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The Case for Vaccinating Prisoners

States of Crisis with Dan Vock
The Case for Vaccinating Prisoners
By Daniel C. Vock • Issue #27 • View online
The distribution of the first COVID-19 vaccines around the country this week has brought long-needed hope to Americans who have been frozen in place for nine months because of the disease.
For public officials, though, the positive development raises questions of who should get inoculated in what order. While health care workers are obvious choices for the front of the line, it gets trickier after that. Where do teachers rank? What about police? Or politicians themselves?
But there’s one vulnerable population that’s getting relatively little attention: prisoners.
They live in communal facilities that share many risk factors as nursing homes, and, like nursing homes, they’ve frequently been coronavirus hotspots. What’s more, state and local governments are directly responsible for the care of prisoners, and inmates cannot choose to simply relocate.
Political considerations, though, make it difficult for some elected officials to prioritize the inmates in their care.
That’s the story this week, as we take a closer look at how the issue is playing out in Colorado.
Welcome back to “States of Crisis,” where we try to give you a glimpse of what’s next in state policy during these tumultuous times.
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Speaking of that, my thanks go out to my friend Liz, who encouraged me to look into how COVID was playing out in prisons. It took a lot longer for me to get to it than it should have, but I welcome the encouragement and insight.
Onto the news…

Governor Jared Polis
I was at the @CDPHE State Lab to personally receive and sign for the first shipment of the COVID-19 vaccine this morning. This is great news for our highest-risk health care workers and individuals in our state & the beginning of the end of the pandemic.

