Experts participating in a briefing on coronavirus issues and recommendations for U.S. prisons and jails this past week presented more than a dozen measures they believe should be taken, most of which are already in place in Tennessee as the state prison system on Friday marked its fourth death amid the pandemic.
Those at the briefing from the Infectious Diseases Society of America said the nation's incarcerated population and communities are closely linked in organizing response to the pandemic.
In Tennessee, Department of Correction records on May 15 showed 20,918 prison inmates have undergone testing statewide for the virus with 2,577 positives, 16,501 negatives and 1,836 test results still pending.
Of those found positive, 901 have recovered and four people who tested positive for the virus have died, although those deaths have not yet been officially linked through autopsies to COVID-19, according to TDOC.
The state's fourth death in state prisons — the third at Trousdale Turner Correctional Center — was added to TDOC's testing report on Friday.
Thanks to that testing, Tennessee's Trousdale County, with a population of less than 10,000, has the highest per capita coronavirus infection rate in the U.S., and Bledsoe County, with a population about 14,600, has the fifth, according to an Associated Press analysis.
"We have well over about 2.2 million individuals who are in prisons and jails, the majority of whom are in state facilities," said Dr. Sandra Spring, Yale associate professor of medicine and director of the Infectious Disease Outpatient Clinic, Veterans Administration Healthcare Services in Newington, Connecticut.
"When you remind yourself of who is in these facilities," Springer said, "many of these individuals have significant chronic health problems that put one at risk of having severe COVID-19 symptoms, including significant numbers of infectious diseases including higher prevalence of HIV and Hepatitis C, chronic liver disease as well as the known conditions that are associated with severe COVID-19 such as diabetes, coronary artery disease, chronic lung disease, and hypertension and other particular chronic medical conditions.
"In addition our correctional health system is comprised of significant numbers of the aging population, again another known risk category for developing severe COVID-19," she said.
In Tennessee, there are 2,520 inmates age 55 and older, according to correction officials.
Springer urged officials to issue guidelines for questioning incoming inmates about the coronavirus as part of the intake routine that already includes medical questions.
Dr. Alysse G. Wurcel, a Tufts University associate professor in the Department of Community Medicine in Boston, recognized the difficulty of social distancing in penal facilities and said that staff and inmates are a "special population that deserves special attention." She described problems with supplies of free hand soap or sanitizer and urged officials to address those shortages to provide needed products to all inmates.
"In our jails we recommend masking of all employees and anyone who's incarcerated," Wurcel said of the situation in Massachusetts.
Springer and Wurcel support widespread testing, which Tennessee has now done in its prisons but not jails.
In Tennessee, state and local courts moved quickly to reduce county jail populations by releasing nonviolent, misdemeanor offenders, citing people for misdemeanors who might otherwise have been booked at the jail and allowing some people arrested to be released on their own recognizance or on a reduced bond.
But the prison holds felony offenders who have sentences they must serve. So far, Tennessee has not considered any early releases.
The Infectious Diseases Society of America's recommendations, in general, call for penal facilities to stick to federal guidelines regarding the virus like social distancing, quarantining, isolation and handwashing, establish proper isolation and cleaning/disinfecting procedures, provide for inmates to receive proper care and possible experimental care, make sure facilities have a stable supply chain of medical supplies and provide appropriate personal protective equipment or PPE for staff and inmates.
So how does Tennessee's response stack up?
State corrections officials and spokesman Robert Reburn this week answered a list of 12 questions based on the society's recommendations and questions that arose from U.S. reporters during the briefing.
Q: Do all TDOC prisons have the ability to isolate confirmed or suspected COVID-19 cases and how is it done?
A: Yes. Offenders who tested positive are placed in housing units designated for only offenders who tested positive, and offenders who tested negative are placed in housing units with only negative offenders.
Q: Does TDOC have a stable supply chain for swabs, transport media and testing reagents for adequate testing, and hand soap for recommended handwashing?
Q: Do TDOC medical staff have PPE, and are they instructed to wear PPE (personal protective equipment like masks and gloves) even when with non-COVID-19 patient-inmates?
Q: Do TDOC correctional officers, staff and volunteers have PPE (masks/gloves) for daily use?
A: Yes. Note, volunteers are not permitted in state facilities as all volunteer-programming has been suspended. Only state and contract employees are permitted within state facilities at this time.
