An explosion of coronavirus infections at California's San Quentin State Prison, the state's oldest, has public health officials there worried about its impact on prisoners, staff and the wider hospital system in San Francisco Bay Area.
"Shocking, heartbreaking are certainly the words I would use to describe it," says Dr. David Sears, a physician and professor of medicine at University of California, San Francisco. He recently toured San Quentin and warned officials about just such an outbreak.
"It's devastating how fast this has moved through the prison," he said.
There were zero inmate coronavirus cases at the prison throughout March, April and May. Today, there are more than 500 infections.
Public health officials and prison advocates say the outbreak was entirely preventable. They point to a transfer in late May of 122 inmates to San Quentin from an overcrowded state men's prison in Chino, where COVID-19 is ravaging the inmate population.
"Unfortunately, they arrived untested and were placed within San Quentin and really kind of seeded an outbreak in a second state facility," says Dr. Matt Willis, the public health director for Marin County, where San Quentin is located. "In the rush of trying to address that epidemic at Chino, that [testing] step may have been overlooked."
It's not clear why, during a deadly pandemic, the inmates were not tested. Prison officials have said they are working with health departments.
Dr. Willis says he's alarmed by the prison's rapid increase in cases and its potential impact on area hospitals.
"I'm concerned that we will see hundreds of more cases," he said. "Even if a small fraction of those people become so sick that they need to be hospitalized, it will stress our regional hospital system."
New data show that Marin County leads northern California, by far, with 200 coronavirus cases per 100,000 residents.
So far, no inmates or staff have died at San Quentin, which houses about 3,700 prisoners. But, so far, at least 20 inmates and two employees at other state prisons have died after contracting COVID-19. That includes 16 fatalities at the California Institution for Men in Chino.
Earlier this month, experts with UCSF and UC Berkeley toured the prison at the request of the body overseeing the prison. Overcrowding in the state's prison system and problems with its health care system is the subject of a long-running legal case.
Afterward, the physicians warned the federal, court-appointed receiver that helps oversee prison health care that "San Quentin is an extremely dangerous place for an outbreak, everything should be done to decrease the number of people exposed to this environment as quickly as possible."
The group of doctors recommended the prison take multiple, immediate mitigation steps. They include rapid, expanded testing, creation of an outbreak emergency response team, and reducing San Quentin's population by half to avoid a potentially devastating outbreak there.
"Priority must be placed on reducing the prison population at San Quentin via decarceration as it will be extremely difficult to ensure the health and safety of all people in this extraordinarily old and complex facility."
Prison officials did not heed the warnings, health officials said.
"None of the cells except in one small area have walls on all sides," Dr. Sears says, which make it "impossible, or nearly impossible, to effectively mitigate the spread of a virus within a prison that's overcrowded and was built over 100 years ago," he said. The prison was built in 1852. It's home to many older inmates and some who are in fragile health. Both are leading comorbidity risk factors for COVID-19, Dr. Sears says.
Despite the challenges of decarceration, Dr. Sears and his colleagues say quickly and carefully reducing the prison's population may be the only viable solution. "I know this is a politically charged topic, but this is a matter of public health and human rights" for inmates, staff, their loved ones "and the surrounding community in the Bay Area," he says.
Meantime, attorneys and families of inmates with the ad hoc group #StopSanQuentinOutbreak are also demanding urgent action to protect inmates and staff. They want more prisoners to be granted early release, as well more masks, hand sanitizer and cleaning supplies, among other moves.
Nationally, prisons and jails have come under withering criticism for failing to adequately protect inmates and staff during the Coronavirus pandemic. A recent ACLU report alleges gross negligence and mismanagement.
"Despite having ample time and information to take the steps necessary to heed the warnings of experts and save the lives of those incarcerated in their prisons and jails, state governments across the country refused to adequately address the threat that the COVID-19 pandemic poses in jails and prisons," the report says.
Dr. Willis, Marin County's health officer, says the state is moving towards setting aside one site to handle a surge of critically ill inmates for this outbreak and, potentially, others like it in prisons across the state. "A larger, single facility dedicated to this would protect community hospitals around the region," he says.
California Department of Corrections and Rehabilitation spokeswoman Dana Simas declined NPR's interview requests on the outbreak and the prison's testing failures.
In a statement, Simas noted that in coming weeks some 80 non-violent, eligible offenders who have 180 days or less on their sentence may be released early to a State Community Custody Program.
The statement said the state prison and prison health systems "will continue to work together, along with state and local health care and public health experts, to implement measures that will protect those who work or live in our state prisons."