Content warning: The following article contains a potentially disturbing photo of a person who has died, as he appeared at the funeral home after succumbing to COVID-19.
North Carolina Health News, after conversations among our editorial team and the family of the individual, is choosing to publish this photo at the request of his daughter, as this is the only photo she has to remember him by at this time.
“I think it shows how miserable and final decisions made can and will become,” she said. “My goal is to open people’s eyes to the world of prison and death of any kind within a prison setting, and how cold it can be.”
By Hannah Critchfield
The last photo Jennifer Wren has of her father shows him lying in a cardboard box, waiting for the crematorium.
They’d spoken just two weeks before.
Another month was passing quickly, and her father Roy Hood, an inmate at Greene Correctional Institution, answered what had become weekly questions about his persistent cough:
Yes, he’d seen a doctor.
No, he hadn’t gotten a COVID-19 test.
He’d gotten prednisone, a steroid used to treat allergies, again. He said his back was beginning to ache from the hacking.
The next time Wren got a call from the prison, her father was in the hospital on a ventilator.
Wren, who lives in Atlanta, traveled up to identify his body six days later.
Roy Hood wasn’t the only one. As North Carolina’s COVID-19 cases stabilized during the late summer and early fall months, outbreaks in prisons continued. The virus has now infected about 10 percent of state prisoners.
Now, a little over a third of all North Carolina’s state prison deaths due to COVID-19 have happened within less than a month, from Sept. 7 to Oct 7.
North Carolina Health News spoke to experts to investigate why incarcerated people continue to die at high rates, regardless of conditions outside.
A steady rate of death
On Oct. 7, Hood became the 17th person to die of COVID-19 while incarcerated in a state-run facility.
Six of these individuals, including Hood, have died since Sept. 17.
This number of COVID-19 deaths is double the number in the previous month-long period, despite North Carolina’s relatively low rate of new COVID-19 cases in the general population. Between Aug. 6 and Sept. 6, three incarcerated people died of COVID-19. In the month-long period that followed, six died.
Another inmate, a man at Pender Correctional Institution, died yesterday, raising the total state prison death toll to 18.
The deaths have occurred despite a judge’s order on June 16 in an ongoing lawsuit against the state and the Department of Public Safety, the agency that oversees state prisons. The order mandated that protective measures such as surveillance testing and quarantines after movement be put in place at each facility.
Current prisoners and their families have linked the ongoing spread of the virus to continued inmate transfers between prisons.
In court filings, DPS has said that two-thirds of these transfers are “administrative,” meaning they are transfers that are “necessary for the prison system to operate,” such as receiving new prisoners after their sentencing in court.
But plaintiffs in the lawsuit have said it’s unclear whether transferred prisoners are properly quarantined upon arrival.
Under the order, prison officials are supposed to either test a prisoner prior to the move or quarantine them for 14 days once they arrive at their new prison. DPS says it houses transferred prisoners away from the general population in cohorts during this period.
Court filings appear to indicate prisons are receiving new individuals weekly, raising questions about whether quarantining inmates are exposed to other, newer arrivals before their 14 days are up.
“It’s unclear because some of the weekly submissions show that there are new transfers coming into the prisons, on consecutive weeks,” said Leah Kang, staff attorney at the American Civil Liberties Union of North Carolina. “How is it that those people are staying quarantined for 14 days if new people are being transferred in?”
New outbreaks have been found at DPS prisons every week since mass testing of all inmates ended on Aug. 8, according to court filings.
The week Hood died, seven prisons reported new outbreaks.
Health experts weigh in
When it comes to who dies of COVID-19 in prison and why, it can be hard to assess, according to Lauren Brinkley-Rubinstein, a public health researcher at the UNC School of Medicine and co-founder of the COVID Prison Project.
“Part of the problem here is that there’s an information transparency issue, especially around death,“ said Brinkley-Rubinstein. “There’s a certain level of opacity [within the prison system]. There’s a lot they just don’t tell us, you know?”
Still, health experts offered some theories.
Denied early release
Incarcerated people are at elevated risk for chronic health problems over the general population, possibly due to both structural health risks such as poverty prior to incarceration, as well as the deleterious impact incarceration itself has on long-term health. Inmates in state prison skew older than people in jails due to mandatory minimum laws of the past few decades. The nationwide prison population has increased five-fold since 1975, leading to more crowded conditions; for the prior 50 years, it had remained relatively stable. Though Hood, who is mentioned earlier in this article, is white, mass incarceration has disproportionately impacted Black people, who also tend to have worse health outcomes than whites.
