COLUMBUS, Ohio - A massive coronavirus outbreak that has sickened nearly 4,000 inmates in Ohio has highlighted the dangers lurking in the nation’s correctional facilities during the pandemic and what system-wide testing reveals about the scope of infections behind prison walls.

The state ordered testing in prisons earlier this month as infections began to streak through guards, and this week the spike sent Ohio’s broader tally of virus cases to nearly 14,000, including more than 550 deaths and over 2,600 hospitalizations.

Prisons have been a major focus of concern since the virus first hit the United States, which incarcerates more people than any other nation — about 1.3 million inmates in state prisons and another 180,000 in federal penitentiaries.

With inmates crammed together in small cells, and eating and exercising in large groups, conditions are ripe for the virus to spread quickly and silently. Hygiene varies widely, and supplies such as soap aren’t always available. Medical treatment and release rates vary widely, making it difficult to track sick inmates who are paroled and the quality of care they receive inside.

“Prison is set up for everything to be close — there is no social distancing,” Cornelius Patterson Jr., a 40-year-old serving 30 years to life for aggravated murder at the Marion Correctional Institution in north-central Ohio, told The Associated Press on Tuesday.

Systemwide in Ohio, 3,762 inmates have tested positive and nine have died, including seven at the Pickaway Correctional Institution, southwest of Columbus. The head of the prison guards’ union is in self-quarantine after his wife, a guard at the Lorain Correctional Institution, tested positive.

The numbers at Marion are particularly eye-popping: Of about 2,500 total inmates, 2,011 have tested positive according to figures from the Department of Rehabilitation and Correction. In addition, 154 employees have tested positive out of a staff of about 350, which includes about 295 guards, forcing those remaining to work 16-hour shifts. One guard has died.

Across the country there are similar stories of flareups in densely packed prison populations.

In North Carolina, more than 330 of 700 inmates at the Neuse Correctional Institution in Goldsboro and about a dozen of its 250 employees have been infected, with about 200 test results pending. State Commissioner of Prisons Todd Ishee said more 90% of prisoners testing positive were asymptomatic. None have died.

In Texas, which has the nation’s largest prison system, more than 200 staffers and nearly 470 inmates at over two dozen facilities have tested positive. Another 42,000 prisoners, about 29 per cent of the state’s total, were locked down in their cells this week in an effort to prevent the spread of the virus, according to the Texas Department of Criminal Justice.

“The rapid spread of it is my greatest concern, not just for myself but for quite a few others that are here in the unit too,” Laddy Valentine, a 69-year-old prisoner with a heart condition, testified during a federal court hearing last week over conditions at the Pack Unit prison northwest of Houston. “Some are in worse condition than I am, and obviously one has already died.”

In Maryland, a civil rights group filed a class action suit Tuesday over what it called an “uncontrolled” outbreak at a county jail housing nearly 600 prisoners. The suit claims that inmates at Prince George’s County Jail who test positive are isolated in cells with walls covered in feces, mucus and blood, and that “they are barely monitored and receive no real treatment.” It’s one of multiple lawsuits filed around the country on behalf of inmates seeking improved conditions or releases to help avoid contagion.

Back at Ohio’s Marion Correctional Institution, inmates said they have at most two masks per person, one disposable and one cloth, which they’re told to reuse. Soap supplies are limited, and there’s currently no access to the commissary where such items can be purchased.

The testing conducted was the nasal swab exam, which detects the virus from the onset, rather than antibody tests, which detect proteins that show up a week or more later.

Multiple inmates on G Block told AP they were tested April 16 but still hadn’t gotten the results. While they awaited word, they were continuing to mingle in common areas and housed in their double-bunked cells.

Republican Gov. Mike DeWine said he would look into reports of inmates remaining in normal living situations without social distancing while awaiting delayed test results.

“Prisons, nursing homes, anyplace where we have Ohioans gathered together in close quarters, we’re very, very concerned about them,” DeWine said.

Several Marion inmates also charged that guards initially handled the outbreak as a security situation, appearing on cell blocks with pepper spray pistols.

“It is an international health crisis, but it was as if the staff members were mad at us and some were actually taunting us,” said Dennis “Sal” Salerno, who’s serving life for aggravated murder.

The Ohio prisons agency said it was working on a response.

The large number of inmates who aren’t showing symptoms is indicative of the virus’ ability to quietly spread through populations and reinforces the need for social distancing policies the state has put into place, said Dr. Amy Acton, the Ohio health director.

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“All of this is about how much we’re spreading and putting others at risk, maybe while not knowing it,” Acton said Monday.

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Associated Press writers Jake Bleiberg in Dallas, Jonathan Drew in Raleigh, N.C., Michael Kunzelman in College Park, Md., and Colleen Long in Washington, D.C., contributed to this report.