How COVID-19 invaded Sacramento jail, triggering major outbreak among inmates

The three caravans of inmates showed no signs of the trouble ahead.

On the day before New Year’s Eve, the first transfer bus carried 30 inmates from the Sacramento Main Jail downtown to the county’s second facility south of Elk Grove. Over the next two days, at least 25 more followed.

None of the inmates had tested positive for the coronavirus or showed signs of illness. But days after their arrival to the Rio Cosumnes Correctional Center it became clear that COVID-19 had finally found its way inside. Now, the jail is a major outbreak.

Last week, the Sacramento County Sheriff’s Office reported more than 170 cases in the general population at the Elk Grove facility. Two weeks prior, more than 190 cases were recorded at the Sacramento Main Jail — the most seen in a single week at the downtown facility.

The outbreak in Elk Grove comes after months of what looked like a nearly flawless record of isolating new inmates and keeping the disease at bay in both facilities. But that record may have been an illusion.

The sheriff’s department did not publicly record a single COVID-19 case at the Elk Grove facility from August to the end of December, which health experts say is an extremely unlikely scenario given the constant turnover of inmates and staff members.

Lawyers who once sued Sacramento County over the conditions inside its jails said the current population is “negatively impacting” the county’s ability to prevent and manage COVID-19.

“There is no question that the jail is a ground zero for mass COVID-19 transmission,” said Aaron Fischer, an attorney with Disability Rights California, which brought the previous case. “The efforts of hardworking jail leadership are remarkable, but the risks remain enormous.”

Fischer said the growing crisis calls for more urgent vaccinations for everyone inside the jails and dramatic population reduction to thwart COVID-19 from spreading.

For months, county health officials seemed to tame the spread of the coronavirus inside two jails by isolating inmates as they entered the crowded facilities. Once inside, the men and women would be held for seven days or longer before they could join the general population.

Sandy Damiano, the deputy director who oversees correctional health within the county Department of Health Services, said the jails had been under “stringent COVID-19 protocols” before the outbreak. The medical staff was isolating inmates in groups depending on their level of exposure to the virus. They have administered more than 8,000 tests since August, data shows.

How the three transfers of inmates over New Year’s breached this system is still unclear. Forty-six of the 55 transferred inmates have tested positive. Damiano told the Board of Supervisors on Jan. 27 that the outbreak was linked to the transfers but a spokesman for the Sacramento County Sheriff’s Office, which oversees the jails, cast doubt on that explanation days later.

“All transferred inmates were asymptomatic prior to transfer,” said Rodney Grassmann, a sheriff’s office spokesman, “so the assertion that the transfers came with COVID is unknown as the symptoms began several days after transfer.”

A long wait for test results, inmate’s wife says

Across the state, county sheriffs who operate jails have used a scattershot approach to testing inmates for COVID-19. Where some counties did surveillance testing among the general population, others like Sacramento did not.

Where some report the information to the state’s jail oversight board, Sacramento chose not to and instead publishes a similar version of the information on its own website. Health experts have been concerned, because without a good baseline, it can be difficult to detect an outbreak of a disease that can spread without obvious symptoms.

The county began vaccinating inmates 65 and older who are medically vulnerable last month. While there have been no deaths linked to COVID-19 in either jail, the sudden upsurge of infections is a grim turning point

Watching the case numbers rise from her home in Livermore has stirred some anxiety in Jael Barnes whose husband is an inmate at the Main Jail facility. He has been working as an inmate custodian, cleaning out cells where people were previously quarantined, but has waited several weeks without knowing the results from his own COVID-19 test, Barnes said in an interview with The Sacramento Bee.

Barnes said he had sent as many as three “kites,” the term used to describe inmate requests for the test results, but received no response. His federal case is still in pretrial and he’s had only two court hearings since May 2019, she said. Barnes said the test results are a major concern in addition to some pre-existing physical and mental health issues.

“He was complaining about not being able to smell or taste,” Barnes said of a recent conversation. “One part of him wanted to find out but another part didn’t because if he’s confined in that cell that’s even scarier.”

Barnes said she’s become increasingly concerned with the messaging from county officials, citing no deaths.

“They always say, ‘Well no one has died (inside the jail from COVID-19).’ What does that mean?” Barnes said. “Well, who cares unless someone has died?”