North Carolina’s state prison population remains high. Few offenders have been granted early release since the pandemic began, making it difficult for inmates to socially distance in dorms that sometimes hold upward of 100 people at once.
“If everything is running as it had been before COVID, and you’ve got big groups of people who are congregating all together, it’s just going to spread like wildfire,” said Brinkley-Rubinstein. “But if you have done some prevention activities, like reduce your population, or in absence of that, created small cohorts, then it doesn’t spread as rapidly, because you’re able to do contact tracing among a small number of people.”
None of the prisoners who have died were eligible for early release, according to court filings.
“And that is exactly the point,” Kang argued during an Oct. 15 status hearing. “The current practices defendants are applying [for early release] are so limited, so narrowly applied, that none of these 17 people were eligible, and they ultimately died in defendants’ custody.”
Exactly 2 percent of the approximately 31,000 people inside North Carolina’s state prisons have been granted early release since the pandemic began, according to DPS. In total, 628 people have been granted some form of release under the Extended Limits of Confinement, in contrast to the 30,925 people currently in state prisons.
“We know that older prisoners are certainly very unlikely to reoffend,” said Stephanie Woolhandler, a physician and professor of public health at the City University of New York at Hunter College. “Large numbers of people in prisons and jails could safely be released to the community. It would be a great benefit to their health because it would prevent them from being exposed inside.”
Medical risk, lack of care
Prisoners may also experience barriers to timely medical care while incarcerated.
“In many parts of the country, the medical care available to prisoners is pretty substandard,” said Woolhandler.
A prisoner may avoid seeking medical care for minor symptoms due to the high cost of a doctor’s visit, according to Woolhandler, as state prisons charge incarcerated people a co-pay to see a medical professional. In North Carolina, this co-pay is $5 for in-house visits initiated by the offender.
“They’re often reluctant to come in and spend a week or two weeks of their own wages in order to see a doctor,” she said.
In interviews with NC Health News and in affidavits filed in court, prisoners across several North Carolina facilities have alleged there’s an added issue: Difficulty obtaining COVID-19 testing. They claim prison officials have declined to test them for COVID-19, even after they display symptoms consistent with COVID infection.
“I think oftentimes there’s a narrative around, ‘Oh, inmates are making up their symptoms, or they have a cold or have allergies or it’s not serious; it doesn’t warrant a health visit,” said Zinzi Bailey, a social epidemiologist at University of Miami and researcher on the COVID Prison Project.
“In one particular case that I can speak of, the prison wasn’t doing regular testing, and a bunch of people had reported certain symptoms. While health professionals said that they were available to provide testing, a vast majority of those people who reported symptoms were not given tests, and not followed up with,” Bailey said. “There was a case of one person who had some symptoms but didn’t pass the muster to get tested. But when they got extremely ill, they then were immediately taken to our public safety-net hospital. That’s what happens with the severe cases — they end up in our hospitals, and it really has implications for our overall capacity. And that is when he got diagnosed, and unfortunately passed away.“
That’s essentially what happened to Hood, according to his daughter.
Hood entered the state prison system after being convicted of attempted rape, attempted sexual offense, and indecent liberties with a child in 2013. He had less than a year left in his sentence.
As Hood’s cough worsened during August and September, his daughter Wren said he paid for visits, through money she supplied, to a Greene Correctional doctor weekly.
Yet he told her he was never tested for COVID-19 after the prison did cohort testing in early August. DPS said this mass testing actually occurred earlier, on July 10.
It wasn’t until he was hospitalized for severe respiratory symptoms on Sept. 24 that he received a test, she said. The test came back positive two days later. This timeline matches the dates of the first inmate to be hospitalized and test positive in the current outbreak, according to statements provided to NC Health News by John Bull, DPS spokesperson.
He was placed on a ventilator the same day, though Wren said she wasn’t notified of his hospitalization or illness until six days later on Oct. 1.
“My dad was a registered sex offender,” said Wren. “And there’s not a day that goes by that I’m not angry at him for that. But at the same time, he should have never been put in that position. Someone dropped the ball. Because a month-and-a-half later, my dad’s dead.”
