The equation for COVID-19 hot spots has been clear since the earliest days of the pandemic: Take facilities where people live in close quarters, then add conditions that make it hard to take preventive measures such as wearing personal protective equipment or keeping socially distant.
Major outbreaks in nursing homes this spring shocked the nation. Now, residents of those facilities are among the first in line for the vaccine.
Similar conditions plague the nation's jails, prisons and detention centers, where outbreaks continue. The 2.3 million people incarcerated in the U.S. are nearly five times as likely to test positive for the coronavirus as Americans generally and nearly three times as likely to die, after adjusting for age and sex.
But the question of when inmates will receive the vaccine remains wide open. Experts say that's because the states and agencies that control distribution face political pressure from a general public that has historically been unsympathetic to the health of incarcerated people.
"In terms of public health risks and priorities, I think this is straightforward public health assessment and response," says Dr. Thomas Inglesby, director of Johns Hopkins' Center for Health Security. "All the conditions that we think about in terms of trying to control COVID, they're all moving in the wrong direction in these facilities. They are basically the perfect conditions for superspreading events."
The Advisory Committee on Immunization Practices, the panel of doctors and health officials whose recommendations shape official Centers for Disease Control and Prevention guidance, already recognizes that jails, prisons and detention centers are dangerous: They've long recommended that corrections officers be in the second priority group, after only health care workers and residents of long-term care facilities.
But the ACIP has been silent on the subject of incarcerated people themselves, even as the panel voted on Dec. 20 to recommend enlarging the third priority group to encompass more than one-third of Americans, including lower-risk essential workers such as bank tellers and construction workers and people of any age with certain underlying health conditions, a broad list that could include smokers. That's left inmates — and their advocates — wondering when it will be their turn.
"We should all imagine what it would be like if one of our family members was in a correctional facility," says Inglesby. "Do we think that that person should be exposed to the risk of COVID at much higher levels than they would be outside of that facility? Do they deserve that just because they were put in that facility for a period of time?"
A life sentence shouldn't mean you're "sentenced to death"
In 2015, Robbie Dennis was arrested after an off-duty police officer saw him rolling a joint in his car just outside New Orleans. According to court documents, a search of the car turned up less than half an ounce of marijuana, a fifth of an ounce of crack and a loaded handgun. Dennis ultimately pleaded guilty to possession with intent to distribute cocaine and ended up with a five-year sentence.
In March of this year, Dennis was transferred to the Louisiana State Penitentiary, known as Angola. By that time, he had about five months left until his release, with his wife and five sons waiting for him at home.
All he had to do was survive the coronavirus.
The state had reported its first confirmed case of the virus about a week earlier.
When he arrived, Dennis was put into two weeks of quarantine in near-solitary confinement, locked in a cell 23 hours a day.
Inmates often dread isolation. But Dennis, who had been following the news, embraced it.
"I felt like I was in the safest place possible," he says. "I told my wife, 'I think I'm in a better position to be here than to be out there moving around in the general population.'"
After quarantine, Dennis says he had to share space with hundreds of other people, sleeping head-to-head on beds just 3 feet apart. The Centers for Disease Control and Prevention first recommended that Americans wear masks on April 3; prisoners at Angola didn't receive them until June or July, Dennis says. Even then, many inmates eschewed them out of fear of being strangled.
At least 16 prisoners have died of COVID-19 at Angola, according to state officials. Three staff members have died. These numbers represent more than half the deaths in their respective categories among all of Louisiana's prisons.
"Just because you have a life sentence don't mean you sentenced to death," Dennis says.
"Vectors of disease" that reach beyond the razor wire
Jails, prisons and detention centers across the U.S. are, at their core, built to house many people in confined spaces. Dozens of lawsuits filed this year have detailed conditions that would make an epidemiologist shudder: dozens, if not hundreds, of inmates sharing communal spaces, sleeping just feet apart; jails and prisons over capacity; delays in isolating symptomatic inmates; a lack of protective gear as basic as masks, soap and hand sanitizer.
Most of the nation's largest outbreaks have occurred at correctional facilities. According to The New York Times, more than 70 correctional facilities have logged more than 1,000 cases of COVID-19. Three — California state facilities in Avenal and Corcoran, and the Harris County jail in Houston — have experienced more than 3,000 cases each.