‘There is no way of stopping it’

In the spring, Sacramento County public defenders collected dozens of testimonials from people locked inside local jails. Attorneys were arguing in court at the time for more people to be released from custody — especially those with heart and lung conditions — amid an escalating public health crisis.

Inmates described crowded dorms with no social distancing. They would sometimes have to reuse the blue surgical masks they received while at court hearings, even after jail staff told them to throw them away.

They described being given only a “yellow disinfectant ball” to mix with water to scrub their own cells. When one man asked about the timeline for getting more cleaning supplies, jail staff reportedly wrote him up for not following orders.

Any semblance of distancing and isolation was set aside when inmates clustered together unmasked in the chow line for meals or when they gathered in common areas. Inmates were denied access to tests, even when they began coughing and requested them. Staff justified it by saying there had been no confirmed cases in the jail.

According to one man, the message from staff regarding COVID-19 was that “if someone is going to get it there is no way of stopping it.”

Gradually through summer, according to the affidavits, more inmates were tested for COVID-19. Inmates appeared unaware of what the testing strategy was but were clear in saying it remained a dangerous situation.

“The jail system remains a tinderbox,” attorneys argued last summer, advocating for more releases.

Last March, nearly 3,600 inmates were housed in the two jails. After two court orders and cash bail was eliminated for some pretrial cases, those numbers dwindled to about 2,400 inmates in May. The number of detainees has since crept upward, stopping at some 3,200 detainees at the end of last month.

“Last year, through the help of the court, they released 30% of their population and now those numbers are back up, and the COVID-19 experience has only worsened during that time period,” said Tifanei Ressl-Moyer, a lawyer and founding member of the activist group Decarcerate Sacramento.

“It’s just so clear to us that for people inside to be safe and our community to be safe they really need to prioritize releasing people from the jail facility. And they’re not doing that and they’re also misinforming people about what they’re actually doing to protect people inside. We just really don’t have a lot of trust in the process right now.”

When Damiano spoke at a county Public Health Advisory Board meeting on Feb. 3, a typically mild event, she found members of Decarcerate Sacramento were there raising concerns about the living conditions for those in custody.

At least two people with relatives inside the Rio Cosumnes facility also attended the virtual meeting, raising concerns about unfulfilled requests for medical attention inside the jails.

One woman said during the meeting that her loved one was in a quarantine pod and although they were physically ill their health needs were not being met.

“There’s an enormous amount of suffering that’s not being addressed. Medical care is not being given. Folks have been putting in medical kites (requests) and they’re not being responded to,” she said. “It’s clear that either you (Damiano) are not aware what’s going on or you don’t care and that’s very upsetting to me.”

The admonition seemed to catch some board members off guard. They vowed to hold another meeting to hear more about people’s concerns.

‘A playbook for how to get COVID’

Sacramento County’s jails have been under greater scrutiny than most. The pandemic was declared a few months after a judge approved a consent decree last January that forces them to improve the quality of its lockups.

Two years ago, Disability Rights California and the Prison Law Office sued the county over “inhumane” conditions and had previously concluded the facilities could not properly serve the health needs of its wards. Managing a COVID-19 response placed new demands on a strained system that often failed to provide adequate medical care.

A report submitted by the prisoner-rights groups in October concluded that their COVID-19 response was lacking in some areas. Chief among them was the need for population control, social distancing and appropriate quarantine procedures.

The court monitors noted cultural and structural barriers to social distancing. In some cases, inmates did not stay six feet apart, particularly at the Rio Cosumnes facility where there is a dormitory-style barracks in addition to single and double cells. But the report also noted a lax attitude around the practice among deputies, medical staff and detainees.

Notably, the main jail did not have enough space to quarantine people for a full two weeks as the Centers for Disease Control and Prevention recommended. The experts strongly advised against group quarantine because it risks airborne transmission, especially in poorly ventilated areas.

When quarantined, inmates are housed in one of four ways. Most are isolated when they enter at intake after being arrested or when transferred from another facility.

When people are exposed to someone who has tested positive, they are placed in a separate area for “close contacts.” There is another area where people exhibiting symptoms are moved in isolation. And there’s another “pod” for confirmed cases of COVID-19.

