As COVID recedes in prisons, will any lessons learned stick?

Derrick Johnson had a makeshift mask. He had the spray bottle of bleach and extra soap that corrections officers provided. But he still spent every day crammed in a unit with 63 other men in a Florida prison, crowding into hallways on their way to meals and sleeping feet from one another at night.

As the coronavirus ravaged the Everglades Correctional Institution, Johnson was surrounded by the sounds of coughing and requests for Tylenol. And while he thought a lot of the prison's policies were ineffective at protecting prisoners, he also wondered if that was the best the facility could do.

"Prison is not built to compete with a pandemic," said Johnson, who was released in December. "The pandemic's gonna win every time."

For 15 months, The Marshall Project and The Associated Press tracked the spread of COVID-19 through prisons nationwide. We counted more than a half-million people living and working in prisons who got sick from the coronavirus. Prisons were forced to adapt to unusual and deadly circumstances. But now, as new cases are declining and facilities are loosening restrictions, there's little evidence to suggest enough substantive changes have been made to handle future waves of infection.

With crowded conditions, notoriously substandard medical care and constantly shifting populations, prisons were ill-equipped to handle the highly contagious virus, which killed nearly 3,000 prisoners and staff.

Corrections systems responded with inconsistent policies, struggling to contain the virus amid understaffing and overcrowding. At its peak in mid-December, more than 25,000 prisoners tested positive in a single week.

But in recent months, infections behind bars nationwide have slowed to a few hundred new cases each week, and many prisons have eased what restrictions they had in place, including mask-wearing, visitors and other movement in and out, going back to business as usual.

It's a critical moment, with new coronavirus cases low but the threat of infection looming as new variants spread around the world, said Dr. David Sears, an infectious disease specialist and correctional health consultant.

"The medical community, prison leadership and society at large have learned so much about COVID in a short period of time," Sears said. "We need to take these lessons and make sure that the things we've learned after a lot of real human suffering are not in vain."

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EDITOR'S NOTE: This story is a collaboration between The Associated Press and The Marshall Project exploring the state of the prison system in the coronavirus pandemic. Additional reporting by Peter Buffo and Tom Meagher of The Marshall Project, and Colleen Slevin and Michael Balsamo of The Associated Press.

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According to the data collected by The Marshall Project and the AP, about 3 in 10 people in state and federal prisons were infected with the virus. But correctional health experts widely agree that this number is an undercount.

"A great many of the people who ever had COVID, they were never tested," said Dr. Homer Venters, a former chief medical officer of the New York City jail system who has inspected health conditions in prisons around the country over the last year. "In most prisons it ran through these places like wildfire. People were never tested."

Even when facilities did conduct tests, they still allowed prisoners who tested positive to come in contact with others.

But many prisons simply lack the space needed to adequately isolate sick prisoners. There are structural and logistical changes prisons could make, such as upgrading ventilation systems and creating surge capacity for staff and health care workers. But the most effective approach, Sears said, is to drastically reduce prison populations.

"When you're filled to the max and you have two people in an 8-by-10 cell right next to two more people in an 8-by-10 cell and on and on, it's impossible to create any form of physical distancing," Sears said. "We have to get people out of prisons so we have that space."

Employee shortages plague many prisons. The federal system is at critically low levels and has been forced to make teachers and others watch prisoners. The Nebraska prison system recently declared a staffing emergency at a fourth facility, and Texas prisons are struggling with more than 5,000 correctional officer vacancies and the lowest staffing levels in recent memory.

In Pennsylvania, transfers and insufficient quarantine policies contributed to spreading the virus between prison facilities, said John Eckenrode, president of the Pennsylvania State Corrections Officers Association. Once there were active cases throughout the state's prisons, including among staff, the department became lax with quarantining and actively contact-tracing staff after someone tested positive.

A few months into the pandemic, Eckenrode believes, a lot of supervisors were tired of quarantining officers and calling in overtime.

"There were definitely officers who went weeks without a day off and sometimes working all 16-hour shifts," he said. "It takes a toll on you, your home life, your time with family, your mental and physical exhaustion."

But like life on the outside, the immediate risk to prisoners in many states has largely receded. Twenty states have administered at least one dose of the vaccine to two-thirds of their prison population, and new cases in prisons nationwide have stayed below 500 a week for more than a month. Prisoners who spent more than a year without family visits, educational programs and outdoor recreation are eager to regain more social interaction and activity.

As prison coronavirus cases have slowed, so, too, has the release of data from state and federal agencies. Michele Deitch, a law professor at the University of Texas at Austin who has researched prison data transparency during the pandemic, said this is a troubling sign that prisons are prematurely moving beyond the pandemic.

"There's a sense that COVID is over, that the pandemic is behind us, and that is just not the case," Deitch said. "We have to remember that prisons and jails were hit so much harder than the outside communities were, and in many jurisdictions, they were late to provide vaccinations to incarcerated people."