📸: David Zalubowski/AP https://t.co/hPehzf3NAL
Colorado Governor Rejects Calls to Prioritize Vaccines for Prisoners
Colorado Gov. Jared Polis, a Democrat, was on hand Monday when the first shipment of COVID-19 vaccines arrived at a state lab in Denver. Not only did he greet the FedEx worker who delivered the package at the freight door, the governor actually helped open the box. “It’s the Pfizer vaccine arriving here in Colorado to end the pandemic!” he cheered.
The governor’s enthusiasm was understandable. He contracted the disease himself in late November, and he had to take his husband to hospital for a severe cough and shortness of breath.
But Polis also stunned prisoner advocates and health experts in his state with how he reacted to recommendations by the state’s own health officials to put incarcerated people high on the list of priorities for the vaccines. The governor forcefully rejected them.
Like many states, Colorado has struggled to keep COVID-19 in check in its state prisons. By one count, some 40 percent of inmates in state custody have contracted the disease. Seventeen inmates have died, including 10 in the last month.
Given those conditions, state officials proposed that prisoners should get higher priority than healthy adults who were 65 years old or older. They included the recommendation in a plan sent to the U.S. Centers for Disease Control and Prevention (CDC). A prosecutor in the Denver area blasted Polis for the plan, and the first-term governor promptly reversed course.
“That won’t happen,” Polis said earlier this month. “There’s no way that prisoners are going to get it before members of a vulnerable population. … There’s no way it’s going to go to prisoners before it goes to people who haven’t committed any crime. That’s obvious. So those are just false.”
When I reached out to the state for clarification for what had changed, the state’s COVID public relations team sent a statement saying the initial plan “was a work in progress.”
“We knew it would evolve as we learned more about the vaccine and its availability. Our initial distribution will focus on healthcare workers at highest risk for contracting COVID-19, as well as residents and staff of long term care facilities,” the statement read.
“People who are incarcerated have not been removed from prioritization,” it explained. “They’ve been integrated into the prioritization phases based on their age or whether they are at an elevated risk of severe outcomes, including adults of any age with obesity, diabetes, chronic lung disease, significant heart disease, chronic kidney disease, cancer, or who are immunocompromised.”
But Dr. Carlos Franco-Paredes, an infectious disease expert at the University of Colorado’s Anschutz Medical Campus, says that prisoners should be higher on the list of the priorities. Franco-Paredes has worked with the ACLU on the treatment of prisoners during the pandemic, and has visited several jails and prisons in Colorado, as well as in Chicago, Los Angeles, Miami, Maryland and Michigan.
Local jails, state prisons and federal immigration detention centers are all “major epicenters” of the pandemic, he argues. Protecting detainees could help stop the spread of the disease to prison staff and reduce stresses on already overburdened hospitals, especially in rural areas where prisons tend to be located.
The effect could stretch much further, he says. For example, a study of the Cook County Jail in Chicago early in the pandemic found that inmates going in and out of the facility accounting for 55 percent of the variance in case rates across zip codes in Chicago and 37 percent in Illinois. Neighborhoods where prisoners were being released, in other words, had higher rates of infection.
Vaccinating Colorado prisoners “will undoubtedly contribute to interrupting this pandemic and will save lives inside and outside the walls of jails, prisons across the state of Colorado and at the Aurora immigration detention center,” Franco-Paredes wrote in a letter to the governor.
Six states – Connecticut, Delaware, Massachusetts, Maryland, Nebraska and New Mexico – have included prisoners in their highest tier of priority for the vaccination, reports the Prison Policy Initiative. A dozen have put corrections staff at the top of the list.
Christie Donner, the executive director of the Colorado Criminal Justice Reform Coalition, a community-based organization that wants to end mass incarceration, said Polis’ remarks about prisoner vaccinations are part of a larger pattern of the governor sidelining concerns about the corrections system.
‘On the razor’s edge’
Prisons have been in lockdown since the beginning of the pandemic. Guards are getting sick. Government employees are now doing work they used to outsource to private vendors or relied on the prisoners themselves to do. And the state is having a hard time finding more workers to get the prisons functioning normally again, she said.
“We have an entire prison system operating on the razor’s edge of operability,” she says. “Not only is the governor not doing anything about the vaccination side – he’s actually doing harm with his flippant, ignorant comments – but he’s not addressing the staffing shortage.”
(After we talked, Colorado media organizations reported that Polis has considered bringing in National Guard troops, on a voluntary basis, to address the staffing shortages.)
Colorado is nowhere near the worst state for coronavirus outbreaks in its prisons. South Dakota, Kansas, Iowa, Michigan, Wisconsin, Minnesota, North Dakota and Idaho all have higher rates of infection, according to data collected by The Marshall Project and The Associated Press.
The COVID-19 case rate is four times higher in state and federal prisons than in the general population — and twice as deadly, according to the National Commission on COVID-19 and Criminal Justice.
Both Donner and Franco-Paredes stressed that what they’re seeing in Colorado is happening in other states and the federal prison system, too.
But both are still alarmed at the conditions in Colorado prisons right now.
The prisons, of course, are densely populated facilities where residents have no real ability to distance themselves from others. Many have long had inadequate medical care for their residents, the advocates say.
Lengthy Lockdowns
When the virus struck, the Colorado prisons tried to prevent its spread by barring visitors and confining prisoners to their cells for most hours of the day. Three quarters of the state prisons are now in the most severe level of lockdowns, either because of COVID-19 outbreaks or staffing shortages. Inmates rarely leave their cells, and even eat their meals there.
Because inmates cannot leave their cells, state employees must do a lot of the work that inmates usually do, including core tasks like preparing food, doing laundry and cleaning.
But state workers are in short supply. Donner, from the criminal justice reform group, estimates that Colorado needs to find 1,000 new officers or supervisors. Existing employees have been at high risk of catching COVID-19, too, with 500 on leave for COVID earlier this month. The state workers who are left may not be doing what they were hired to do, either, because it’s all-hands-on-deck to get the basic chores done.
