Tracking the new coronavirus, which causes COVID-19, requires coordination between state and local agencies. Carolina Public Press’ reporting on the ongoing outbreak in the state’s largest women’s prison, the N.C. Correctional Institute for Women, exposed confusion among the local health department, the division of prisons and the state’s Department of Health and Human Services.
Take, for example, the discovery and classification of outbreaks, a key public health metric in tracking the spread of COVID-19.
First, a prison has to identify possible cases of COVID-19 and get the sick people tested. Then, both the Department of Public Safety, which oversees prisons, and DHHS need to get test results back and input them into internal medical databases. Finally, the agencies, including the local health department where the prison is located, need to categorize the cases consistently across systems.
Carolina Public Press’ reporting last week revealed confusion within DPS and among the agencies.
DPS classifies identified cases of COVID-19 into “active” and “presumed recovered.” When CPP first inquired about the spike in cases, DPS provided the wrong number of active cases. CPP noticed a discrepancy and inquired further.
The problem, department spokesperson John Bull said, was that DPS had not yet updated its internal medical database to reflect the number of positive cases DPS had posted on its website.
Then, CPP asked DPS and DHHS about the number of outbreaks at the prison. The question is significant because it has implications for how the prisons are identifying possible cases, testing for COVID-19 and reporting those results.
NCCIW was the second prison in North Carolina to see a mass outbreak of COVID-19. The outbreak was identified on April 21, with new cases identified until May 10, reaching 91 cases and one death.
Then, DPS did not report another case in NCCIW on its website for another 53 days, when the agency discovered an even larger outbreak. This outbreak, with the first case identified on July 2 and which is still ongoing, has reached 178 cases.
In reporting on the ongoing illnesses and the poor conditions inside the women’s prison, CPP asked both DPS and DHHS if the two surges in cases counted as two separate outbreaks or a single outbreak.
At first, neither DPS nor DHHS could answer. Each agency said it was working with the other to find the answer. CPP published that confusion in its story.
Then, a day after publication, DHHS called CPP to clarify that there was a single outbreak. CPP updated the story.
Another day later, at 5:15 p.m. Friday, DHHS emailed CPP to say that, actually, there were two, separate outbreaks at NCCIW. DPS followed up shortly afterward to confirm.
The confusion was caused by a communication breakdown between the state agencies and the local health department.
DPS did not publicly report positive COVID-19 test results from May 10 to July 2 in NCCIW, but DHHS’ internal data showed a number of positive results in that time, in effect bridging the gap between the two outbreaks. That is why DHHS told CPP there was a single, continuous outbreak.
What DHHS’ data did not show was that those positive test results were actually retests. At least “a half dozen” women in NCCIW had prolonged cases of COVID-19, according to DPS, and the prison was retesting the women to see if they still had detectable levels of the virus in their bodies.
The fact that these were retests was not reflected in DHHS’ database.
For DPS, the positive test results were confirmation that there were ongoing cases of COVID-19 in NCCIW. For DHHS, this looked like new cases and the continued spread of the virus.
Each of these data points is important for understanding the spread of the disease and responding to it. That it took over a week for the state agencies to answer what should be relatively basic questions about the outbreak in a single prison is concerning, in part because DPS oversees 55 prisons and is responsible for the health of over 32,000 incarcerated North Carolinians.
There is an ongoing lawsuit against DPS, Gov. Roy Cooper and the state’s parole commission, in which the plaintiffs argue that the state’s response to the disease has been insufficient, creating unconstitutional conditions in the state’s prisons.
So far, the judge in the case has agreed in a preliminary decision that the conditions are likely unconstitutional. Then, he ruled that the state was out of compliance with the court’s orders, in large part for providing inconsistent or inaccurate information, if the agencies provided what the court asked for at all.
On Friday, Judge Vinston Rozier Jr., heard arguments in Superior Court about enforcing his orders. The plaintiffs argued that the state had been ignoring the court’s orders at the detriment of people held in the state’s prisons. The state disagreed.
Rozier has not yet made his ruling, though he did indicate that he would appoint a court liaison to ensure that the information DPS presented was accurate.