A year after the more than 460-case outbreak at Neuse Correctional Institution in Goldsboro became one of the biggest hot spots for COVID-19 at the time, the N.C. Department of Public Safety (DPS) is reporting only 18 active cases of the disease across all 55 state prisons, in addition to 139 staff members who are currently off the job for testing positive or being exposed to an active case.
Since the pandemic began, more than 10,000 confirmed cases have occurred among people incarcerated in North Carolina state prisons and another 3,828 cases among staff. Since January, about half of the more than 42,000 people who live or work in the state’s prisons have received at least one dose of the vaccine.
Now, DPS is reducing vaccines and slowing the rate at which it is vaccinating its staff and people in prison. The reason, prison spokesperson Brad Deen said, is that after vaccinating almost 22,400 people, fewer incarcerated people or prison staff are left who want to be vaccinated.
“The key point is that the goal for Prisons has been and will continue to be getting ‘shots in arms’ as promptly as possible,” Deen wrote in an email to Carolina Public Press.
Over two weeks, starting April 5, DPS accepted only 1,500 first doses of the Moderna vaccine the state Department of Health and Human Services offered, half of what DPS received every week since late March. Prisons continue to distribute 3,000 second doses of the vaccine each week.
The slowdown in vaccinations could hurt people in the prison system by delaying a return to more normal operations, which both prison staff and incarcerated people have said they want, or by putting staff and incarcerated people at risk of illness if they return too quickly.
In March, Deen wrote to CPP, “Any actions that bring us to adequate levels of herd immunity would facilitate a quicker return to regular operations.” When asked what level of vaccination DPS would deem “adequate,” Deen wrote, “That’s a better question for public health and epidemiology experts to answer.”
If the goal is to limit potential outbreaks, using vaccines to reach herd immunity, or “community immunity,” the point at which enough people in a group are immune to a disease that its spread is limited, could help.
But a 50% vaccination rate in the prisons is likely too low for that, according to Dr. Chris Beyrer, public health and human rights professor at Johns Hopkins University.
“That’s troubling because that probably isn’t high enough,” Beyrer said.
“Vaccines have multiple roles. One is to protect the individual. The second is to really have a role in reducing transmission and that probably isn’t high enough to really achieve the kind of public health protections we want to see where we really reduce transmission overall.”
With a high level of immunity, either through prior infection or vaccination, even if a virus is introduced to a prison, it would not spread like wildfire as it has for most of the last year.
Prisons have restarted certain privileges like family visitation and work release on a limited basis.
“The most important thing is going to be able to be able to communicate with their family members,” said Sandra Hardee, executive director of the advocacy group NC-CURE. “Not having visitation privileges, and having them be so limited during this pandemic, has been really hard on these men and women.”
But restrictions will not fully ease, and the risk of outbreaks will continue, until more people are vaccinated, according to both DPS policy and the opinions of experts like Beyrer.
North Carolina began vaccinating health care workers in December, including medical staff at the state’s prisons. Shortly thereafter, DPS began getting its own vaccines and distributing them to prison staff.
To date, 6,500 prison staff members are partially vaccinated, which is just under 50% of the workforce. DPS is not tracking data on which staff members are getting vaccinated, according to Deen, so it is not clear what the vaccination rates are for the medical staff or corrections officers who actually work face-to-face with incarcerated people, as opposed to administrators and other staff who may have a more removed role.
In February, DPS began vaccinating incarcerated people ages 65 and older, which makes up just over 1,100 of the 28,600 incarcerated people in the state. Not until late March did DPS began vaccinating the entire prison population, a delay DHHS implemented in accordance with guideline updates from the national Centers for Disease Control and Prevention. The rollout came months later than the state’s initial plans or recommendations from public health experts and the National Academies, another federal organization.
To date, DPS has administered at least one dose to 15,872 incarcerated people, and those needing second doses are scheduled to be completed within a month.
Now, DPS is running out of other volunteers to take the shot due to hesitancy among both incarcerated people and prison staff, which follows similar trends in other prison systems.
People’s trust in their vaccine provider is essential, according to Julie Ward, a registered nurse and doctoral candidate in health and public policy at Johns Hopkins University. Without it, people are less likely to take the vaccine.
“There are a variety of reasons that people, in general, tell us they are hesitant to vaccinate,” Ward said. “Sometimes it’s because they think the vaccine is inconvenient, unpleasant or hard to get. Sometimes it’s because they don’t have all the information about vaccine safety, or they don’t trust the people who are conveying that information.”
