Review: County stemmed outbreak at jail
CDC finds sheriff, staff quelled COVID-19 cases
The Cook County Jail successfully beat back its outbreak of COVID-19 even as the virus spread dramatically outside its walls, according to a new paper authored by medical officials from the Centers for Disease Control and Prevention and various county and city offices.
Earlier in the pandemic, the jail had “one of the largest outbreaks of COVID-19 in a congregate setting described to date,” according to the document.
But after expanded testing, mask-wearing, limiting detainee movement and opening up previously unused buildings to allow for greater distancing, the spread within the jail slowed down significantly compared with Chicago at large, the paper said.
“We not only bent our curve, we killed off the curve,” Sheriff Tom Dart said at a news conference Wednesday.
While officials could not pinpoint exactly which action was most effective, the cumulative result was successful, according to the examination of the jail.
“When this thing hit, I just threw everything I could come up with (at it),” Sheriff Tom Dart told the Tribune in an interview late Tuesday after the paper was initially made public. “… it was like, no, we’ve got to find out what we can do, and we’ve got to do it in the quickest and most massive way.”
The paper has not yet undergone peer review, and its authors include medical experts from the jail’s health center and the sheriff’s office, along with investigators from the Chicago Department of Public Health, the CDC and the University of Illinois at Chicago.
Even to an outsider’s eye, however, the drop in COVID-19 cases at the jail is significant. In March and April, the jail counted more than 900 cases among detainees and staffers, and seven detainees died at local hospitals after testing positive.
But as of Tuesday, only 11 detainees out of about 4,800 are positive, Dart said, and eight or nine of them entered the jail with the virus.
“We’re testing at the door now,” he said. “You could literally say being in the jail is one of the safest places to be right now.”
Detainees are tested upon intake, kept separate from the general population for two weeks and tested again before moving to a regular tier, said Dr. Chad Zawitz, lead physician for infectious diseases at the jail and one of the paper’s authors.
Since May, the jail has had only one symptomatic detainee who tested positive from within the regular jail population — the rest were asymptomatic, and the vast majority of positive cases were detected at intake, Zawitz said in an interview with the Tribune.
After widespread efforts among prosecutors, judges and defense attorneys to get more detainees out on bond, the jail population dropped significantly — enough to facilitate the social distancing that was effective in slowing the virus’s spread, Dart noted.
A lawsuit filed this spring by the Loevy and Loevy law firm and the MacArthur Justice Center at Northwestern University alleged Dart failed to stop a “rapidly unfolding public health disaster” at the jail, which at the time had been identified as one of the nation’s leading hot spots for coronavirus infections.
As a result, a federal judge mandated several reforms, including increased testing and social distancing.
Alexa Van Brunt, part of the team that brought the lawsuit, said the CDC review should have mentioned that a judge ordered several of the interventions.
“This wasn’t a matter of voluntary compliance or voluntary initiative,” she told the Tribune. “We should really be honest about what it took to get the infection to get under control and what it will take if there is another outbreak.”
County officials have maintained that those measures were already in progress or in place by the time of the judge’s mandates, a point Van Brunt disputed.
Dart this week warned that the progress could be reversed if the population increases much more. There are about 438 people in county jail simply awaiting transfer to state prisons, which are still not taking new transfers due to the pandemic, he said.
“I’ve tested every one of them, they’re in quarantine, isolation,” Dart said, “… these people are free of COVID, they’re not going to present a problem in downstate Illinois.”
A spokeswoman for the Illinois Department of Corrections refused to comment on the continued need to bar transfers, citing pending litigation. The Illinois Sheriffs’ Association has filed suit against IDOC over the barred transfers.
The new paper also noted that jail staffers played an “important role” in bringing the virus into the jail — echoing what several activists alleged in their efforts to empty the facility.
Positive COVID-19 cases among staffers “often preceded cases in detained persons,” the CDC review states. Most of the jail’s buildings saw a staff member test positive first, and then, a median of three days later, a detainee.
Dr. Chris Beyrer a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, who reviewed the conclusions, agreed that the paper suggests that measures inside worked to stop the outbreak.
Details from the paper also illuminated other concerns about the national response to the pandemic, including that the first test at the jail required 10 days to get a result. Also, the testing of staff was not mandatory.
While these concerns were reflective of testing issues across the country, it was not best practices from a public health perspective, he said.
County health officials, have always acknowledged that a shortage of tests and lack of fast testing was an issue for everyone at the start. Early public health guidelines did not require staff be tested, in part because of that shortage. But all staff were required to wear PPE, have temperatures checked and be screened - measures that appeared to work.
“We clearly demonstrated that even without such testing, the outbreak was contained,” Zawitz said.
Zawitz warned that it would be wrong to conclude that the outbreak among detainees could directly be traced to staffers. For example, officers in the general public had access to testing before detainees, he said, “so of course we’re going to detect disease in a population that had access to tests first.”
“It’s reasonable to assume that COVID entered the jail from the outside, but it is a muddier picture to conclude that it came from staff,” he said.
Sheriff’s staffers working at the jail were screened for symptoms beginning at the end of March, and required to wear surgical masks in early April. But testing for staffers was not mandatory.
Dart said it was not within his power to force correctional officers to get tested, though his office encouraged and facilitated as much testing as it could. And officials at Cermak said the guidelines at the time of the study did not require mandatory testing.
Dr. Connie Mennella, chair of correctional health at the jail’s health service and one of the study’s authors, emphasized in an interview with the Tribune that the jail cannot be untangled from the outside community.
“The jail may have barbed wire, it may have concrete walls, it may feel like a very secluded place, (but) it is the community,” she said. “… We are part of the community. How we can slice and dice and understand where that line is drawn? It’s impossible.”