HJNO Jul/Aug 2020

HEALTHCARE JOURNAL OF NEW ORLEANS I  JUL / AUG 2020 23 Connecticut with 110 per 1,000, New Jersey with 145 and Tennessee with 121. Lauren Brinkley-Rubinstein, an assistant professor of social medicine at the University of North Carolina, said she viewed Louisi- ana’s reported numbers with suspicion. It is one of only two states, she noted, that sepa- rately counts inmates who test positive but are deemed “asymptomatic.” “It seems to be a way to protect them- selves, to say, ‘Hey, look, everybody here is asymptomatic so we don’t have to worry about anything — there is no serious COVID here,’” said Brinkley-Rubinstein, who is also an investigator with the COVID Prison Proj- ect, which tracks the pandemic’s spread in U.S. correctional facilities. Jackson, theAngola inmate who did grad- uate studies in epidemiology, said he esti- mated that three-fourths of the 86 prisoners in his dormitory might have been infected. After his release in early June, he took an antibody test. It came back positive. “My impression is that everybody’s atti- tude was: ‘We’re definitely not going to test because the results would be horrible, and we’d have to shut the entire place down and we don’t want to do that. Let it burn through here for 90 days and we’ll figure it out.’” On May 6, two 78-year-old inmates died from complications from COVID-19. Three days later, another two men died and anxi- ety inside the walls ratcheted up, prisoners recalled. Some started eating cloves of gar- lic, which they bought from an inmate food concession. Those who could afford it bought orange juice ($1.54 for a 10-ounce can) and honey ($3.26 a jar). In one dormitory, inmates encircled a war- den and demanded to be tested. “It’s not going to happen,” one prisoner said he told them. In all there were 13 deaths at the prison in May, afiguremore than three times higher than during the samemontha year earlier. Ninewere attributed to COVID-19. The proportionally low number of corona- virus deaths at prisons around the country, especially when set against the scope of some of the outbreaks, is emerging as a new mys- tery of the pandemic. California, for instance, officials recommended, corrections officials should work with prosecutors, judges and others “to reduce the size of the jail popula- tion of the least non-violent inmates.” Similar steps were being taken in many other states. Probation officers and parole boards were already recommending steps toward the release of some people jailed for less-serious offenses. Still, the suggestion so angered the corrections leadership, those of- ficials said, that the Health Department was forced to immediately withdraw the advisory. That same day, April 9, the corrections department issued a long, public litany of steps it had taken to mitigate the spread of the coronavirus. Separately, Edwards an- nounced that the department was compiling a list of state prisoners eligible for medical furloughs. (As of June 1, when the furlough programwas discontinued, the state had re- leased only 66 of 594 inmates it considered, according to official figures.) The two advocacy groups that sued the state government to try to block the transfer of prisoners intoAngola fromparish jails, the Promise of Justice Initiative and the Southern Poverty Law Center, emphasized the decrepit conditions of Camp J, a notorious cellblock that had been shut down in 2018. Singh, the corrections department’s for- mer medical director, called it “a dungeon.” In court statements and interviews with Pro- Publica, inmates described the cells there as coated in black mold, with rusted metal toi- lets and a large population of spiders. Dick, the federal judge, was not persuaded, noting that the state had cleaned up the camp and retrofitted it with air conditioning be- fore the jail patients arrived. She also ruled that it was reasonable for state officials to remove those inmates from jails where they could spread the virus and quarantine them at Angola, even if the conditions were less than ideal. With limited testing, Louisiana has reg- istered about 21 positive inmates per 1,000 — a rate significantly higher than the 5 per 1,000 in the general public. Some states that have conducted mass testing in their prisons have reported much higher rates, including some might occasionally feign illness. But lawyers in the federal suit have argued that the medical staff’s mistrust defines a system in which truly sick inmates are often exam- ined inadequately or even have their prob- lems ignored. Since the pandemic, the pris- oners said, the shortcomings of that system have only multiplied. Patrick Johnson, a 46-year-old inmate serving a life sentence for second-degree murder, fell sick onApril 4, with chills, sweats and dizziness. When the screeners took his temperature, it was 98.2 degrees. After he persuaded them to try again it registered 100.4 — just high enough to be taken to the prison hospital. But when his COVID-19 test came back negative, he was sent back to his dormitory. Over the next 10 days, his condition de- teriorated. He made five more sick calls but was left in his bunk each time. “I wasn’t sick enough to be seen by a doctor,” he said he was told. Finally, with his temperature over 101 and his blood-oxygen level dangerously low, he was rushed to the hospital, where he overheard a nurse tell a doctor he might not survive the night. When the hospital tested him again for COVID-19, the result came back positive. In a court declaration onApril 1, less than two weeks before he quit as the corrections department’s medical director, Morrison em- phasized that he was consulting closely with the Louisiana Department of Health. But ac- cording to current and former state officials, that collaboration did not last. On April 8, the Health Department’s se- nior official for emergency preparedness, Dr. Jimmy Guidry, issued a short, seemingly straightforward set of recommendations for the state’s prisons and jails. A similar advi- sory had already been sent to Orleans Parish, where the jail was facing a serious outbreak. Hands should be well-washed, the state- level advisory said. Coughs and sneezes should be covered. Sick inmates should be isolated in “sick rooms.” Only the final bullet point stuck out: Prison officials should try to keep all inmates 6 feet apart, it said. If that was impossible, health