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Editor’s note: This story was updated with comments from the Department of Public Safety that were received after the story was originally published, and with an additional reported death of a person in state custody due to COVID-19.
Since March, 41 people have died from COVID-19 while incarcerated in a North Carolina prison.
Most of the deaths have been among elderly prisoners, such as the man who died on Saturday. He was in his early 70s, according to a press release from the Department of Public Safety, which oversees the state’s prisons.
But several have been younger. Since December, the deadliest month in the prisons during the pandemic so far, 16 people have died from COVID-19. All but one were identified as having “preexisting medical conditions.” Two were women in their 40s, and two were men in their 50s.
Even so, DPS officials claim the rate of people dying behind bars is not as bad as in the state’s population as a whole.
But there are problems with this analysis, according to Lauren Brinkley-Rubinstein, an assistant professor at the UNC School of Medicine and the co-founder of the COVID Prison Project, which monitors the pandemic in prisons across the country.
“It’s a little bit of a red herring,” Brinkley-Rubinstein said.
“What we have to do is age adjust, because … the population of people who are incarcerated are actually much younger on average than the general population.”
Just 1% of North Carolina’s prison population is over 75 years old, while 8%-11% of the general population is over 75. COVID-19 is deadlier for older people, so comparing mortality rates in prisons and in the state needs to account for this difference, Brinkley-Rubinstein said.
That’s just what the COVID Prison Project did, for the nation and for North Carolina. The group found that the mortality rate in North Carolina’s prisons was higher than the state’s as a whole, and that gap widened even further once adjusted for age.
“The national average there is about 3.5 times higher,” Brinkley-Rubinstein said. “So, the adjusted mortality rate in North Carolina is very high above the rest of the nation.”
DPS disputed the COVID Prison Project’s analysis that the prison population was younger than that of the state as a whole. DPS took the median age of both groups and, using that measurement, the prison population is slightly older. But the fact remains that the proportion of older people, for whom the virus is the most deadly, is smaller in prison than it is for the rest of the state.
One limitation to the COVID Prison Project’s analysis is that investigators only know the current prison population for each state but not the total number of people who have moved through the prison system since the beginning of the pandemic. That inflates the mortality rate a bit.
But Carolina Public Press was able to roughly calculate the total number of people who have been in North Carolina’s prisons since March. The state has released about 2,000 people each month for 10 months, with about 3,000 fewer people in total coming into the prison system, which puts the total number of prisoners potentially exposed to COVID-19 in North Carolina prisons at about 50,000 people.
When using this higher number in the COVID Prison Project’s calculations, the mortality rate in prisons evens out with the state’s as a whole. But by adjusting for the age and sex differences, the “age-sex-adjusted mortality rate” is still seven times higher than for the state as a whole.
This all means that the death rates for people in prison is higher than it is for people who are not incarcerated, both in North Carolina and nationwide.
Understanding DPS’ claim
In a press call on Jan. 7, Tim Moose, the chief deputy secretary of the Adult Correction & Juvenile Justice Division of DPS, said people in prison were dying from COVID-19 at lower rates than people across the state.
“The state’s COVID mortality rate is 1.3%,” Moose said. “In our prisons, it’s one-third of that.”
Calling it a mortality rate was incorrect, according to Brinkley-Rubinstein.
What Moose meant to say was that the case-fatality rate was higher for the state as a whole than in the prisons. This is a measurement that is calculated by dividing the number of people who die from COVID-19 by the number of people who test positive for the virus.
Using this measurement, Moose is right, the prisons’ case fatality rate is much lower than the state’s as a whole. The case fatality rate and the mortality rates simply measure different things, Brinkley-Rubinstein said. But both should still account for the age difference between populations.
Conflicts over these kinds of measurement differences and interpretations are not new ground for DPS. In April, civil rights groups sued the state over alleged unconstitutional conditions in the state’s prisons.
Since then, the plaintiffs and lawyers for DPS have been presenting conflicting evidence over the severity of the pandemic behind bars. On Dec. 14, Wake County Superior Court Judge Vinston Rozier Jr. appointed a court liaison to monitor these kinds of evidentiary disagreements and get to the truth.
Having a clear understanding of what the numbers are indicating about the state of the pandemic behind bars is important, said Leah Kang, an attorney with the American Civil Liberties Union of North Carolina, which represents the plaintiffs in the case.
“The state has taken a position in their filings before the court that the conditions in their prisons are no different than the conditions that the rest of the state of North Carolina face,” Kang said.
This has been true for the mortality rate that Moose mentioned and was the basis for DPS’ calculations about rates of infections in court filings in December.
“The case is bringing to light the conditions of confinement currently in the state’s prisons, which place people at a heightened danger,” Kang said.
If the prison conditions are not any worse than the state as a whole, it weakens the plaintiffs’ case. Back in June, Rozier ruled that the conditions in prison were likely unconstitutional in large part because people behind bars were put at an increased risk for illness and death from COVID-19.
According to the calculations from the COVID Prison Project, that risk remains high, much higher than for North Carolinians as a whole.
That is, at least in part, explained by the fact that “the proportion of the prison population with underlying/predisposing medical condition — which also portend worse medical outcomes if infected by COVID-19 — is significant,” according to a statement from DPS spokesperson John Bull.
“The proportion is likely to be substantially higher among offenders than in the overall state population.”
Public health experts and advocates for better prison conditions during the pandemic have been pointing this out since March, before any COVID-19 cases were detected in the state prisons, as a way of showing that people in prison are at a heightened risk for serious illness and death from COVID-19.
On Wednesday, DPS announced that it received its first 1,000 doses of vaccine and began distributing it. Prisoners and staff over 75 years old are prioritized for the first inoculations, along with staff members working in units where prisoners have tested positive for COVID-19.