Multnomah County began offering adults in custody at Inverness Jail COVID-19 vaccines on Feb. 2. At least 108 people were vaccinated in the first wave, six weeks after the County formally asked Governor Kate Brown to prioritize those in custody because —like other congregate residential settings being prioritized—the staffing, spacing and underlying health conditions of residents in corrections settings greatly increases risk of transmission, severe illness and death from COVID-19.
People in custody are five times more likely to get infected, and three times more likely to die of COVID-19, according to a state and federal prison study. Multnomah County also has a particular legal obligation to respond to the risk of those in custody. Both the United States Constitution and the Oregon Constitution require the State to provide adequate medical care to those it confines. The government may not be deliberately indifferent to the serious medical needs of individuals confined in its jails and prisons.
The County’s position was reinforced by a federal court ruling yesterday ordering the State of Oregon to immediately begin vaccinating people incarcerated in state prisons, finding the delay in doing so — even as the state prioritized other congregate settings and corrections staff in Phase 1A of its vaccination rollout—amounted to a deliberate indifference to inmates medical needs and risked violating their Eighth Amendment rights to be free from cruel and unusual punishment.
Corrections Health and corrections staff at the facility were offered vaccines in January as part of the state’s Phase 1A priority groups. Vaccinations to adults in custody at Inverness began Feb. 2 as the County manages the first major outbreak at Inverness since the pandemic began.
Although there have been individual cases among staff and adults in custody, until this latest outbreak, there was only one other outbreak of multiple cases (an outbreak is defined as two people or more), at Inverness since the pandemic began. The Inverness outbreak that occurred prior to the current situation was among staff only.
Those cases are a sharp contrast as the County responds to a rapidly developing outbreak identified last month. Since Jan. 15, 2021, 107 adults in custody have tested positive for COVID-19 across multiple dorms at Inverness Jail. The cases were detected through a series of frequent rapid testing of anyone exposed to a known positive case.
All infected individuals are being monitored closely for signs of severe illness. So far, only a small number of people have developed symptoms, almost all of them mild. All adults in quarantine will continue to be screened daily for signs and symptoms of COVID-19, with additional testing planned. There have been no deaths among those in custody.
Steps taken to reduce the spread of COVID-19
The County takes the health of all adults in custody and the corrections staff extremely seriously. Because of the potential disproportionate impact of a highly transmissible virus on people in custody, the County has taken the following precautions:
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The total population has been lowered by 30 percent to allow for more physical distancing and fewer chances for the virus to enter the facility. (The daily census at Inverness Jail is 512. That is down from a daily average of 730 in January 2020.)
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Adults in custody who have tested positive for COVID-19 are being watched closely with 24/7 access to medical care.
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Adults in custody who have been exposed to COVID-19 are being tested every few days so we can quickly identify new infections.
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Anyone in the facility with symptoms is offered testing for COVID.
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Because of space and staffing constraints, the County is working to boost the level of protective mask use for nearly everyone in the facility.
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The County will continue offering vaccines to those in custody, and are planning for how to administer to those adults in custody at the Multnomah County Detention Center, as soon as doses become available.
Since February 2020, Corrections Health has worked with Public Health and the Multnomah County Sheriff’s Office to reduce the risk to adults in custody and staff. The County developed stringent protocols in case of COVID-19 arrival in corrections settings. Some basic prevention measures included reducing the jail population and creating special housing options to increase physical distancing, performing additional health screenings, providing masks, cleaning more frequently and pausing in-person visits to reduce risk of transmission.
When Governor Kate Brown released her vaccination priorities for the State, Multnomah County Chair Deborah Kafoury advocated to prioritize people in custody and the County began planning for those vaccines as the doses became available.
At the same time, the County also prioritized people living in other prioritized congregate settings, working with the Oregon Health Authority and Metro area health systems to identify and and connect vaccine to facilities where people live in long term care and assisted living facilities not covered by the federal pharmacy program; in more than 620 small adult care homes, behavioral health homes and homes for people with intellectual and developmental disabilities.
When a case occurs in custody
When an adult in custody tests positive for COVID-19, Corrections Health responds with rapid testing, isolation, quarantine and detailed contact tracing efforts. The Multnomah County Sheriff’s Office responds by quarantining the affected housing units, stepping up deep cleaning and using a higher level of masks.
When Corrections Health identified a number of cases in multiple dorms in January, all adults in custody with potential exposure were placed in quarantine. Regular testing every few days has been ongoing, and all the adults in custody with a positive test are isolated as a group and separated from those who have tested negative.
The Feb. 2 vaccines were first administered in areas where the Health Officer and Corrections Health staff said they would likely prevent the most spread: to people living in large open dorms who had not yet been exposed to the virus, as well as some with high-risk underlying medical conditions. Subsequent vaccines, when available, will be offered to those who have been exposed and are in quarantine. Finally, those with a positive test qualify for a vaccine but will likely be offered vaccine later as they have at least three months immunity from their own infection.
Outbreak response continues
In addition to carefully following individuals health, the County working with the Sheriff’s Office has increased the level of PPE required across the facility. Appropriate personal protective equipment is used in all clinical encounters, and prior to each work shift, every Corrections Health employee performs a temperature check and attests to a lack of symptoms and COVID-19 exposure.
Communication will continue to be provided to adults in custody directly from Corrections Health personnel and Sheriff’s Office staff, and by electronic reader boards installed in the dorms and posted public health guidance throughout the facility. Messaging includes information about the virus, recommendations on handwashing, physical distancing, wearing face coverings, and updates on facility and dorm status.
The County has posted public updates regularly on multco.us and will continue as the situation evolves.