Testing of Prison Staff Lags as COVID-19 Spreads

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The California Medical Facility is a men's prison in Vacaville, California, which contains a skilled nursing facility.  (Sruti Mamidanna/KQED)

Updated Aug. 6

Five months into the coronavirus pandemic, the California state prison system is still struggling to control the biggest risk factor for transmitting COVID-19 to inmates — its own staff.

Even after acknowledging that workers, who come and go every day, are the main vector for infecting incarcerated people, the California Department of Corrections and Rehabilitation (CDCR) missed a court-imposed deadline of July 16 to test all of its 49,000 staff, according to a recent court filing.

The agency is also struggling to finalize a plan for ongoing testing of corrections officers, cooks, cleaners and medical workers that attorneys for inmates have challenged in federal court.

“We are very concerned,” said Sophie Hart, a Prison Law Office attorney. “There are apparently hundreds of staff members who still haven’t been tested, any one of which could bring the virus into the prisons.”

CDCR said it had tested an average of 90% of the staff across the 35 prisons in the system, according to the agency’s July 22 data.

However, that average obscures the fact that some prisons have tested far below that rate. Approximately 20% of the staff had yet to be tested in a dozen prisons, while one prison had only tested 59% of their staff, according to court documents.

CDCR said that testing all its workers — or baseline testing — hadn’t been completed for a number of reasons.

“Some institutions have experienced a recent increase in retirements, and a large number of staff members have been out on long-term sick leave, pre-approved time off, or family and medical leave,” department lawyers wrote in a court filing.

CDCR said it is taking steps to complete the initial testing as soon as possible and the agency is negotiating how to continuously test employees.

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‘Staff as the Main Vector’

More than 8,500 incarcerated people have contracted the virus in California, and at least 50 have died. Once the virus gets inside the close confines of a prison, it spreads rapidly among people sharing cells and bathrooms and congregating in exercise yards and chow halls.

The court-appointed federal receiver responsible for monitoring whether prisons are providing adequate health care has identified prison staff as the “main vector for spreading COVID-19 in the state prisons and has recommended that all staff at all institutions be tested for COVID-19.”

CDCR halted intake of new felons in early March, and after a disastrous transfer of inmates from a prison with an active outbreak to San Quentin, strengthened its transfer protocols. But the flow of tens of thousands of staff to work and home every day continues.

“The biggest concern by far is staff,” said Stefano Bertozzi, dean emeritus of the UC Berkeley School of Public Health. “Staff can't be quarantined every time they enter the prison.”

Even after baseline testing of all prison staff is completed, repeat testing — or “surveillance testing” — will be critical to preventing future outbreaks of COVID-19.

"CDCR worked closely with the California Department of Public Health (CDPH) to develop a comprehensive staff-testing plan that includes ongoing testing of staff at all institutions statewide,” said CDCR press secretary Dana Simas.

At prisons that provide skilled nursing care for medically vulnerable people, the CDCR says it will routinely test 25% of the staff every seven days, such that all staff get tested once a month. If there are any active cases at those facilities, staff get tested every seven days.

Prisons with lower-risk populations that have active cases of COVID-19 should retest all its staff every 14 days, while prisons that don’t have active cases should test 10% of its staff every 14 days.

But Bertozzi said that even testing every seven days may not be frequent enough.

“Seven days is a very long time,” he said. “If you turn positive on the day after testing, then you will spend most of your infectious period ... without being detected until testing comes back around.”

The testing schedule that the CDCR plans for lower-risk prisons — 10% of staff every 14 days — will do even less to catch a case early and prevent a potential outbreak, Bertozzi said.

“That's not at all helpful unless you happen to catch somebody when they happen to be infected and are able to respond,” he said. “It means that 90% of the people, if they happen to be infected, they're not going to be removed from susceptible staff or prisoners. They're going to continue working.”

The current CDCR policy also directs any staff member who experiences potential COVID-19 symptoms to seek a medical evaluation to assess whether they need a test.

But the Prison Law Office’s Hart says that guidance isn’t stringent enough. Instead, said Hart, any symptomatic employee should be immediately given a test, because arranging to see a doctor first isn’t a rapid enough response.

“The most important thing when you're doing a staff testing plan like this is to quickly identify staff members who have it and then to figure out who they might have come into contact with,” Hart said. “We don't think that the CDCR's plan does enough to reach either of those goals.”

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The CDCR said in its rebuttal that it is following guidance issued by the Centers for Disease Control and Prevention (CDC) and also pointed out that “testing resources are at a premium and testing volumes and turnaround times statewide are stretched thin.”

“It is therefore important for staff who believe they may have a symptom consistent with COVID-19 to undergo a medical evaluation and to be assessed by a medical professional who can better determine whether testing is warranted in light of their symptomatology,” the CDCR wrote in a court filing.

Currently there are more than 1,030 active cases of the coronavirus among staff, and eight have died since late May.

Testing Between Yards

While most prison staff are assigned to certain posts for three years at a time, they’re also often asked to work in more than one area of a prison.

In a memo from early May, the CDCR said, “It would not be feasible to make all dorm assignments permanent and completely static because the prisons need to have the flexibility to send custody staff to locations where they are needed, which can change from day to day due to staff illness, leave, emergencies, changes in programming, staffing shortages, promotions, and transfers, among other reasons.”

This is despite national guidance from the CDC that “it is essential for staff members to maintain a consistent duty assignment in the same area of the facility across shifts to prevent transmission across different facility areas” (emphasis is the CDC’s).

Bertozzi said that any staff member who works in more than one housing unit within a prison should be tested on the day they change work assignments.

The CDCR is still negotiating the details of how widespread testing should be if a new case is confirmed at a prison — whether to limit testing to an employee’s regularly assigned yard or to conduct broader contact tracing and test across multiple yards.

Both the California Correctional Peace Officers Association and the Service Employees International Union, the unions representing prison officers and other prison staff respectively, have expressed support for regular testing of staff if it is free of cost and provided during work hours.

“They’re fearful about bringing something home to their families or their being patient zero and bringing something into the institution,” said Yvonne Walker, president of SEIU Local 1000, which represents nearly 19,000 service workers throughout state prisons.

Ultimately, Bertozzi said, rigorous staff testing doesn’t only protect those incarcerated inside, but also the surrounding community.

“The introduction [of COVID-19] to the prisons is most typically through staff. But that doesn't mean it stays there,” Bertozzi said. “It then gets amplified in the prison because so many staff get infected and take it back out to their communities.”

A federal judge could rule this week on whether the CDCR’s staff testing plan is adequate.

Updated Aug. 6: This story was updated to clarify the CDCR's surveillance testing plan and to include information about COVID-19 cases among prison staff.

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