This post has been updated.
The San Diego County Sheriff’s Department recently had to relocate dozens of people in custody after a surge in coronavirus cases  at the George Bailey Detention Facility in Otay Mesa.
More than 50 people detained there tested positive for the virus in mid-November in one housing unit. The Sheriff’s Department administered tests to two adjacent housing units, where they discovered four more positive cases in one of those units. One person who was transferred to the Vista Detention Facility from George Bailey before the department discovered all the cases also tested positive , along with several others that person was housed with at Vista.
It’s a scenario that’s played out multiple times throughout the country since the pandemic began: Cases among inmates or detainees in one housing unit spread COVID-19 to another housing unit, and even to other facilities.
The outbreak at George Bailey is one of several in various detention facilities in San Diego County. Two federal facilities that house U.S. Marshals Service and Bureau of Prisons detainees in downtown San Diego have experienced outbreaks since August. The Otay Mesa Detention Center, which holds Immigration and Customs Enforcement and U.S. Marshal detainees, had one of the worst outbreaks in any immigration detention facility in the country in the spring – and has recently seen COVID cases yet again.
A federal detainee, an ICE detainee and a Sheriff’s Department staffer have died from the virus.
People incarcerated have tested positive for COVID-19 at a rate 5.5 times higher than the general public, according to research  by the UCLA COVID-19 Behind Bars Data Project  and the Johns Hopkins Bloomberg School of Public Health. The COVID death rate of those incarcerated is 39 per 100,000 people, which is also higher than that of the general public, which has a rate of 29 deaths per 100,000 people.
“There is a dramatically higher risk of contracting the virus and dying from it if you are an incarcerated person versus a person in the free world,” said Aaron Littman, deputy director of the COVID-19 Behind Bars Data Project.
All these outbreaks, despite happening in different facilities operated by different agencies and companies and housing different populations, lay bare just why incarcerated people are getting sick and dying at higher rates than everyone else.
“All the things that ordinary citizens have been asked to do – social distance, wear face masks, wash your hands – have proven to be virtually impossible for people in detention to do,” said Chris Beyrer, a professor of public health and human rights at the Johns Hopkins Bloomberg School of Public Health.
Most Precautions Are Impossible in Prison
COVID-19 is primarily an indoor virus, transmitted through droplet and aerosol spread . The primary reason why there is so much transmission in jails, prisons and immigration detention facilities, according to experts, is simply that there are so many people who are inside and near one another.
“Of course, it is much more likely to spread in places that are crowded or overcrowded, that are dense with people and in places where social distancing is not occurring,” said Beyrer said.
Once the virus is brought into a facility – by a staff member who got it out in the community or from a transfer from another facility where there were active cases – there is no question that it will spread.
In places like Otay Mesa, the Metropolitan Correctional Center and the GEO Western Region Detention Facility, many people are detained in dormitory-like settings, where sometimes dozens of people will be sleeping and living in a room, often sleeping on top of one another in bunk beds.
The Western Regional Detention Facility is run by the private prison company GEO, and holds primarily U.S. Marshals Service detainees. Otay Mesa is run by CoreCivic, another private prison company, and hold ICE and Marshals Service detainees, who are awaiting their federal court proceedings. The Metropolitan Correctional Center downtown holds federal Bureau of Prisons and Marshals Service detainees.
On top of the overcrowding, incarcerated people often need to be accompanied by staff to make phone calls, shower, eat and do other things, said Wanda Bertram, communication strategist for Prison Policy Initiative, a nonpartisan research institute. Such policies could increase the likelihood of the virus spreading between staff and those incarcerated.
At the beginning of the pandemic, many counties, including San Diego, released people in an effort to reduce their jail populations to prevent COVID-19 outbreaks, Bertram said. But her organization has noticed jail populations have been creeping upward again nationwide.
