How a piecemeal Covid-19 response in one prison fueled a fatal outbreak

Roderick Keith Dirden has been trying for months to get out of an overcrowded dormitory at the California Institution for Men, where he has been in intermittent lockdown since Covid-19 started sweeping through the prison.

“I’m not looking for somebody to jump out of a parachute to save me,” he said in a phone interview with STAT. He’s simply looking, he said, for the system to keep inmates safe.

With 767 cases and counting among inmates, CIM has one of the largest coronavirus outbreaks among all 35 facilities within the California Department of Corrections and Rehabilitation (CDCR). As of June 11, there are still 515 cases classified as active, as well as 112 cases among staff at the prison, which is east of Los Angeles. With 13 inmate deaths to date, CIM was, for months, the only state prison in California to have inmates die of Covid-19.

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The outbreak at CIM — described by several current inmates to STAT — illustrates how a slow and piecemeal response to the novel coronavirus put the prison’s standard operating procedures ahead of the demands of a public health emergency. That approach, combined with existing overcrowding, has fueled the spread of the virus.

“I have become obsessed with staying alive,” inmate Darrell Harris, 65, wrote in a letter to STAT on May 23, when there were 452 active cases in the prison, describing himself as“a germophobe…sterilizing everything.”

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Another inmate, 56-year-old Anthony Barker, who is serving a life sentence, wrote to California Correctional Health Care Services, which oversees medical care in prisons, to raise concerns about the lack of face masks among guards — and how it could put himself and other inmates at risk.

“Do prisoners still have a federally protected right to safe and humane conditions?” he asked in the letter, a copy of which he shared with STAT.

Like nursing homes and cruise ships, prisons are designed to concentrate a large group of people in a small area, crowding them into communal spaces with little room to isolate the sick. In prisons, many of the public health recommendations for coronavirus prevention — 6 feet of social distancing, frequent hand-washing, and wearing face masks — are difficult to achieve. Those challenges are only exacerbated by overcrowding, aging inmate populations with a high rate of preexisting conditions, and the inherent focus on safety, rather than public health, in correctional departments.

Perhaps, then, it is no surprise that prisons have become coronavirus clusters. According to the New York Times, there are at least 59,000 infections among incarcerated individuals in jails, prisons, and other federal facilities across the country, and at least 557 inmates and prison workers have died of Covid-19.

Speaking of the challenges at CIM, Lauren Brinkley-Rubinstein, a professor of social health at University of North Carolina at Chapel Hill who studies the effect of incarceration on health, said: “I don’t know if I can pinpoint an exact time that you know they should have acted.’’

But, she added, “they acted late.’’

CIM’s first known Covid-19 cases date from March 22, when two staff members were reported as testing positive. (Until late May, the state corrections department did not test its own employees for coronavirus, instead depending on staff to test and self-report.) On April 4, the first inmate tested positive, along with 11 more staff.

In late March, the Centers for Disease Control released interim guidelines for coronavirus in detention facilities, suggesting that prisons prioritize prevention for the immunocompromised, medically isolate inmates with symptoms, improve hygiene and cleaning regimens, and rearrange housing units to allow inmates to maintain 6 feet of social distancing where possible, among other measures.

The state corrections department took additional steps. To prevent potential sources of infection, it shut down family visitation on March 12, paused inter-prison transfers between March 24 and May 30, and released more than 3,400 inmates convicted of nonviolent crimes that were within 60 days of parole. CIM began quarantining infected units, limiting inmate movements, ceasing housing transfers between dormitories, putting jobs on pause, and delivering meals rather than having large groups congregate in the “chow hall.”

These efforts were aimed at containing spread. But even if they were followed perfectly by each individual prison, and each correctional officer, they could do little to change the reality that across the prison, groups of up to 160 men lived in open dormitories in spaces designed for around 100, with just a few toilets, showers, and sinks between them.

“They’re public safety institutions. Their mission is not oriented towards well-being,” said Brinkley-Rubinstein, who has been tracking the responses of correctional facilities to Covid-19 across the country through the Covid Prison Project.

The state corrections department has not released data on how Covid-19 cases break down by race. But the pandemic has taken a disproportionate toll on Black people, who are also disproportionately represented in the criminal justice system.

“When you obscure racial data in the prison system in the context of a racist system with a pandemic that disproportionately impacts people of color, then it’s very problematic, so we’re unable to know you know who is being more affected while they’re incarcerated,” Brinkley-Rubinstein said.

