Prisons see case numbers tumble
Facilities give researchers unique opportunity to study strategies that could help fight coronavirus
A precipitous decline of coronavirus cases in state prisons has transformed California’s correctional system from a cautionary tale of mass incarceration in the time of a plague to something more unexpected: An intensely monitored field study that could help scientists develop strategies to defeat the pandemic outside prison walls.
Highly effective vaccines distributed in the prisons combined with the lack of reinfections among inmates and staff previously diagnosed with COVID-19 appear to have quelled the explosive viral outbreaks that have rocked state prisons during the past year.
Active cases have dipped so low that some researchers are theorizing that California’s state prison populations, which suffered spectacularly high coronavirus infection rates through January and were among the first targets for ongoing mass vaccination campaigns, are manifesting collective resistance to the virus.
“I think what you’re seeing is herd immunity,” said Dr. George Rutherford, a professor of epidemiology and biostatistics at UC San Francisco.
At the height of the winter surge, the California Department of Corrections and Rehabilitation reported 10,617 new infections among prisoners
over a two-week period in mid-december. In January, 13 staff members died from Covid-19-related illnesses as the outbreak continued.
But Thursday, the department reported there were only 183 new cases discovered during the previous two weeks — a 98% decline in prisoner infections.
“If you look across the system there are probably at least 10 prisons that had over 60% prevalence of infection; some were even higher,” Rutherford said. “At Chuckawalla the levels were over 90% … so given the high prevalence in prisons, you can make a case that this is a good marker to understand herd immunity.”
Biologists are using the term herd, or “community immunity,” to describe the point at which enough of the population has developed collective resistance — either by vaccines or natural antibodies — that the coronavirus is no longer a threat. With COVID-19, they estimate that threshold at more than 75%.
Public health experts use the term to refer to the endgame of current vaccination programs, business closures and masking mandates in public spaces imposed to mitigate the pandemic.
How close is the prison system? According to California Department of Corrections and Rehabilitation statistics, more than 75% of the inmate population has either been vaccinated or been previously diagnosed with COVID-19.
More than 42,000 prisoners, or 43% of state prison inmates, and nearly 26,000 prison staff, or 42% of the workforce, have been vaccinated, according to the CDCR. More than 49,000 inmates and nearly 16,000 staff have been diagnosed with COVID-19 at some point during the pandemic. The state also released 24,000 prisoners since last March, bringing the total number of inmates down by nearly one-fourth since the pandemic began.
California as a whole is a long way from herd immunity. To date, about 3 million of California’s 40 million residents have been fully vaccinated and about 3.6 million have contracted the virus.
The impact within the prison system is encouraging. No prisoners or staff who were previously diagnosed with COVID-19 have been reported to have been reinfected. Neither have reports emerged of prisoners or staff contracting COVID-19 after taking a dose of the Moderna or Pfizer-biontech vaccines being distributed in the penitentiary system.
California was among 22 states that chose, from the earliest days of vaccine distribution, to provide immunization to prison inmates and staff.
Despite COVID-19 outbreaks in prisons across the country, many states, such as Texas, Arizona and Illinois, initially vaccinated staff only. Prison systems in states such as Florida, Pennsylvania and Georgia forewent vaccines altogether.
California’s early commitment to vaccinating inmates was a striking policy decision at a time of fierce competition for doses between groups around the state, including teachers unions and groups representing chronically ill and vulnerable citizens.
The decision is largely a result of a two decadeold federal consent decree that arose out of a classaction lawsuit that determined that a federal receivership was necessary to institute a constitutional level of health care and reduce overcrowding in the prison system.
While contract tracing successes outside prisons have been modest, outbreaks in highly surveilled U.S. penal systems have become events of acute scientific interest among researchers seeking strategies to quell the worldwide pandemic.
“If I walk down the street, unless a camera is monitoring me all the time, you will not be able to identify all the people I might pass, and so my exposure is unknown,” said Jeremy Goldhaber-fiebert, a Stanford University School of Medicine professor who has been studying the prison COVID-19 outbreak and participating in discussions with California correctional health care workers about mitigation protocols.
By comparison, medical histories of inmates and staff, which now include regular coronavirus tests, are scrupulously recorded. Movements in and around prisons are tracked in real time.
“So, over a long period of time, you can hold those exposures constant and control for them and look at the differences in other things,” Goldhaber-fiebert explained, describing a hypothetical study that might consider relative infection rates among different numbers of inmates dispersed among identical prison cells.
Goldhaber-fiebert said such a study might illuminate what sharing spaces “means for very rapid transmission.”
UCSF’S Rutherford suggested that medical researchers should study inmates’ antibodies to determine which were able to develop natural defenses against the virus and which were dependent upon vaccines.
Goldhaber-fiebert warned that different virus strains could introduce additional waves of infection if too few prison inmates and staff avail themselves of vaccines, which is a concern since many who have been offered Moderna and Pfizer-biontech doses have rejected them. Thus far, one-third of all inmates and more than half of prison staff have declined voluntary immunization.
Medical experts also cautioned that as sites of contagion, prisons and free world contexts differ significantly. For example, prisoners may have greater access to medical care than similarly vulnerable socioeconomic groups outside of prison and inmates also skew both younger and older, which may account for the fact that while a majority of CDCR’S more than 95,000 inmates were infected, only 212 died.
Infections in California prisons are a matter of wide political concern because of the scale of last year’s outbreak in the nation’s second-largest correctional system after Texas. The crisis attracted worldwide attention after prison health officials in an effort to prevent contagion transferred 189 inmates from an outbreak at the California Institution of Men in Chino to San Quentin, Corcoran and other state prisons, each of which housed many elderly and medically vulnerable inmates. Many of those transferred had not been tested and infections soared.
The catastrophic rise of infections across California’s prison system initiated a leadership shakeup and embarrassed and alarmed state correctional authorities.
U.S. Ninth Circuit Judge Jon S. Tigar, assigned to manage the federal oversight of health care in California prisons, said stopping the virus in the prison system is vital to stopping it throughout California. Last month, in comments from the bench, he cited a study that estimated that mass incarceration in California contributed to an additional 114,000 cases of COVID-19 from May 1 to Aug. 1.
“There is a public health benefit to everyone in getting incarcerated persons vaccinated,’’ the judge said, “because COVID then is less likely to jump over the walls of the prison and spread to surrounding communities.”