Not vaccinating is a risky decision, Ward said, and one that affects others, because people who vaccinate also make the people around them safer.
DPS issued an incentive program for incarcerated people to get vaccinated, informally encouraged its staff to get vaccinated and released educational materials to both groups.
To determine who wants a shot, “Wardens and other administrators report estimates based on anecdotal discussions and other informal information-gathering practices,” Deen wrote, noting that the number of willing participants changes constantly.
Across the country, more people are deciding to take the vaccine over time, according to a Census Bureau report, as people wait to see if it is safe for others.
Getting to community immunity
In the North Carolina state prisons, COVID-19 has killed 53 incarcerated people and 12 prison staff members since March 2020. Roughly one out of five incarcerated people and one out of four prison staff have tested positive for the disease, according to data from DPS.
Each survivor now has some built-up immunity to the virus, though people who are vaccinated are even better protected, according to Beyrer at Johns Hopkins, especially from the virus variants, which can cause a second round of COVID-19 illness and are seeing increased spread throughout the United States.
But it’s not clear what level exactly needs to be met to achieve community immunity, and that level changes based on the risk of transmission that a group of people has, according to Dr. Jason Andrews, an associate professor of medicine at Stanford University.
“The first thing is that the transmission rates … are much higher in prison than in the community, everywhere in the country and really in every prison system in the world,” Andrews said.
Transmission rates also vary depending on the type of prison and how openly it’s operating.
For example, the level of COVID-19 immunity through vaccination and illness needed to protect prisons against the rapid spread of COVID-19 is higher for a dormitory-style prison allowing visitation than it would be for a single-cell prison, where the only people to come and go are prison staff.
“I don’t know that we have a good idea of what that would be for different prisons in North Carolina, but it’s probably higher than one might imagine,” Andrews said.
In a December interview with The New York Times, Dr. Anthony Fauci, the chief medical adviser to both Presidents Donald Trump and Joe Biden, said he estimates achieving community immunity will take close to 90% immunity across the population, significantly higher than what many public health experts had previously estimated.
At the current pace of vaccination of 800 first doses per week, it would take another seven months for NC prisons to reach 90% vaccination rates, assuming enough people would volunteer to take the vaccine and the population remained the same. Thousands of people are booked into and released from prison each month.
Unless more prison staff and incarcerated people volunteer to be vaccinated, North Carolina will fall well short of that benchmark. DPS is not currently considering an incentives program or making vaccines mandatory for inmates or staff, according to Deen.
Quality of life and normal operations
Most of North Carolina’s prisons have gone on lockdown in the last year to try to control the spread of COVID-19, with some prisons limiting movement for months at a time.
That means fewer opportunities for people to get out of their cells or out of dormitories they share with dozens of other people, to get outside, exercise or call a loved one.
“I think they’re going to be much happier to not have their movement so restricted,” Hardee said of incarcerated people in North Carolina. “So many lockdowns to one unit, very limited space, very limited time in any recreation or exercise. That has been the state of affairs during this pandemic.”
Hardee gets numerous letters from people in prisons and calls from their family members. The fear that people had of getting sick and dying has eased somewhat since the beginning of the pandemic, she said, in large part because so many people have already survived.
But the fear, lack of visitation and long weeks of lockdown have worn on people.
Andrews has seen similar stress on people in California’s prisons, where he has observed a worsening of incarcerated people’s mental health over the last year.
Resuming programming in prisons is important, he said, which puts the people who run prisons in a tricky place.
The solution is improving vaccine uptake, he said, so that people can be safe from the virus and restart visitations and other activities that are essential to well-being while incarcerated.
Even though Beyrer thinks 50% vaccination is not enough, he also said many activities like family visitation could likely resume safely, given continued safety measures like mask wearing, 3-foot social distancing and proper hygiene. Other medical experts also say visitors should be vaccinated or test negative for COVID-19 within 48 hours of arriving at the prison.
But risk is a constantly changing variable, both doctors point out. What may be safe in one place may not be safe in another, and it depends on a complex interplay between the percentage of people in a group who are immune to COVID-19 and the risk people in that group have of spreading COVID-19 to each other.
As prisons bring in new staff and newly incarcerated people, DPS should strongly encourage them to get vaccinated, Beyrer said, even if the department cannot mandate it. The more people there are without immunity, the more they put themselves, and everyone around them, at risk.
Correction: DPS continues to distribute 3,000 second doses of vaccine each week. An earlier version of the article gave the wrong number. Also, prisons have not restarted work release programs. The article originally made an inaccurate statement on this point due to information that was taken out of context.