Dana Simas, a state prisons spokesperson, told STAT CIM was taking a number of isolation measures made in conjunction with health experts, including “to safely move inmates who test positive into isolation where they are monitored multiple times a day by health care staff.”

But while some inmates have been placed in medical isolation, inmates in three separate housing units told STAT that prison authorities continue to house inmates who have tested positive and those who have tested negative in the same dormitories, “isolating” them on opposite sides of an open room. While buildings with positive cases are quarantined from the rest of the prison, there are no restrictions on inmates in the same unit, who can still move freely around the space and also share bathroom facilities.

This falls short of CDC recommendations to medically isolate those infected “in a separate environment from other individuals,” ideally in a single room with a separate bathroom or, if that’s not possible, housed only with other inmates that have tested positive and away from others, particularly those at high risk of having a severe case if infected.

And while movement between buildings slowed significantly under quarantine, it hasn’t stopped outright. CIM still needed inmates to do essential work in the kitchens and laundries, for example, which put them in contact with inmates elsewhere.

That has fueled concern among many inmates, some of whom said they were worried long before the prison took steps to prevent Covid-19 from spreading.

Harris, the inmate worried about “staying alive,’’ is a respiratory therapist by training. He said he began wearing face masks, and encouraging others in his unit — including Dirden — to do the same long before it was recommended. On April 1, just days before the CDC officially advised the public to wear cloth face masks and the CDCR followed with its own policy, Harris said a correctional officer confiscated his mask. Facial coverings historically haven’t been allowed — a security policy that allows correctional officers to quickly identify inmates.

After going through the internal appeals process, Harris petitioned a court to not only request the return of his mask, but to also order correctional officers who work at the facility to wear masks and gloves. “They come from the outside and may unknowingly bring the virus inside,” Harris wrote, referring to the fact that with visitation closed, any transmission would be coming from staff. He also asked a judge to require the prison to provide inmates with cleaning supplies.

By the time the court received the request at the end of the month, the state prison department had already concluded that Harris’ requests were best practices to follow. But even with these new guidelines, inmates told STAT that correctional officers failed to wear masks throughout April and early May, as coronavirus cases in CIM grew exponentially.

Grant Muldrow, a 26-year-old inmate scheduled for release in August, told STAT in a letter that he pressed a correctional officer about the lack of concern that her staff showed toward inmate health at a public meeting at the prison.

“I’m not a lifer nor am I sentenced to death,” Muldrow recalled saying, “So are you telling me, with only a few months left, that me and everyone else here just has to sit here and wait to die?”

The officer’s reply, according to Muldrow: “Pretty much.”

On May 26, in response to an ongoing lawsuit filed by the Prison Law Office in an attempt to force CDCR to provide better care, the department of corrections agreed to move 700 CIM inmates with preexisting conditions — including Dirden — who had tested negative for Covid-19 to prisons without outbreaks.

But days after the transfers began, they were halted after new outbreaks were found in the prisons that were previously free of Covid-19. Corcoran State Prison, where Dirden was to be sent, had its first case on May 31, followed by San Quentin State Prison on June 1.

Since then, the virus has spread significantly. By Tuesday, June 9, Corcoran has 98 cases, while San Quentin has 15. Simas, the state prisons spokesperson, says that just one of Corcoran’s cases came from CIM, while all 15 of San Quentin’s cases are traceable to CIM.

Dirden said that he was only tested once, in mid-May, along with the rest of his housing unit, which at the time, was one of the only two buildings that had no cases and was not quarantined. Since then, however, housing transfers between units — including of positive or previously positive patients — have continued. Dirden said he wasn’t tested again before he was to be moved.

Two days after his scheduled transfer to Corcoran, Dirden remained at CIM, in a housing unit that — with quarantine lifted — is again overcrowded. At the height of social distancing, every third bunk was purposefully left empty. Now, all of the bunks are full — including, Dirden said, with inmates the prison claims have recovered from Covid-19. But given that they are not being retested, he and other inmates and family members are concerned that, the individuals being moved in are still infectious

On June 5, Dirden said that CIM was asking for 40 volunteers to move into a tent set up in the yard, which would clear some space and allow for more distancing. But he had yet to decide if he would volunteer. As with everything else with this virus, he said he just wasn’t sure where he would be safer.