COVID testing questions in NC prisons cause confusion

By Elizabeth Thompson

As the most recent COVID-19 outbreak spread throughout the North Carolina Correctional Institution for Women late this summer, the most pervasive feeling among those incarcerated was fear.

Fear that they would get sick, fear that they wouldn’t make it home, fear that no one on the outside really knew exactly what was going on inside the Raleigh women’s prison.

Though about 80 percent of the women incarcerated at NCCIW are vaccinated against COVID, there is still a lot of confusion over who gets tested for the virus and why.

“Right now the only qualification that they have for anything is ‘Oh, aren’t you vaccinated? If you’re vaccinated, then you’re fine,’” said Jessica Nash, who is vaccinated and incarcerated at NCCIW.

When the prison was reporting more than 40 active cases of COVID infection in early September, several incarcerated women said it seemed like no one was being tested. The Centers for Disease Control and Prevention recommends that vaccinated incarcerated people should be tested for COVID-19 after potential exposure to the virus or if they are experiencing symptoms.

Some incarcerated people have been in prison for years, long before the pandemic began, and their main source of information about the disease is what they hear from the prison staff. They don’t have regular access to a computer to look up information about COVID.

Because women incarcerated at NCCIW said prison staff were not testing vaccinated people during a COVID outbreak and no one understood why, they felt distrust for the system that was supposed to ensure their medical safety.

“Everybody in my room would die if they got COVID,” said Marisa Johnson, a woman incarcerated in NCCIW’s assisted living facility, where older people and people with disabilities and chronic medical conditions are housed.

What’s the COVID testing policy in prisons?

North Carolina Health News spoke with close to a dozen women incarcerated at NCCIW and their families, all of whom expressed confusion and concern over the ongoing outbreak there.

Terri Smith, who is incarcerated at NCCIW, got COVID during NCCIW’s recent outbreak while working at the facility’s dining hall. Because Smith was unvaccinated, she said she received a COVID test. But for others who were vaccinated, it was more difficult to receive a test.

“[Vaccinated prisoners] knew they had it,” Smith said, “but they were literally having to beg to get tested.”

Tricia Cranford, another woman incarcerated at NCCIW who recently recovered from COVID, said a “handful” of vaccinated women experiencing symptoms told staff, “I’m sick. You have got to test me. I’m having symptoms.”

“But if they didn’t do that, they weren’t tested,” Cranford said.

When NC Health News reached out to the Department of Public Safety about its testing protocols for prisoners, we received inconsistent answers.

John Bull, spokesman for the Department of Public Safety, said testing in the prisons is determined using CDC criteria for exposure to the virus. He said that meant people who were in “close contact, defined as within six feet of an infected individual, for a cumulative time exceeding 15 minutes over a 24 hour period.”

“Individuals who meet that criteria are tested,” Bull said.

After further inquiries for more information on DPS’ policies for testing people in prison who are vaccinated, Bull maintained in two separate emails that “vaccinated offenders who are potentially exposed to COVID-19 are tested if they are symptomatic.”

When asked why vaccinated people incarcerated in the state’s prisons exposed to COVID-19 are only tested if they are symptomatic at a recent press conference, Secretary of the North Carolina Department of Health and Human Services Mandy Cohen said it’s because the risk of viral spread after vaccination is low.

“When someone is vaccinated, there are cases where they are getting a so-called breakthrough infection,” Cohen said. “But what we haven’t seen is if someone has been vaccinated, they don’t have any symptoms, we haven’t seen that someone then continues to spread that virus.”

There isn’t sufficient data on the asymptomatic spread of COVID-19 by vaccinated people, but as the highly transmissible Delta variant spread across the country and the world, the CDC updated its testing guidance on July 27. The CDC now recommends that fully vaccinated people who have come into close contact with “someone with suspected or confirmed COVID-19 to be tested 3-5 days after exposure, and to wear a mask in public indoor settings for 14 days or until they receive a negative test result.”