Q: Do inmates have PPE and hand soap for daily use?
A: Yes, all offenders have been issued cloth masks and have been instructed on how to wash and care for them. Offenders are issued soap every other week and are permitted to buy as much as they would like off commissary.
Q: What about cellmates; can inmates sharing a cell maintain social distance?
A: It is difficult for offenders to adhere to normal social distancing recommendations, but they can maintain distance between one another.
Q: Are COVID-19 testing and care procedures covered at no cost for inmates?
Q: Are inmates able to receive experimental care like plasma therapy if/where available?
A: Offenders are permitted to receive treatment provided to them by medical professionals at the medical facility they are being treated at.
Q: Has TDOC seen any cases of reinfections from COVID-19?
A: Not that I am aware of.
Q: Is reinfection a concern for TDOC, and are there any plans if that turns out to be an issue?
A: Discussion has begun with the Department of Health about possible retesting.
Q: If an inmate has been confirmed with the coronavirus and that inmate has served his or her sentence and is about to be released, how is that handled?
A: If the offender and their family/residence receiving them agrees, we move forward with the offender's release plan. Otherwise, the offender remains in our custody until they have recovered.
Q: Are there any specific or special support procedures related to COVID-19 when an inmate is released from custody like support for housing, behavioral/substance abuse care, food and workforce support?
A: Offenders being released from TDOC's custody continue to receive assistance in securing employment and housing, much of which occurs as part of the offender's release plan prior to leaving.
Contact Ben Benton at firstname.lastname@example.org or 423-757-6569. Follow him on Twitter @BenBenton or at www.facebook.com/benbenton1.
TDOC COVID-19 TIMELINE
March 12: Visitation suspended
March 13: FAQs page launched on TDOC website
March 16: Non-invasive screenings initiated for all individuals entering facilities
March 17: Enhanced cleaning & disinfecting schedules implemented at all facilities; suspected all intake from local jails and non-emergency internal transfers; limited contractor projects at all facilities
March 18: First two suspected cases of COVID-19 among inmate population appear but produce negative results
March 23: Board of Parole suspends all in-person hearings
March 26: Inmates at Morgan County Correctional Complex and West Tennessee State Penitentiary TRICOR facilities mass-produce PPE; inmate work crews limited, Day Reporting Center programming suspended
March 28: CoreCivic notifies TDOC of first confirmed case of COVID-19 among staff at South Central Correctional Facility
March 30: Educational programming modified to reduce class size and to allow for social distancing
March 31: All in-person legal visits suspended
April 1: Contract/vendor employee at Bledsoe County Correctional Complex confirmed with COVID-19; three exposed inmates quarantined; three exposed TDOC staff embers self-quarantined for 14 days
April 2: Second contract/vendor employee at BCCX tests positive for COVID-19
April 3: Inmate at Turney Center Industrial Complex tests positive for COVID-19 while being treated for non-related illness at outside medical facility
April 6: Washable cloth masks distributed to all staff, inmates and local jails; CoreCivic notifies TDOC of confirmed case of COVID-19 among staff at Hardeman County Correctional Facility
April 8: TDOC staff member at TCIX tests positive for COVID-19; contractor/vendor employee at Northwest Correctional Complex tests positive for COVID-19; five exposed inmates at NWCX quarantined
April 9: Second contractor/vendor employee at NWCX tests positive for COVID-19
April 13: Mass testing of employees begins at BCCX and NWCX in collaboration with the state Department of Health and the Tennessee National Guard
April 16: Six inmates test positive at BCCX; one inmate tests positive at Trousdale Turner Correctional Center; testing breakdown released to public
April 18: Mass testing of inmates based on contact tracing and potential for exposure begins at BCCX
April 19: Mass testing of inmates completed at BCCX, NWCX and TCIX; mass testing of officers and staff completed at TCIX
April 22: 24/7 public information COVID-19 hotline launched
April 24: To date, a total of 49 staff members tested positive for COVID-19; 36 TDOC employees and 13 contract/vendors
April 28: Mass testing of all inmates and staff begins at TTCC; TCIX inmate who tested positive for COVID-19 makes full recovery after completing 14-day isolation
May 4: Mass testing of all TDOC staff and inmates begins
Source: Tennessee Department of Correction