Compare that to meatpacking plants, which also have been hot spots for the spread of the coronavirus: Just two have had more than 1,000 cases.
"Prisons are vectors of disease, as are jails," says Pamela Metzger, director of the Deason Criminal Justice Reform Center at Southern Methodist University's law school. "They are filled with people who enter with preexisting health conditions, many of which may be undiagnosed. You have cramped living conditions with exceptionally poor nutrition. Ventilation is problematic in many places. You have limited access to medical care."
The virus doesn't stop at the razor wire. When loved ones visit inmates, when workers go home each day or when people get released, an outbreak at a prison or jail can easily escape. Researchers have documented spikes in communities near incarceration facilities.
Public health advice clashes with public opinion
Now that the FDA has authorized emergency use of two COVID-19 vaccines, the CDC has begun to issue guidance about who should receive them first. But each state and federal agency will ultimately make its own decisions about who gets vaccinated when.
Though there's broad agreement among scientists that incarcerated people are at increased risk and therefore should get the vaccine early, the politics of such a decision are a different matter.
In October, Colorado released a draft vaccine distribution proposal that prioritized incarcerated people. Inmates would be vaccinated after front-line health care workers, at the same time as front-line essential workers, but before healthy older adults.
A conservative backlash characterized the draft policy as ensuring "convicted murders will get immunized before grandma," as one Fox News host put it.
Afterward, Colorado Gov. Jared Polis, a Democrat, backtracked.
"There's no way it's going to prisoners before it goes to people who haven't committed any crimes. That's obvious," Polis said with a laugh at a press conference on Dec. 1.
In the distribution proposal submitted to the CDC a few days later, the state placed correctional staff in the high-priority group, but not inmates.
"What you have is, on the one hand, a really urgent public health need to prioritize both corrections staff and incarcerated people," says Sharon Dolovich, director of the UCLA Prison Law and Policy Program. "On the other hand, you have at least four decades of tough-on-crime rhetoric which has primed the American public to think of people in custody as somehow less than human and less deserving."
So far, only seven states have followed public health officials' advice to specifically prioritize incarcerated people so they can be among the earliest groups to be vaccinated, according to the nonprofit research group Prison Policy Initiative.
About 20 states are prioritizing corrections staff before inmates, an approach shared by the federal Bureau of Prisons.
Public health experts, and some corrections staff themselves, say that strategy doesn't make sense if the goal is to reduce infection rates and deaths.
"I think the priority level would be the same," says Byron Osborn, president of the Michigan Corrections Organization, the union of corrections staff in Michigan. "I don't necessarily think the staff should get it before the prisoners or vice versa."
Michigan experienced a huge spike in coronavirus cases this fall, and the state's prison system is still reeling. At the Chippewa Correctional Facility where Osborn works, more than 1,000 inmates have tested positive for the coronavirus along with 99 staff members, according to state officials. More than 500 of those cases are still considered active.
Michigan has placed correctional staff in its second-highest vaccine tier. But it, and about a dozen other states, do not include incarcerated people in any phase of their vaccine distribution plans. And six states don't specify incarcerated people or correctional staff at all.
"Anybody who's been paying attention to the outbreaks in the correctional system in Michigan for the past several months realizes this has been a significant disruption to the operation of these correctional facilities," Osborn says. "I can't believe anybody would not be able to rationalize that those two groups of people would be in that second tier of people that are being provided the vaccine."
A test, and a reunion
For now, with such limited quantities of vaccine doses, incarcerated people and their loved ones are playing a waiting game. States' plans are constantly in flux as the CDC continues to update its guidance.
In August, Robbie Dennis was released from prison in Louisiana. His wife picked him up. The thing he wanted most was to go home and hug his five sons for the first time in years.
But he knew the coronavirus had rampaged through Angola, and he'd never received a test.
"I felt like it was a must because I didn't know my own fate being released," he recalls. "I was fearful that — me not being tested and knowing my fate coming home — was to bring that virus home to my family and friends that was waiting on me to get out of prison."
It took him four days to get the result. It was negative. Then he went home and hugged his kids.