Hood’s positive test initiated the current outbreak at Greene, according to Wren and other inmates. This account matched a cross reference of dates provided to NC Health News by a DPS spokesman about when the first offender was hospitalized and tested positive for COVID-19 in the current outbreak, as well as the dates on the DPS press release of the first offender death at Greene.
DPS at first did not test Greene prisoners unless they exhibited a fever or were in two housing units that were deemed “exposed,” Bull previously told NC Health News on Oct. 5. The facility recently moved to do mass testing of all asymptomatic inmates; the results are supposed to come back by Oct. 16.
Bailey said there’s another factor to consider when it comes to inmate deaths — public health responses require political will.
“We have had a lot of mobilation, and attention, and changes around nursing homes, from families who are arguing for the rights of their family members, said Bailey. “We have had similar protests from people arguing for the rights of family members who are in prison, but we have not responded in the same way. And I think that there is an ethical issue here where we are valuing those in nursing homes more than those in correctional facilities.”
‘Canaries in the coalmine’
After a period of relative stability, North Carolina has seen a rise in cases over the last few weeks, as well as a sharp uptick in the number of hospitalizations due to COVID-19.
Some worry renewed prison outbreaks may be partially to blame.
A recent Health Affairs study that analyzed data from Cook County Jail in Chicago, which at one time held the largest COVID-19 outbreak in the country, found that the influx of people in and out of the facility was associated with about 16 percent of all documented COVID-19 cases in Illinois. No such analysis has been conducted for any North Carolina prisons or jails.
Woolhandler said it could “absolutely” be contributing to the increasing case count in the general population, in particular in rural counties where many correctional facilities are located.
“All of the guards, and the entire prison staff, go in and out of that prison every day,” she said. “So there’s a constant risk to the community from allowing COVID to run rampant in prisons and jails.”
DHHS declined to comment on whether they have identified any county outbreaks that were linked to outbreaks inside nearby carceral facilities through contact tracing.
Bailey said it’s also possible that the reverse is true — that state prisoners, who live in close quarters where it’s difficult to social distance and transmission is rapid, were simply the ‘canaries in the coalmine’ warning the public of an already increasing viral spread.
“Prisons have their own ecosystem, and they’re going to be mirroring the environments outside of the prison,” said Bailey. “In general, there’s been a relaxing of basic personal preventive measures due to ‘COVID fatigue’ — we’re loosening up on contact with other people, going back to work.
“That does have impacts on specific locations that are at increased risk of transmission,” she said.
Testing prison staff
On Oct. 12, the Department of Public Safety announced a pilot mandatory testing of all staff at three of its facilities with ongoing COVID-19 outbreaks — Greene, Scotland and Dan River.
Greene and Scotland have had prisoners die of the virus in the last month.
The mandatory testing program may be expanded to other state prisons, Bull said, but it’s “hard to tell at this point.”
Over 1,200 prisoners have died of COVID-19 nationwide as of Oct. 16.
“I grew up with my dad singing, and his favorite was Elvis,” said Wren. “He won Elvis impersonation contests — my dad would rent the costume with the solid black and the gold and red rhinestones, he’d wear the wig and sideburns, and he’d sing ‘Burning Love” and bring the house down. He sang ‘My Way’ at my mother’s funeral because that was her favorite.
“I think the thing I’m going to miss the most is never hearing him sing again,” she added.
UPDATE: This story has been updated after another person incarcerated in a state prison died yesterday. Eighteen people have now died of COVID-19 in a state-run facility.
CORRECTION: An earlier version of this article stated Wren’s father was last tested in what she remembered to be sometime in early August, when the prison did mass testing. According to a Department of Public Safety spokesman, the prison last did mass testing much earlier, on July 10. This article also originally phrased a sentence in a manner that made it seem like DPS revealed the identity of Hood in statements provided to NC Health News. The departmental spokesman did not provide any of Hood’s confidential information.
UPDATE: A DPS spokesman reached out to NC Health News to note that the department has waived all co-pays for offender initiated visits for COVID-related symptoms. According to Hood’s daughter Wren, he told her this was not the case for his visits, which she gave him money to pay.
He also noted that the department has been following CDC guidelines for managing the coronavirus and has had extensive communication with the NC DHHS on the best ways to contain the spread of COVID-19. He also said detailed medical transportation COVID-19 protocols have been in place since May.