WASHINGTON – There have been much worse outbreaks during this pandemic. But 39 inmates testing positive for the coronavirus at Neuse state prison in Goldsboro, North Carolina, was still cause for alarm.

Of the more than 50 detention centers across the state, none had more infections at the time than Neuse, prompting officials to take the extraordinary step of testing all 700 prisoners at the medium-security facility near Raleigh.

Within a week, infections had surged to 444. Perhaps even more revealing: More than 90% of the newly diagnosed inmates displayed no symptoms, meaning that the deadly virus could have remained hidden had the state followed federal guidelines that largely reserve testing for people displaying common symptoms, such as fever and respiratory distress.

“We would never have known,” North Carolina Department of Public Safety spokesman John Bull said.

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Even as vulnerable prison systems have ramped up scrutiny of inmates and staffers with broad quarantines and elaborate contact tracing investigations, increased testing is proving just as crucial in assessing the virus’ spread within detention systems as it is in the free world.

Mass testing at three state prisons in Ohio has yielded results similar to North Carolina's, with officials suggesting that the strategy and findings could have broad implications, not just for containing outbreaks in detention centers but in making larger decisions about when states should reopen for business and loosen social distancing restrictions.

The federal Bureau of Prisons, the largest detention system in the country, has announced that it, too, is expanding testing for asymptomatic inmates in an attempt to control the spread of the virus that has so far infected nearly 1,000 inmates and staffers and claimed the lives of 24 prisoners.

Testing capacity has been the central focus of many governors as they weigh when and how they will re-emerge from near total lockdowns prompted by the coronavirus pandemic.

Ohio Gov. Mike DeWine, who recently won approval from the federal Food and Drug Administration for use of a compound that can identify the virus in test samples, also has formed a special working group to find reliable sources of testing supplies.

The broader testing in prisons, however, has already produced striking findings.

"While we know coronavirus does pose a specific threat to congregate settings," DeWine said, referring to the prison testing, "this comprehensive testing will give us insight on both how to best coordinate response at these facilities, as well as data and insight on how comprehensive testing within a cohort will affect testing numbers."

Leonard Rubenstein, a professor at Johns Hopkins Bloomberg School of Public Health, said the broader testing in detention centers where small cells and densely packed dormitories make social distancing directives nearly impossible to maintain underscores the need for testing beyond prison walls.

"Unless you do universal testing in all environments, the risk of spread is enormous," Rubenstein said. "If you are waiting for symptoms to emerge before you do the testing, you are getting a false picture of what is going on. ... It's too late."

Testing 'key' to recovery

Ohio was among the first prison systems in the country to launch a mass testing program aimed at diagnosing the scope of infection at three virus-plagued prisons, including Marion Correctional Institution, which has contained the largest number of infections of any prison in the country – now at more than 2,000.

As expected, the universal testing yielded more infections, including a large contingent of asymptomatic inmates.

In one dormitory at Marion, officials said that of 152 prisoners tested, 39% tested positive for COVID-19 even though they displayed no symptoms.

Ohio has reported 3,762 total inmate infections and nine confirmed deaths while more than 28,000 of the state's 50,000 inmates were in some form of quarantine. By comparison, at least 620 of the more than 140,000 inmates in the federal Bureau of Prisons have tested positive, while 357 staffers have been infected.

DeWine said the state numbers "did not necessarily indicate a new problem at these facilities, but simply wider testing."

Still, DeWine spokesman Dan Tierney said that the asymptomatic infections are striking and underscore the need for wider intelligence.

"Testing is going to be key for the recovery phase," Tierney said. "We have been working hard to acquire more testing capacity."

'We really needed to know more'

In North Carolina, officials are considering a broader prison testing regime after learning this week that the virus had spread throughout the Neuse facility, largely undercover and without producing the tell-tale symptoms of fever, respiratory distress, muscle aches, cough, chills or the loss of taste and smell.

Suspicions first peaked this month when infection numbers involving symptomatic inmates began to mount at the facility.

"There was a feeling that we really needed to know more," Bull said. "The interest was clear."

Testing of the entire facility began Thursday and ran through the weekend.

"I think we were very shocked to discover how many more had this virus," Bull said, adding that testing also was offered to all of the facility's 250 staffers. At least 22 have tested positive so far.

The results were so jarring that state authorities earlier this week announced the temporary closure of the nearby Johnston Correctional Institution and moved all 600 inmates to other facilities so staffers could help colleagues at the troubled Neuse prison.

“The staff at Neuse have been working in the toughest conditions, for weeks on end, and desperately needed support,” North Carolina prisons Commissioner Todd Ishee said. “They are owed everyone’s thanks for their commitment to serving the public, standing tall in their daily responsibilities and helping ensure safety of their co-workers and those in custody.”

With some test results still pending at Neuse, Bull said there have been "discussions" about expanding testing across the system to account for the so far unknown number of asymptomatic inmates who could be carrying the virus.

"So far, there have been plenty of discussions, but no firm path," Bull said. "Nobody's confronted anything like COVID-19. This is a significant challenge for a prison population, which is a difficult environment on a good day. These have not been good days."

Beyond prison walls

Concern for the overall health of the Neuse facility has spilled into the broader North Carolina community of Wayne County, where a number of prison staffers live.

"We are all concerned," Wayne County spokesman Joel Gilley said. "But we need more testing across the country; it's not just an issue for Wayne County."

So far, the overwhelming majority of the 572 infections in the county are the 458 cases inside the prison. Gilley said the staffers are quarantined in their homes, limiting the contact with other local residents.

There are regular conference calls, linking local officials with prison authorities for updates on the virus' spread.

"We want to make sure we are prepared," Gilley said.

Yet there are sad reminders that the threat is strikingly close to home.

Gilley said six local residents, all elderly with underlying health complications, have succumbed to virus so far.