Mass testing at two Tennessee prisons has uncovered nearly 2,000 cases of the coronavirus behind bars so far.
Officials have repeatedly said most inmates who have tested positive are not showing symptoms. But some health experts are cautioning prisons to prepare for that to change.
When the Tennessee Department of Correction first reported that 162 inmates at the Bledsoe County Correctional Complex had tested positive for the coronavirus on Apr. 20, officials said the “vast majority” were asymptomatic.
They said the same thing when men 93 at the Trousdale Turner Correctional Center tested positive on April 28. And again when that number jumped to 1,300 last Friday.
“The good news is that 98% of them are completely asymptomatic, ” Heath Commissioner Lisa Piercey said at the governor’s press briefing on Tuesday. She said many of the inmates still seem “well” and “feel good.”
“The thing that’s still a head scratcher is why ostensibly younger and healthier inmate populations have such an incredibly high asymptomatic rate,” Piercey said. “And we’re starting to see this all over the nation.”
But Marc Stern says it’s unlikely that so many people are truly asymptomatic. He’s the former medical director for Washington State prisons and is now working to prevent the spread of the coronavirus behind bars.
“If I were to take it at face value that that there are large numbers of people who are legitimately asymptomatic, my first reaction would be that a number of them are going to become symptomatic,” Stern says. “Just give it time.”
Stern, along with other health professionals, also distinguish between pre-symptomatic and asymptomatic individuals.
Someone who is asymptomatic tests positive for the disease but never develops any symptoms. Dr. Maria Van Kerhove, an infectious disease epidemiologist with the World Health Organization, told ProPublica in early April that the WHO had found few people who fit that criteria. She said many at least had minor symptoms, like low fevers or aches.
Pre-symptomatic individuals, on the other hand, have contracted the virus and aren’t yet showing symptoms, but will later on. The Centers for Disease Control has found in several early studies that people who don’t seem sick when they test positive can start to feel ill days later.
Piercey said that pattern has played out at many nursing homes, where older adults with weak immune systems have taken a longer time to show symptoms after testing positive. But she held firm that nearly all Tennessee inmates with the virus are “asymptomatic” at this point.
Causes For Doubt
Stern says there are a few reasons why the state’s estimate of asymptomatic inmates could be unreliable.
First, he says inmates who feel sick might be afraid to report symptoms, because they don’t want to be put in solitary confinement. There’s also a chance that tests weren’t totally accurate, if they weren’t conducted properly.
But either way, he says prisons with many confirmed cases should be preparing to treat an influx of sick inmates, whether they’re currently showing symptoms or not.
“They need to be monitoring carefully and expect that they will have more cases. And be planning of what are they gonna do,” Stern says. “Do they have the resources? Are there people who they can let out so that they have more space to spread people out?”
The governor, who ran on a platform of criminal justice reform, says he has no plans to release inmates this time.
“This pandemic,” he said at a press briefing, “and our testing of and subsequent treatment of inmates does not include any change to release for any of the inmates or shortening of any of those sentences.”
A spokesperson for the Board of Parole says that extra parole hearings have not been scheduled during the outbreak. But he says the board is continuing to conduct hearings remotely and “is taking steps to expedite release where possible without negatively impacting public safety.”
For now, officials say they’re taking extra precautions to keep inmates safe. A spokesperson for the governor’s office says all inmates who test positive and are asymptomatic will be monitored daily for symptoms. Those who get sick will be treated either at the correctional facility or at local hospitals. And staff members who test positive are isolating at home.
But Stern thinks such measures may not be enough — especially in prisons, where social distancing is nearly impossible.
“We need to take correctional facilities serious as places that could breed the infection, and they pose, therefore, a risk to the public safety — not just to the people in the jail or prison,” he says. “It is very easy for infections to spread within a correctional institution. And while they can’t be emptied out completely — nobody wants that — the more they can be reduced in size, the less risk.”
Samantha Max is a Report for America corps member.