These pods, as they are called, sometimes include several people in quarantine together which the CDC allows but infectious disease experts say can be dicey in jails.

Dr. Peter Chin-Hong, an infectious disease expert at UCSF who is familiar with the jail’s protocols, said like hospitals and nursing homes, jail populations are intrinsically vulnerable because of their living conditions.

“It’s 180 degrees against any semblance of what’s safe. It’s like a playbook for how to get COVID,” Ching-Hong said of group quarantine. “That’s the whole reason for quarantine. Even if somebody was negative, you’re next to somebody in a pod who has no symptoms but they (could be) shedding tons of virus.”

Dangers of a false-negative test

There were other signs of cracks in the system before the outbreak.

In early December, another inmate tested positive for COVID-19 on the same day that he was transferred to a state facility. He was brought back to the jail the next day but court monitors found no record of the positive test or any contact tracing after the transfer.

For months, the only case not discovered during intake screening involved an elderly man who had been jailed since 2018. He became ill enough that he was taken to a hospital where a test revealed he had COVID-19. Although contact tracing was performed, he was not linked to any additional cases, according to the report by the court monitor.

His positive test was likely recorded the week of Sept. 30 when sheriff’s office data noted for the first time a confirmed case not found during intake. As experts warned of another COVID-19 surge and flu season loomed, county officials said they contemplated more rigorous testing in the jails during the same month.

“We discussed random surveillance with Public Health in September,” Damiano said through a spokesperson. “It was not deemed necessary at the time.”

Damiano did not answer a question asking why that decision was made. But inside the jails, the medical staff has been strained without key directors over medical and mental health and an excessive lack of physicians.

The California Department of Public Health said as early as April that people inside correctional facilities should be prioritized for routine testing. The CDC’s advice left the decision up to individual jails and prisons. The federal agency said detention and correctional facilities “may consider” testing inmates who don’t show symptoms but never made it a requirement.

However, researchers found in August 2020 that regularly testing inmates was more effective than waiting for symptoms to appear. Their study, published in the CDC’s Morbidity and Mortality Weekly report, concluded mass testing helped identify 12 times more COVID-19 infections in prisons and jails. The authors examined the practice in 16 facilities, including six prisons and one jail in California.

It’s unclear if the county ever considered mass testing again. Damiano said they will assess the need for random testing once the outbreak is over.

UCSF’s Chin-Hong said the inadequate quarantine practices underscore the need for broader surveillance testing.

“Unless you’re conservative with quarantine, you can have people falsely negative when you release them into the general population so you have to continue doing surveillance,” Chin-Hong said. “Ideally, every four days do a rapid screen or at least random testing would be the best way.”

An inevitable COVID-19 outbreak

The turn of events in Sacramento County came as no surprise to criminal justice experts.

To some extent, outbreaks in jails were inevitable as community transmission increased, said Aaron Littman, a clinical teaching fellow at UCLA School of Law who is studying the spread of COVID-19 in jails and prisons. Among the biggest factors has been a return to crowded conditions after a population drop-off in the spring and summer.

“That obviously makes social distancing even less possible,” Littman said. “It means that once the virus is in, the outbreak spreads more rapidly and is harder to control.”

Several jails around the state have grappled with dozens or even hundreds of cases.

Fresno County recorded hundreds of positive cases during an out-of-control outbreak last summer. The culprit behind outbreaks in a Contra Costa County jail and San Quentin State Prison was linked to the transfer of medically vulnerable inmates. But Sacramento was an outlier even as the number of cases in the community increased in the fall.

Coinciding with the jail outbreaks, , the number of infections in the Sacramento region exploded at the beginning of the year, forcing lockdowns.

From the earliest days of the pandemic, it’s been clear that if the virus spread uncontrollably in the community, it would find a foothold in jails and prisons, said Michele Deitch, a jails and prisons expert who teaches at the University of Texas at Austin’s School of Law and Lyndon B. Johnson School of Public Affairs.

But that didn’t mean jail officials were powerless to slow the spread, she said. And it does mean they’ll be a key part of slowing transmission outside the jail walls

“Was it inevitable, or were there steps they could be taking?” Deitch said. “The answer is, it’s both.”

This story was originally published February 11, 2021 at 5:00 AM.