Virus World

More than 1,000 incarcerated people died from hepatitis C-related complications between 2014 and 2019, even though a simple cure is available, according to a new STAT investigation.

He knew he had hepatitis C. And he knew, too, about the simple, once-daily pills that could fully cure him of the potentially deadly viral infection in about 12 weeks. But Ritchie was serving a 20-year sentence for armed robbery, and the Missouri Department of Corrections refused to treat him. Ritchie begged repeatedly for the medicine. He went through all the formal steps to request medical care. The prison system knew he was getting sicker and sicker — it documented his deteriorating condition in his health records. The prison’s doctors wrote frequently he would benefit from hepatitis C treatment. But officials still denied him, in the same way a STAT investigation documented prisons around the country are still denying thousands of others the cure. So the virus infecting Ritchie’s blood continued to replicate, scarring his liver until it was so damaged that it could hardly function. Eventually he was diagnosed with liver cancer, a common complication of untreated hepatitis C. Now, the prison argued, he was too sick for the drugs to work. They refused him again. “I don’t have the energy to do nothing anymore,” Ritchie told a court in 2019. “I try to talk too long, I can’t breathe … I get out and get a little fresh air, but I can’t do a lot of walking, and I can’t get in the sun.” He died in June 2021 at the age of 64, nearly five years after his first request for medication.

STAT’s investigation found that 1,013 people died of hepatitis C-related complications in states’ custody in the six years after the first cure, a Gilead antiviral drug called Sovaldi, hit the market in late 2013. This tally, based on an analysis of 27,674 highly restricted death records, has never before been reported. Many of those 1,013 people were not serving life sentences; they would likely have had the chance to return home, reapply for jobs, and reconnect with parents, spouses, and children — or, in Ritchie’s case, his one grandchild, Gabe. Many should not have died. In fact, the treatment for hepatitis C is a modern medical marvel. The scientists who paved the way for its discovery won a Nobel Prize. Public health experts say it’s possible to cut hepatitis C deaths to virtually zero, and effectively eliminate the virus as we’ve done with smallpox or polio. Francis Collins, the White House science adviser and former longtime director of the National Institutes of Health, called STAT’s findings “unacceptable.” “You have to wonder if this individual [Ritchie] had received [treatment] at the first opportunity, would he still be alive today?” Collins said. Told of STAT’s findings, Chelsea Clinton, a global health advocate and vice chair of the Clinton Foundation, said the rationing of hepatitis C care by prisons and people dying as a result is “incredibly infuriating.” “It certainly is a gross injustice that we are continuing to punish people who are already incarcerated as a punishment,” she said. “That sometimes there’s a death sentence attached if there’s untreated hepatitis C — that to me is morally indefensible.....

Two nurses have been placed on administrative leave after at least 77 inmates at the Iowa State Penitentiary in Fort Madison received shots that contained six times the recommended dosage.  Dozens of inmates at an Iowa prison were sickened this week after the prison’s nurses inadvertently administered overdoses of the Pfizer coronavirus vaccine, an error medical experts fear could erode trust among a population already wary of vaccinations. At least 77 inmates at the Iowa State Penitentiary in Fort Madison received shots on Tuesday that contained six times the recommended dosage. The Iowa Department of Corrections said that it had temporarily halted administration of the vaccine at the facility and that two nurses had been placed on administrative leave pending an investigation. Cord Overton, a prison spokesman, said that none of the inmates had been hospitalized, but that they were suffering from ailments consistent with people who have had adverse reactions to the vaccine, including body aches and low-grade fever. While prison inmates in most states have begun to receive vaccinations, the hesitancy rate among both incarcerated people and prison guards is a concern for public health officials. In Pennsylvania, for example, as many as 75 percent of correctional staff and 45 percent of inmates have not yet been inoculated, despite the availability of the vaccine.

Public health experts fear that given the reluctance to get inoculated, outbreaks in correctional facilities might continue well after much of the rest of society has been vaccinated, creating islands of infection. Jaimie Meyer, an associate professor at the Yale School of Medicine, said dosing errors involving the Pfizer vaccine had been “rare.” She said that medical care at prisons presented particular problems because of inadequate staffing. “When there’s a single nurse practitioner who’s meant to take care of a thousand patients, they often don’t have the same levels of support that you would elsewhere,” Dr. Meyer said. In Iowa, the Corrections Department said its nurses had been told to follow the instructions on the medication when preparing the doses and to consult a statement on proper procedures from the manufacturer.

More than two-thirds of fully vaccinated people in a Texas prison caught COVID-19 during an outbreak of the Delta variant in July, but vaccines protected against severe illness, a study from the Centers for Disease Control and Prevention found. Of 185 fully vaccinated prisoners at the unnamed prison, 129, or about 70%, caught the virus, data compiled by the CDC and the Federal Bureau of Prisons showed. This was a much lower rate than the unvaccinated prisoners, 39 of 42 of whom – or about 93% — caught COVID-19 during the outbreak, said the study, published Tuesday in the CDC's Morbidity and Mortality Weekly Report. Four people, three of whom were unvaccinated, needed treatment in a hospital, the study said. One unvaccinated person died, it said.

Most of the prisoners were white men, and many had received Pfizer's vaccine at least four months before the outbreak, the data showed.  The study adds to growing evidence that COVID-19 vaccines cut the risk of severe disease and hospitalization. Prisons tend to have higher rates of COVID-19 and deaths because of cramped living conditions and underlying health conditions, the CDC said. Another CDC study from this month found that unvaccinated Americans were 11 times as likely to die of COVID-19 as vaccinated people. About 45% of people in the US are unvaccinated, according to the CDC. The latest CDC study showed that the Delta variant can spread among both vaccinated and unvaccinated people. "Infectious virus was cultured from vaccinated and unvaccinated infected persons," the study said. Measures like masks and regular testing are "critical" where physical distancing is "challenging," even if vaccination rates are high, the CDC said.

High profile inmates like ex-Trump lawyer Michael Cohen are among those who have asked for early release. 

New York City is releasing "vulnerable" prisoners, the mayor said on Wednesday, days after Los Angeles and Cleveland freed hundreds of inmates. Prison reform advocates say those in jail are at higher risk of catching and passing on Covid-19. There have been more than 9,400 cases of Covid-19 and 152 deaths in the US so far, according to estimates. Globally there are some 220,000 confirmed cases and over 8,800 deaths.

New York City Mayor Bill de Blasio said on Wednesday that city officials will this week identify individuals for release, including people who were arrested for minor crimes and those most vulnerable to infection due to underlying health problems. His announcement came hours after a guard and a prisoner tested positive for coronavirus at Rikers Island prison, where disgraced former Hollywood producer Harvey Weinstein, 68, is a high-profile inmate. Weinstein will be moved to a different state prison, an official said on Wednesday. Other New York prisons, such as Sing Sing, have had inmates test positive for coronavirus and one employee for the state's corrections department has died from it.