By the time a court ordered North Carolina to test every person in state prison, COVID-19 clusters had been seen in a dozen prisons, some with mass outbreaks, for a total of 1,011 confirmed cases from early April to July 10.
Exactly a month later, the Department of Public Safety, which oversees the state’s prisons, gave the court the results of its comprehensive testing. Three prisons had new mass outbreaks, and two prisons had secondary outbreaks, totaling 545 cases. An additional 74 cases were scattered throughout the prison system.
Since that testing was completed, even more cases have been found, and the current count is up to 1,650 positive cases of COVID-19 in state prisons since early April. Ten people have died from complications of COVID-19, which is caused by the new coronavirus, while in state custody.
In a press release Aug. 6, before the testing numbers were delivered to the court, DPS described a low rate of COVID-19 in its prisons.
“Of the 29,062 offenders who were tested during mass testing, a total of 619 tested positive,” the release said. “This positivity percentage of 2.1% is much lower than in prison systems in other states.”
In that calculation, DPS left out all offenders who had previously tested positive for COVID-19 and those who had been tested upon their transfer from jails to the prisons. Due to the lack of detail in the state’s public information on positive test results, it is difficult to tell what the positivity percentage actually is, though it is likely between 4% and 5%.
That is still less than half the rate of positive cases compared with some similarly sized states such as Michigan and Ohio. However, both of those states started mass testing sooner than North Carolina and may have identified more cases due to more extensive testing at the time.
Now that the mass testing is over, the state will need to begin “surveillance testing,” per Wake County Superior Court Judge Vinston Rozier Jr.’s July 10 order. The surveillance testing is designed to randomly test people in the prison system — along with continuing to test people who develop symptoms — to enable early detection of new cases of COVID-19.
Rozier is overseeing the state’s response to COVID-19 in a lawsuit brought by civil rights groups. To date, Rozier has ruled that conditions inside the state’s prisons were likely unconstitutional and that the state was not following court orders.
Asymptomatic cases among people in prison
Across the country, prison systems have reported that a very high percentage of the people who test positive for COVID-19 do not show any symptoms. The director of Ohio’s prison system then walked back the claim that 96% of the positive cases were asymptomatic.
DPS is continuing to claim that nearly all cases in its system are asymptomatic.
In April, in the middle of what was then one of the country’s largest outbreak of COVID-19 in prison, DPS said that 98% of the over 330 positive cases at Neuse Correctional Institute were asymptomatic.
Though the asymptomatic rate for COVID-19 remains uncertain due to limitations in testing, the national Centers for Disease Control and Prevention modeled various scenarios planning for a COVID-19 outbreak. The model with the lowest rate for asymptomatic cases was 10%. The highest rate was 70%. The “best estimate,” the CDC report says, is the midpoint of 40%.
Even so, DPS claims that 100% of the 210 COVID-19 cases found by mass testing in the Lumberton Correctional Institute on July 22 were from asymptomatic cases.
This can likely be explained in several ways. A cluster of COVID-19 cases was detected in the days leading up to mass testing at that prison. In the week before mass testing at Lumberton CI, nine people tested positive for COVID-19.
At that time, DPS policy was to test only people who were symptomatic. Those people were not retested along with everyone else in the prison, therefore removing them from the calculation of symptomatic cases.
DPS is also unclear about what qualifies as a symptomatic case. In emails with CPP, DPS spokesman John Bull said the prisons follow CDC and N.C. Department of Health and Human Services guidelines on what counts as a COVID-19 symptom.
According to DPS, none of the 210 people who tested positive at Lumberton CI had congestion or runny nose, cough, fever or chills, headache, shortness of breath or difficulty breathing, muscle pain, sore throat, new loss of taste or smell, fatigue, nausea, vomiting or diarrhea.
DPS did not answer questions about how prisons collect information on symptoms.
When CPP asked similar questions in April, when DPS claimed that 98% of cases were asymptomatic in Neuse CI, Bull wrote, “Asymptomatic is just that—no complaints of fever, chills, body aches, cough, flu-like symptoms—all staff and offenders are being asked this on a daily basis through posters and direct questioning.”
Bull did not explain how posters could ask questions about symptoms. Dozens of people in prisons have reached out to CPP and news organizations across the state complaining that even when they do have symptoms, they are not seen by medical staff or given a test.
Mass testing confirmed that the complaints of unidentified COVID-19 cases in those prisons were accurate.
When there is symptom monitoring, as happened in both the N.C. Correctional Institution for Women and Neuse mass outbreaks, staff only checked temperature and oxygen levels. DPS has not answered questions about what ranges of temperatures and or oxygen levels would count as being symptomatic.
In that same April 20 email, Bull wrote, “For mass screenings there is no need to do a medical screening as this is testing all offenders.”
If this procedure remained consistent for the Lumberton testing, it is not clear how DPS would have collected data on COVID-19 symptoms among those who tested positive.