As the number of coronavirus cases grew outside jail and prison walls in Massachusetts, advocates started sounding the alarm: People in custody were too close together. Neither the incarcerated nor correctional officers were properly protected.
This, they said, was a public health emergency waiting to happen.
Whether that predicted crisis is building is difficult to discern: Testing inside prisons remains uneven and reporting of outbreaks is inconsistent. But Massachusetts ranks sixth in infection rate among state prison systems, despite testing less aggressively than most of the states with higher infection rates, according to data compiled by the Marshall Project, a nonprofit news agency focusing on criminal justice.
And amid a flurry of lawsuits and calls for reducing prison populations, the outbreaks have only grown.
State officials are quick to point out that the virus has yet to breach the walls of several state facilities. As of Sunday, only about 500 of the roughly 13,000 people incarcerated in Massachusetts had tested positive for COVID-19. But as prisons and jails have increased testing of employees and inmates, the number of people infected have steadily climbed.
Through the end of last week, 367 people incarcerated in Massachusetts prisons, 107 correctional officers, and 56 other staff members had tested positive for the novel coronavirus, according to data provided to the Supreme Judicial Court. As of Friday, eight inmates had died. In county jails, which hold pretrial detainees not released on bail and people convicted of misdemeanors, at least 142 inmates, 90 correctional officers, and 31 other staff members are infected — about one-third of people tested in each group.
In state prisons, about one-quarter of tests for correctional officers and 13 percent of inmate tests came back positive.
Advocates have called for releasing more people from prisons and jails, saying social distancing and sometimes basic sanitation are all but impossible under current conditions. Those realities have turned prisons in other states into some of the largest outbreaks in the country. In Ohio, the scene of one of the nation’s largest outbreaks, comprehensive testing of state prisoners at affiliated facilities revealed a massive spike in coronavirus cases. Nearly 4,500 people have tested positive since the onset of the pandemic, leading to 46 deaths.
Testing is paramount, said Dr. Josiah Rich, professor of epidemiology at Brown University in Rhode Island. The disease can move in stealth, spread by carriers who may not show any symptoms before falling ill.
“People can look fine, and then not look fine and in a hurry,” he said. “If you don’t test aggressively, you don’t know where you’re at.” It’s a scenario that has played out in prison systems across the country.
Ariel Pena, who is serving a six- to eight-year sentence for drug possession at MCI-Shirley, wrote in an April 13 affidavit that distancing from other people in prison is “impossible.”
“We are in lockdown right now, meaning we are in our cells all day and night except for approximately 40 minutes daily to use the shower and phones. I have a cellmate and depend on nurses and correctional officers to meet my needs so I am still not able to socially distance," Pena wrote. “My mental health is deteriorating and I recently asked to speak to mental health [professionals]. The lockdown and the news cause me a lot of stress. My biggest fear right now is dying in prison, alone.”
Another recently released person, William Goforth, said prisoners at MCI-Norfolk were kept in their cells 22 hours a day and given cleaning supplies to wash common areas like phones and showers.
“They let you come out for the phone, they let you come out for your shower, and chow three times a day. You got your chow and came back to your cell,” Goforth said. He was released April 15, and moved into a residential re-entry program in Boston, where he believes he contracted the virus. He said he tested positive about three weeks after his release from prison. He was briefly hospitalized, and now lives with his sister, he said.
Prisons and jails are not as separated from the rest of the world as people outside sometimes think, said Leslie Walker, an attorney and former executive director of the group Prisoners’ Legal Services of Massachusetts.
Correctional officers and other staff members go in and out of the facilities every day, interacting with both incarcerated people and the outside world. People in county jails may only stay there a short time; and the vast majority of people in prisons are not there for life sentences. They will get out too. So if the virus enters a jail or prison and begins rapidly spreading, cell walls won’t contain the outbreak.
“The issues are the crowding,” Walker said. “People are too close to each other to maintain social distancing. And the lack of testing of people, while they’re inside and before they’re released.”
Dr. Alysse Wurcel, an attending physician at Tufts Medical Center who advises the Massachusetts Sheriffs’ Association, said she has recommended county jails and houses of correction treat anyone coming into the facilities as a presumptive positive case, kept away from the general population and monitored for 14 days.
Wurcel said she has not advised sheriffs to begin testing everyone, including asymptomatic people who have not had known contact with an infected person.
“I think it’s not necessary,” Wurcel said. “If you’re already taking the necessary precautions to stop the spread and to aggressively look for people who have the disease and are at risk for decompensation [organ failure], transferring them out to a tertiary care center. That is what is needed.”
Massachusetts is one of a handful of states that have expanded testing inside prisons, but those efforts fall short of being universal. State authorities expanded testing at prisons in Shirley, Framingham, and several others. A recent round of testing at the Bridgewater prison revealed the number of confirmed cases had doubled since the early days of the pandemic.
Department of Correction spokesman Jason Dobson said the agency is working with its contracted health care provider to expand testing at other prison facilities.
Wurcel said she has been speaking with other health care leaders around the country, paying close attention to New York and Washington state.
“When we do these sterile surveillance studies of prisons and jails and these high numbers come out, people are very shocked,” Wurcel said. “I’m not shocked. This is not shocking. If we tested everyone who lives in Wellesley right now we would find the same — you know, we would find a lot of people who are positive who didn’t know they were positive.”
In mid-March, Wurcel contacted Judy Jensen, chief administrative officer for the Department of Pathology at Beth Israel Deaconess Medical Center, and asked if they could help provide swabs and run samples. The samples would be collected by jail staff and delivered to the hospital’s lab for testing. Jensen said she was glad to help. They started running tests for the Middlesex County sheriff, then the Essex County sheriff, taking in samples collected in the jails.
“I think that we have been across the board helping the greater community because we’ve had the testing ability,” she said.
Dr. Stefan Riedel, a Beth Israel Deaconess Medical Center pathologist, said the medical and scientific communities are turning to lessons from 2009′s H1N1 pandemic. They’re looking at what they know about how the novel coronavirus spreads in other close quarters, like university dorms, where social distancing practices are much easier to observe than they are in custody.
“People who are entering any area where there’s closeness, and where there is restricted space — [like] the confined spaces of the prison systems — are certainly, more likely to allow for an easy spread of such disease,” Riedel said. “Virus testing becomes really important, as with testing we have the only means by which we can identify a person. And then, appropriate interventions can be taken.”