of Public Health and Environment. On April 15, when the state released outbreak data for the first time, there was a single correctional facility on the list. On Wednesday, the list included five jails, two prisons and four community corrections programs.

Denver’s two jails have by far the highest number of positive cases among the jails, although testing there also has been more robust than at other facilities. Denver Health staffers have administered 1,641 tests to inmates in the downtown jail and the county facility, and 201 of those tests were positive, according to data provided by the city. The vast majority of the positive cases are at the downtown facility.

While some of the inmates have recovered or been released, 139 actively sick inmates remain in Denver’s jails. That means 14% of the jails’ current population of about 1,000 has COVID-19.

The Denver jails in late April began expanding the parameters for testing. Through March and much of April, only inmates with symptoms were tested. On April 27, the jail started testing all inmates during the intake process. Three days later, testing also was expanded to include all inmates leaving a 14-day quarantine after possible exposure to the virus and, on May 5, any inmates being moved to the Department of Corrections.

“As seen during this pandemic, when testing increases so does the number of positive cases,” Nancy Kuhn, a Denver city spokeswoman, wrote in an email.

The number of tests administered at Denver’s jails is more than 20 times the number administered at the facility with the next-highest testing numbers, the Jefferson County Detention Center.

Seventy-five inmates have been tested at the Jefferson County facility, and 22 were found to have the coronavirus. The testing ratcheted up after one inmate started showing symptoms after being at the facility for about nine days, said Rob Reardon, chief of detentions at the jail. The jail then tested others and found more cases, including in some inmates who showed no symptoms. Prior to April 20, the jail had tested one inmate.

In the first weeks of the pandemic, the jail had access to very few tests through its health care provider, Wellpath, Reardon said. Knowing whom to test is complicated, he said, in part because many of the symptoms of the coronavirus align with the symptoms of substance abuse withdrawal, which affects at least half of the people being booked into the jail.

“We have a little more tests now, though we’re still struggling to get more,” he said.

The availability of tests will dictate the strategy the jail uses going forward, Reardon said, and whether it will pursue broader testing.

A lack of available tests also complicated efforts in the Boulder County jail until recently, said Melanie Dreiling, health services administrator at the Boulder County Sheriff’s Office. As of Tuesday, three jail inmates had been tested for the coronavirus in the facility, which is housing about 200 people. All results were negative.

Testing is limited to inmates who are showing symptoms of COVID-19 and who fail flu and strep testing, although Dreiling said she recognized the chance that an asymptomatic inmate could get past those screenings. That’s why the jail has created a multistep process aimed at preventing the introduction of the coronavirus in the first place.

Symptomatic inmates are isolated immediately if they fail the initial screening questions and temperature checks, which are completed in the jail’s garage. Those who pass the screening are then grouped with other new arrivals for 14 days before being admitted to the general population. That way, the jail knows exactly whom to test if someone starts showing symptoms.

“Because this is difficult to contain once it’s in the jail, we decided the best method was to keep it out,” Dreiling said. “So far we’ve been successful in doing so.”

The jail recently gained access to more tests through the state health department and is now discussing whether to test all inmates before they are moved to the general population after the two-week quarantine, Dreiling said.

The drop in jail populations has allowed more opportunity for inmates and staff members to practice social distancing, Dreiling and Reardon said.

Many of the 80-person dorms at the Jefferson County jail are about half full. In Boulder County and Denver, facilities have space to create isolation rooms and quarantine units.

“In jails, all space is a commodity,” Reardon said.

Broad testing in any correctional facility where staff or an inmate has tested positive will likely reveal far more cases, Franco-Paredes said. He pointed to Colorado’s Sterling Correctional Facility, where eight positive cases prompted mass testing that revealed more than 400 inmates had COVID-19. The same has been true in other states.

But an outbreak of COVID-19 inside a jail doesn’t stay inside the facility’s walls, Franco-Paredes said. Workers travel in and out of the facility every day. Jail inmates return to the community after posting bail or after a court hearing.

“Public health in the jail is public health in the community,” Franco-Paredes said. “It’s an extension of the larger community.”