San Diego’s federal courts began issuing fewer arrest warrants for people charged with crimes and instead began issuing what are called Notices to Appear, so people accused of non-violent or less serious crimes could stay in their homes during their court proceedings, instead of entering U.S. Marshal custody. Before the Metropolitan Correctional Center outbreak in August, federal defense attorneys also raised the alarm  that prosecutors were beginning to increase the number of people they wanted detained as they awaited their court proceedings. Marshals Service detainees are all awaiting the completion of their court proceedings, meaning people often come and go as they are arrested, attend their court hearings and are sentenced.
In a GEO facility in El Centro, several federal detainees awaiting their trials in July were pepper-sprayed while peacefully protesting against being transferred to a facility in San Luis, Arizona, where cases were surging at the time, according to a lawsuit filed on behalf of the men.
ICE told the San Diego Union-tribune that it has restricted intakes and transfers  to the Otay Mesa Detention Center. But Anoop Prasad, a senior staff attorney at the Asian Law Caucus, said it remains one of the few ICE detention facilities in the state that still takes transfers, predominantly from California state prisons and county jails.
“That’s a recipe for disaster,” Prasad said.
Experts have also heard reports about difficulties accessing things like masks or soap in various facilities, or that sometimes staff members don’t always use masks while interacting with those detained.
In Otay Mesa, detainees were initially asked to sign a contract in order to receive a mask, the Union-Tribune reported in April. When they refused to sign and continued to demand surgical masks, they were threatened with pepper spray . A spokesman for CoreCivic denied the allegations to VOSD.
“There was no use of force, nor were any chemical agents dispersed,” CoreCivic public affairs manager Ryan Gustin wrote in an email.
A survey of women  with incarcerated loved ones in California during the pandemic by the Essie Justice Group found that although 52 percent of survey respondents reported that their incarcerated loved one has at least one underlying medical condition that the Centers for Disease Control has identified as “high-risk” for severe illness or complications should they contract COVID-19, only 7 percent reported that their loved one had adequate access to basic necessities to prevent the spread of the virus, like soap, disinfectant, hand sanitizer and surface cleaners.
CoreCivic, GEO, ICE, the U.S. Marshals Service, the California Department of Corrections and the San Diego County Sheriff’s Department have all repeatedly said to Voice of San Diego and other news organizations that they provide PPE and other hygienic measures to detainees and staff.
“Taking the precautions that you need to take to prevent getting the virus is virtually impossible in a jail,” Bertram said.
Questionable Testing and Quarantine Protocols
Testing has been a serious problem in jail facilities since the beginning of the pandemic, Beyrer said.
Early on, many didn’t have on-site testing, which meant people would have to be taken out of the facility to get a COVID test. That not only created a risk for everyone – since that person may be exposed to others while being transported to wherever they were getting tested – it also created a disincentive to test people who weren’t symptomatic, he said.
“Testing only symptomatic people is completely inadequate,” Beyrer said. According to Centers for Disease Control estimates, roughly 40 percent of COVID infections are asymptomatic .
Prasad, the Asian Law Caucus attorney, said that inadequate testing protocols have also helped spread the virus between facilities. Sometimes facilities will test a group of people and put them all back in the same unit to wait for results. Then those who tested negative will be transferred to another facility – even though they could have been exposed to someone with the virus while waiting for the results. An irresponsible transfer from the California Institution for Men in Chino triggered a deadly outbreak in San Quentin State Prison , he noted.
Beyrer said that facilities like these have also have issues with quarantine protocols once someone tests positive. Often, people who tested positive will be grouped together to quarantine, or housing units where most people tested positive will simply stay intact, which is called “cohorting.”
While the CDC guidelines do include cohorting when everyone in the cohort has a confirmed COVID-19 case, Beyrer said that in detention facilities, it often seems like officials are just giving up on people who are asymptomatic.
“It’s really a statement of failure,” he said. “It seems to me that it’s cruel and unusual punishment. These facilities effectively give up on their duty to protect people.”
One person detained at the Metropolitan Correctional Center told Voice of San Diego in September that he believes he infected his entire cell  after leaving the facility for a heart procedure, getting infected with the virus and not being quarantined upon his return. That same detainee said once he recovered he was brought to another floor with others who were positive because he was told he wouldn’t get sick again. But he did, and tested positive a second time.