The CDC also updated its guidance for correctional facilities on June 9 to clarify that fully vaccinated incarcerated people should also be tested “following exposure to suspected or confirmed COVID-19.”

When NC Health News asked DPS officials about the CDC’s updated guidance for testing in prisons, we received an email statement from the prison Chief Medical Officer Les Campbell saying that all inmates considered in close contact with an infected person are tested, regardless of symptoms or vaccination status.

“There is a distinction regarding testing for fully-vaccinated offenders, primarily confirmation of meeting the criteria for close contact as determined through contact tracing,” Campbell said.

“The majority of our testing during outbreaks is intentionally broad as it relates to the unvaccinated population, specifically not requiring confirmation of ‘close contact’ in order to implement testing, but instead simply even a potential exposure,” Campbell continued. “For fully vaccinated offenders who meet the criteria for close contact, however, testing is indeed conducted. Additionally, in instances where there are more than just isolated break-through infections in a housing unit, all offenders (regardless of vaccination status or symptoms) are tested.”

Campbell said the prison’s reports of low hospitalizations for incarcerated people and zero reported COVID-related deaths over the past few months since the vaccine rollout are evidence that the prison’s protocols are working.

However, without regular screening tests for COVID-19, public health experts say it would be difficult or impossible to know the true rate of infection.

Vaccine limitations in carceral settings

While vaccines are very effective, characteristics of the carceral system, such as dense overcrowding, under testing, understaffing and unsanitized facilities, make it easier for people to get sick and pass on the disease, said Eric Reinhart, lead health and justice systems researcher at Data and Evidence for Justice Reform at the World Bank.

“The rate of transmission in U.S. carceral contexts, in particular, is higher than any other known contexts in the world, higher than even confined cruise ships,” Reinhart said. “ … The rate of transmission really matters for a lot of reasons. One, obviously it puts people at risk if they’re subject to high risk of exposure, but also now after vaccines have been rolled out, it has major implications for the real world effectiveness of vaccines.”

In mid-September, the North Carolina prison system reported that 19,691 of the roughly 28,000 people incarcerated in its facilities are fully vaccinated, close to 70 percent. An additional 1,171 were partially vaccinated.

Recent research from the CDC found that during a COVID-19 outbreak involving the Delta variant in a Texas prison, though vaccinations against COVID helped keep people out of the hospital and prevented deaths among incarcerated people, “transmission rates were high, even among vaccinated persons.”

The CDC’s findings underscore the “importance of implementing and maintaining multiple COVID-19 prevention strategies in settings where physical distancing is challenging, even when vaccination coverage is high,” the report said.

“As long as prisons are crowded places, they’re going to be hotbeds of viral spread,” said Wanda Bertram, communications strategist at the Prison Policy Initiative. “Even if people are vaccinated, you still have to address the main issue, which is density.”

Testing as a public health tool

Testing is an important tool not just in a clinical sense, where it is used to trace the amount of virus in a person’s body, but also from a public health perspective, Reinhart said.

“We don’t even know what the disease rate is, what the infection rate is in our carceral facilities because we’re not testing,” Reinhart said, “and the first step to get outbreaks in jails or prisons under control is to know what the hell is going on. And to do that, you have to test.”

By putting the onus on incarcerated people to report their own symptoms, there is plenty of potential for data to be skewed, Reinhart said.

In many institutions, testing positive for COVID means an incarcerated person is placed in what is essentially solitary confinement, incentivizing them to not report possible symptoms. But other issues such as understaffing, which is prevalent in North Carolina’s prison system, could lead to under testing of the vaccinated population.

In phone calls with multiple people incarcerated at NCCIW, North Carolina Health News asked if the active case numbers the Department of Public Safety reported on its website corresponded with what they were experiencing.

Some women laughed in response.

Nash, who got COVID last year at NCCIW, said it felt like the past was repeating itself, even though she is now vaccinated.

“I guess I should just cross my fingers like I did last year,” Nash said.