It's a critical moment, with new coronavirus cases low but the threat of infection looming as new variants spread around the world.
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."
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.
According to the data collected by The Marshall Project and The Associated Press, 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."
One man housed at a low-security federal prison compared the Bureau of Prisons' public data to what he was seeing inside. At least half of his unit fell ill, he said, but the bureau's data didn't reflect that. He spoke on condition of anonymity because he is still incarcerated and afraid of retribution.
"For the first year of the COVID, they never tested anybody in my institution unless they had a fever," he said in a call from prison. "The easiest way to not have a positive at your institution is to not test anybody. ... It's like, hello, we're dying from this s-—. Can you test us?"
In the early days of the pandemic, testing within the Bureau of Prisons was limited, and staff at some prisons were told there was no need to test prisoners and they should just assume everyone had the coronavirus. The Justice Department's inspector general found that at some facilities, like FCC Oakdale in Louisiana, which emerged as an early hot spot, prisoners who tested positive for the virus were left in their housing units for days without being isolated.
The Bureau of Prisons said it follows guidance from the Centers for Disease Control and Prevention and that any prisoner who is symptomatic or tests positive for the virus is placed in medical isolation until they recover.
Even when state and federal prisons did conduct tests, they still allowed prisoners who tested positive to come in contact with others.
Texas prison officials transferred more than 100 infected prisoners in East Texas to prisons just outside Houston in the first months of the pandemic. Officials said the move would bring the men closer to medical resources, but other prisoners worried it would just bring the virus closer. A few days after a group of the sick arrived to his unit, Jason Duncan fell ill.
"The unit nurse came around to take temperatures, mine was checked at 102," he wrote in a letter at the time. A few hours after having his temperature taken, he fainted. "When I came to, my body was so hot I could not stand at all. I could not breathe, it felt like the life was being (sucked) out of me. I was also covered in sweat — all my clothes wet."
Eventually, he ended up in a hospital and "hooked up to a breathing machine." Finally, he got a COVID-19 test. "I was given no medication at all," he wrote, adding that he was instead sent back to the prison and housed in the wing with the sick prisoners who'd been transferred in.
Scott Medlock, an attorney who represented prisoners in a class-action lawsuit accusing Texas of inadequately protecting them from the virus, said the failure to properly quarantine prisoners was key to the spread of COVID-19 at Texas' Pack Unit. While staff would isolate those who tested positive for two weeks, they considered prisoners "recovered" when the quarantine period ended, regardless of whether prisoners were showing symptoms.
"They were moving people who had quote-unquote recovered, who were still having symptoms, sometimes into dormitories where there would be people who have not tested positive yet," Medlock said.
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."
While many jails emptied out during the pandemic and prison populations declined, the criminal justice system has not fundamentally changed. Lauren Brinkley-Rubinstein, who leads the COVID Prison Project, said she hasn't seen the systemic change needed to address the next pandemic.
"What we're seeing over the past couple weeks and months is a real return to status quo, which makes me worry that prisons and jails didn't learn much at all," Brinkley-Rubinstein said. "I see incarcerated populations returning to what they were before."
Staffing is also a massive problem. 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."
The Pennsylvania Prison Society, a group that advocates for humane prison and jail conditions, found at one point during the pandemic 1 in 6 corrections officers was out sick or in quarantine. Prisoners contacted the society to say their medical request slips were piling up.
"Because so many staff members were out sick during COVID-19, what we found was people had an even harder time getting access to medical care," said Anton Andrew, the society's education and advocacy fellow.
The strain of understaffing and working in a high-risk environment has led to corrections staff leaving their jobs, Venters said. These staffing shortages will have long-term consequences, especially as prison populations rise.
"Understaffing means people don't get to their health care appointments and certainly don't go outside," Venters said. "It's unlikely when they have an emergency that anybody is going to see it or respond to it."
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. Despite these promising signs, however, doctors and advocates for the incarcerated fear that prisons are letting their guard down too quickly.
New variants of the coronavirus are more contagious, which Sears said may call for higher vaccine rates to bring about herd immunity. Maryland, Michigan and Colorado found variants within their prisons earlier this year, though case numbers remained low.
In Hawaii, one of the few states where cases have risen in prisons in recent weeks, state authorities attribute the outbreak to overcrowding and transfers into its facilities. Unlike most states, Hawaii's correctional system houses both sentenced prisoners and people awaiting trial, a more transient population with lower vaccination levels.
"Our jails have all been burdened by extreme overcrowding for decades, and now added to that are the unique challenges posed by the COVID pandemic," Toni Schwartz, a spokesperson for the Hawaii Department of Public Safety, said in an email.
While vaccine acceptance among prisoners has been higher than anticipated, most systems have seen staff vaccination rates lagging behind.
"We know that COVID doesn't just spring up from the ground within a prison. COVID is introduced by people coming into and out of a prison," Sears said. "Ninety-nine percent of that movement is staff ... so creating that ring of protection around a prison with higher staff vaccination rates is vital."
In Colorado, where 55% of corrections workers are fully vaccinated, unvaccinated staff are tested daily with rapid tests, said Brandalynn Anderson, spokesperson for the Colorado Department of Corrections. Both vaccinated and unvaccinated staff take weekly PCR tests.
Not all prisons take as thorough of an approach. In some states, such as Wisconsin and South Carolina, staff are tested every two weeks. Others only mandate testing when employees are suspected to have been exposed to the virus.
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."