Lack of Transparency
Experts agree that is also has been impossible to get a full grasp on what is happening inside most detention facilities because of inconsistencies in how they’re reporting infection data. Even the places that release data vary widely in practices. Some don’t release the number of tests given, so you can’t tell if only symptomatic people are being tested, for example. If only symptomatic people are being tested, then many people who are infected may not be counted or treated as though they are contagious.
ICE, for instance, does not publicly post the number of people tested, only current confirmed cases , detainee deaths and the cumulative total of COVID-19 cases that a facility has had.
“The lack of transparency is problematic in a couple of ways,” Littman, from the COVID-19 Behind Bars Data Project, said. “One is that it might reflect that the jail doesn’t know what is going on. The detailed information may not be collected because of inadequate testing, and that directly implicates outcomes. Either the jail isn’t doing testing or the jail wants to minimize publicly the situation to avoid the appearance that they have an outbreak. That is exactly the opposite of the type of proactive approach to try and mitigate harm when there are outbreaks.”
The U.S. Marshals Service, for example, doesn’t publicly post any data about testing or active cases. It provided some information to Voice of San Diego when asked – 378 of its detainees in San Diego County have tested positive for the coronavirus at some point during the pandemic – but noted that “Data on prisoner health comes to the USMS through established reporting mechanisms that may vary from jurisdiction to jurisdiction; the data is not real-time and may not reflect the most current information.”
The San Diego Sheriff’s Department posts the number of tests administered , cumulative positive cases, current positive cases, recovered cases and number of people in isolation solely for precautionary measure, meaning they are being monitored or isolated because they have been potentially exposed to the virus or are exhibiting COVID-like symptoms. The data doesn’t break down how many cases are in each of the seven different county detention facility.
The Union-Tribune, which first wrote about George Bailey outbreak, noted that the Sheriff’s Department put out a press release on the situation five hours after the reporter inquired about it, but never actually responded to the reporter’s request .
Bertran said jails and prisons are often a “black box,” and without full transparency it’s truly impossible to understand how many people are infected and dying and why. Many of the means of communication that families, advocates, attorneys and researchers have had in the past have been shut down due to the virus, like in-person visitation, she noted.
Perhaps the biggest transparency issue is that sometimes even family members can’t figure out when their incarcerated love one has gotten sick, Bertran and Beyrer said.
Many family members of people with COVID-19 who were being detained at Metropolitan Correctional Center told Voice of San Diego that they only found out about their loved one’s sickness  because their loved one or one of their cellmates were able to call them, despite the fact that the Marshals Service said it was its policy to notify family members when someone in its custody tested positive.
“I’m an epidemiologist,” Beyrer said. “If we don’t have the data, we can’t tell if your efforts to mitigate spread are working. You need that quality data to understand if things are improving or if you’re having a worsening situation.”
The experts I spoke with suggested several measures to try to improve the situation inside these facilities during the pandemic. First and foremost, they all agree that a drastic reduction in the number of people in all these facilities needs to occur.
Beyrer and Littman also said that the COVID-19 vaccine, which will start being distributed in limited amounts to states in mid-December, could provide a solution if state leaders prioritize staff and people incarcerated for vaccinations.
On Monday, Gov. Gavin Newsom announced he anticipates California will receive an initial 327,000 COVID-19 doses later this month. Health care workers and first responders on the frontlines of caring for COVID-19 patients will be the first group to have access to the vaccine, but the initial distribution won’t even cover all those people in the state.
There are also some smaller things that could be done, Beyrer said, like waving payments for additional soap and hand sanitizer that are currently available in limited quantities. There should also be mandatory reporting standards for data on testing and positive cases, and for communication with family members about incarcerated loved ones who become infected during the pandemic.
“I think largely all of this was very predictable and avoidable,” Prasad said. “All the answers were given by public health experts to policymakers even before the pandemic hit jails and prisons. They were just ignored for political reasons.”
Update: This post has been updated to include information from a CoreCivic spokesman provided after this story initially published.