Extensive and ongoing testing at one North Carolina prison has exposed one of the largest outbreaks of COVID-19 in a confinement facility in the country.
The N.C. Department of Public Safety announced Thursday that it would test each of the 767 people incarcerated at Neuse Correctional Institution for the new coronavirus, which causes COVID-19. The prison had seen a significant spike of positive cases following normal testing procedures when inmates were first tested for flu A and flu B before being given a test for COVID-19.
The Department of Public Safety announced Monday that “more than 330 offenders are infected with (the) virus.” Another 197 tests are still outstanding.
That means that a dramatically high rate of infection exists in the prison. Over 57% of those tested have the disease. This is an indication that the precautions the DPS put in place were not adequate to stop the spread of the disease once it entered the incarcerated population.
Public health experts warned Gov. Roy Cooper and Erik Hooks, secretary of the Department of Public Safety, that the spread of COVID-19 would be nearly impossible to control once inside prison facilities. The only remedy, they warned, is to decrease the prison population to allow social distancing inside, something that is currently impossible.
The outbreak is also spreading among prison staff. The DPS reported that 13 staff members also tested positive. The department worked with the Wayne County Health Department to make testing available to all staff.
Those 13 positive tests may not be a complete picture of staff illness. John Bull, public information officer for state prisons, previously told Carolina Public Press that “self-reported numbers may not present a complete, true and accurate picture of potential staffing impacts.”
To support current staffing at the prison, the DPS temporarily closed another prison, Johnston Correctional, to reassign staff to Neuse. The staff will be paid time-and-a-half, according to the department’s website.
The people incarcerated at Johnston were transferred to two prisons, Southern Correctional Institution in Troy and the Burke Confinement in Response to Violation Center in Morganton. About 100 offenders were transferred from Southern Correctional Institution to Tabor Correctional Institution to make room for the inmates from Johnston prison.
All people were medically screened before transfer, and the transfer buses were disinfected, according to the department’s statement.
Public Safety: Infected inmates 98% asymptomatic
The DPS did not include an update Monday on how many people are hospitalized due to COVID-19. At the end of last week, six people in custody were hospitalized with COVID-19 statewide.
In its statement Monday, reiterating a statement from Friday, the Department of Public Safety said 98% of cases were asymptomatic.
That rate of asymptomatic cases — when a person tests positive for the virus but does not show signs of illness — has not been observed or reported anywhere else.
This phenomenon could be explained in a number of ways, according to David Rosen, a public health researcher at the UNC School of Medicine who studies disease spread in prisons and jails.
“It could be that people in prison are asymptomatic, presymptomatic or just have very subtle symptoms,” Rosen wrote to CPP.
Asymptomatic means that throughout the full course of the illness, a person is infectious to others but does not show symptoms such as fever, tiredness or dry cough.
Presymptomatic means that the tests detected the presence of COVID-19 before a person shows symptoms.
Due to the medical screening procedures within prisons, the institutions would not have data on people who do not self-report mild symptoms.
The distinction among asymptomatic, presymptomatic and having subtle symptoms has important health implications.
“At the forefront, I think it’s crucial that there be adequate medical staffing in place and a plan if patient medical needs outpace staffing capacity,” Rosen wrote.
Rosen, along with other health researchers, provided a statement in a lawsuit against Gov. Cooper and Secretary Hooks that made broad estimations for what could happen if there was a COVID-19 outbreak across the entire prison system.
Based on the data the Department of Public Safety has released and compared to existing research on COVID-19, the “rates of health problems seem low” at Neuse prison, Rosen wrote.
“But the existing data — based on people who were symptomatic, may overstate the relationship between infection and adverse health outcomes,” Rosen wrote.
Usually, when people are tested for COVID-19, they either are showing symptoms or were in contact with a person who was positive for the disease. That means that there could be an inflated sense of how often infected people experience adverse health outcomes, Rosen said.
Testing every person at Neuse prison provides a data snapshot that has not been widely seen. According to Rosen, if the health outcomes for people in the prison are adequately tracked — and the people who become sick are adequately cared for — the information could be useful in understanding what could happen at other prisons where people in custody have tested positive for the disease.
“Understanding the health outcomes of this population over time can inform what we might expect at other prisons with similar populations,” Rosen wrote.
It could well be that 98% of cases in Neuse prison are asymptomatic. It could also be the case that the prison is about to see a massive spike in medical care needs that will further strain staff and spill over into the nearby rural hospitals.
The American Civil Liberties Union of North Carolina refiled a lawsuit Monday against Cooper and Hooks, according to ACLU spokesperson Citlaly Mora. The lawsuit seeks to force the state to release a significant number of people from the prisons in an effort to protect them, staff and communities around prisons from the spread of COVID-19.
The case was originally filed as an emergency lawsuit with the N.C. Supreme Court, which on Friday dismissed the case “without prejudice” and without an opinion.
Part of the state’s argument against that case was that the state Supreme Court was not the right avenue for the lawsuit. The dismissal without prejudice could be an indication that the court agreed and that the case could be filed again in a lower court, according to UNC School of Government professor Ann Anderson.
The ACLU refiled the case Monday in Superior Court. In its original filing, the ACLU argued that the additional time required to work through Superior Court could cost lives.
“A large-scale outbreak has already occurred at Neuse Correctional, making swift action by officials and our courts all the more urgent,” ACLU Legal Director Kristi Graunke wrote in a statement.
“We filed suit today to ensure that the governor and other public officials meet their basic constitutional obligations to protect the lives of people in their custody.”