The lockdown in state prisons is also affecting local jails. Nearly 800 inmates in local lock-ups are waiting to be transferred to state prisons. The state processes all of its incoming inmates at a central facility in Denver. Now, it has to quarantine incoming inmates for 14 days before they’re sent to their eventual destination. But moving all the prisoners through a central point when infections are so rampant is fraught with risk. Corrections workers have to try to make sure that no infection comes in from a county jail, or else it could spread rapidly through the state’s prison system.
On the way out, the state has no process for making sure prisoners who served time in coronavirus hotspots are healthy before they rejoin society, either.
Risky Responses
Even under restrictive conditions, prisons and jails have struggled to implement basic protocols to stop COVID-19 from spreading, Franco-Paredes told me.
The facilities were slow to update their practices regarding mask-wearing and social distancing, he said. Part of the problem was that they were relying on vague CDC plans that were far less prescriptive than the federal guidance for nursing homes, he said. Many facilities still rely on temperature checks as a way of screening inmates, even though people who are infected can be asymptomatic for several days. As late as July, Franco-Paredes said, some facilities were still asking new inmates whether they had any recent contact with people who had traveled to China.
To contain infected prisoners – or even potentially infected prisoners – facilities tend to take one of two approaches. Either they have put all the sick prisoners together in one cohort, or they have isolated patients so thoroughly that they have little contact with anyone else at all. Both are problematic.
“I’ve seen people put basically into solitary confinement, not because they did something wrong, but because they have insufficient information about the infection,” the physician said.
That is an especially cruel irony in Colorado, where previous heads of the prison agency have tried to abolish the use of long-term solitary confinement. Rick Raemisch, a former executive director of the Colorado Department of Corrections, likened the practice to torture.
Medically, the prolonged isolation is dangerous too, Franco-Paredes argues.
“In a hospital, you have a nurse or a medical assistant who checks on you every few hours,” he explained. “Here, they wouldn’t do that. They would basically say ‘hi’ through the window. They don’t go in and listen to symptoms. They don’t do a physical exam that may be indicated. They lose a lot of that.” Many even take temperatures from a distance using infrared thermometers, but those instruments are less reliable than devices that use direct contact.
Plus, of course, keeping infected prisoners in their cells means they don’t have access to medicines like remdesivir, which can help reduce the severity of COVID-19 infections but can only be administered in hospitals and other health care settings.
In one local jail, Franco-Paredes saw COVID patients who were bunking together in a room but were otherwise isolated from other people. That meant when the toilet clogged, there was no janitorial staff to fix it or clean up the mess on the floor. So one of the sick patients had to do it himself, because his bunkmate was too weak to stand.
In many prisons, it’s not just infected inmates who are in lockdown. Whole facilities are confining prisoners to their cells, sometimes for as much as 23 hours a day. That can lead to mental health breakdowns, the doctor said. He saw guards in one Maryland facility beat up two inmates for complaining that their food was cold, because it was supposed to be the one hot meal a day the inmates received. Other inmates told Franco-Paredes that such incidents were common during the pandemic.
On the other hand, Franco-Paredes said, other facilities place all prisoners who have tested positive for COVID-19 in a cohort with other sick patients.
Unfortunately, many of those prisons have also placed people in those cohorts who appear sick but who have not received their test results. That, of course, means that people who did not originally have COVID (but who may have had flu or a cold) end up with the disease, because they are isolated with people infected with it.
El Paso County, which includes Colorado Springs, had especially harsh conditions, Franco-Paredes said.
There, Sheriff Bill Elder did not provide prisoners with masks for months and, according to a lawsuit filed by the ACLU, staff prohibited prisoners from wearing masks in their living quarters. Meanwhile, infected prisoners were co-mingled with healthy prisoners, and new inmates were integrated into the same units as established inmates. Jail staff, according to the lawsuit, told inmates, “We’re just going to let the virus run its course.”
Since the pandemic began, 1,073 jail inmates have had lab-confirmed cases of COVID-19, according to the sheriff’s office. Active infections peaked at 859 cases in early November, for a facility that handles about 1,200 inmates at a time. Meanwhile, 165 staff members have been infected, as well.
Sounding the Alarm
The ACLU’s lawsuit seeks better medical care and two free cloth masks for the jail’s inmates.
One way to reduce the severity of COVID outbreaks in penal institutions is to reduce their populations through early release programs. But that would require changes in the law or executive orders. An executive order allowing certain prisoners to go home earlier that Gov. Polis issued in the early days of the pandemic expired long ago.
Donner, the criminal justice reform advocate, worries that few people in the criminal justice system understand how their decisions affect other institutions, and that could exacerbate the spread of COVID behind bars.
“Jails don’t know what’s going on in prisons. Health care doesn’t know what’s going on in jails. Jails don’t know what’s going on in health care…. Judges have no idea what’s going on in the prisons. The DAs have no idea what’s going on in the prisons,” she says. “We’re just trying to sound the alarm.”
If the governor’s office can’t do a better job of addressing the crisis in prisons, she hopes that local officials can coordinate among themselves.
“With everything else that is going on, the primary attention is paid to the overwhelmed health care system. But in the shadow of that are other systems that are on the verge of collapse. Prisons and jails are one of them,” she says.
“People don’t want to have a prison system that either implodes or explodes as the next thing on their to do list,” Donner says. “That’s what we’re trying to avoid, because if [prisoners] feel ignored, and they feel like nobody cares whether they live or die, they will fight for their lives.”
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Daniel C. Vock

A pandemic. Recession. Civil unrest. State leaders are grappling with several enormous crises all at once. We explore how they're responding.

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