By Annie Sweeney
Chicago Tribune
CHICAGO — Victoria Furlow took a step back so she could clearly see her patient sitting at her workstation in the busy intake area of Cook County Jail.
In a calm and quiet voice, through her clear plastic face shield, Furlow, a paramedic by training who is regularly assigned to intake, told him to pick up the paper napkin on the desk next to him, in case he needed to sneeze.
“Hold your head back,” Furlow continued as she steadied the long, thin white swab at his nose.
“You ready? You ready? It’s going to be a little bit uncomfortable,” she said. “Don’t move. Don’t flinch.”
The patient let out a little gasp the further she pushed the swab, forcing her to stop for just a second or two.
“It’s OK, it’s OK,” Furlow assured him. “Cover your mouth. Let me know when you ready, we can get the other side.”
Seconds later it was done. Furlow thanked him.
COVID-19 tests are now standard during the intake process for all new detainees entering the jail, one of several measures that officials said has helped them turn a critical corner on the pandemic. At its worst, over a two-month period, the deadly virus infected just over 700 inmates, including seven who died.
Two correctional officers have died, with hundreds also infected.
But Dr. Connie Mennella, who oversees medical care at the jail, told the Chicago Tribune that testing data indicates the facility has moved beyond the stage of flattening the curve and into containment, with a positive test rate below 10%.
The news comes two months after the first public alarms sounded about the potential disaster of a major COVID-19 outbreak at the jail.
The reported turnaround has been challenged by a group of civil rights attorneys who have alleged the opposite in a federal court filing, saying jail officials failed to adequately respond to protect those in custody as the crisis overtook the sprawling, Southwest Side complex.
The lawsuit likely will play out over some time.
But Mennella, Cook County Sheriff Tom Dart and their staff made clear that they are ready to answer the challenges. They have been working since January to respond to a rapidly moving health crisis that forced them to be just as nimble, they said, shifting inmate housing assignments to open single cells, opening long-shuttered buildings for medical care, and adapting testing practices to better understand where the virus was moving.
Furlow, a 19-year-veteran, was one of those at the front lines, armed with full PPE and her faith that health care is the work God wanted her to do — and that you don’t back down when it gets tough.
“I have to admit the first day they said, you have to swab today I was terrified,” Furlow said. “I believe in my God, and he says, ‘Where’s your faith?’ There is always a risk. Somebody sneezes, now it’s airborne. They cough, it’s airborne. God has brought me through other things. He is going to bring me through this too.”
As of last week, fewer than 100 of the 4,000 detainees housed at Cook County Jail had tested positive and were in isolation for COVID-19, down from one-day totals of in early April of nearly 300.
Another key metric for jail and county health officials is the facility’s test-positivity rate, which they said has fallen to 6% as testing at the jail as expanded to include both symptomatic and asymptomatic detainees.
“We’re past flattening. We’re in prevention and containment,” said Mennella.
Menella and staff at Cermak Health Care services had been monitoring health care alerts since January about the pending crisis. As soon as the first positive case was detected in Chicago on Jan. 24, jail and health officials started screening new detainees, isolating and masking anyone with flu-like symptoms.
At that point, testing was not available to anyone. And even when it first became available in March, tests had to be sent out to labs, taking up to two weeks to get results.
Today, testing is a main focus of intake, where detainees already get a full medical screening — including a chest X-ray — as part of Cermak’s mission to be a community health care provider, Mennella said.
Incoming detainees to the jail are tested twice for COVID-19: when they first arrive and when they leave a mandatory 14-day receiving tier where they wait to make sure symptoms don’t develop. Jail health officials also conduct contact tracing, Mennella said. If a detainee tests positive, their entire tier and any other tier they have been on is tested.
Mennella insisted, however, that testing is just one piece of responding to the virus.
“The key to this disease was monitoring — making sure if someone had a change in condition, making sure you got them to the right level of care,” she said.
Expert epidemiologists said the data released by the county suggested that the spread of the highly infectious disease has slowed in the complex. But they cautioned that continued success hinged on both the population at the jail remaining down and the new measures staying in place.
“This is a decline in positivity and that is encouraging, and that does tell you that you are not in an expansion mode,” said Dr. Chris Beyrer a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, who also specializes in infectious disease inside prisons. “These close settings are going to remain places where we have to be hypervigilant. … It is fundamental to this virus: Population density is your enemy.”
Meanwhile, the attorneys who have filed the lawsuit remain skeptical that strong enough measures are in place. Among their requests in the lawsuit is that the county provide more details on testing.
“We don’t think this is a handled emergency in any sense,” said Alexa Van Brunt, one of the lead attorneys.
A full city block east of the jail, across the boulevard of California Avenue, there is a large sign on a chain-link fence.
“Thank you CCSO staff for your unwavering sacrifice and commitment,” it reads. “You are heroes.”
In the wide, grassy area behind the fence there are rows of nondescript brown brick bureaucratic buildings, the so-called barracks area that was converted to care for those who would contract the virus.
The barracks, formerly used as a boot camp for the jail, opened March 16 after three days of around-the-clock work to ready the buildings.
A leaky roof was patched and temporary medical stations were set up in closets, carving out space for computer workstations, adhesive bandages and boxes of surgical masks and bright blue gloves. Medicine cabinets were rolled in, for not only drugs, but also the once highly coveted N95 masks.
Currently, there are 50 detainees housed there who have tested positive and have mild symptoms, and who continue to be monitored by nurses who work for the Cook County Health and Hospital System.
On a recent afternoon, a group of nurses and medical assistants, who have come on temporary assignment from all over the county, sat at a long conference table quietly tapping notes into laptops. A sign on the bulletin board read “Bootcamp Covid Warriors 2020.”
It wasn’t exactly easy to get staff members to agree to come work in the jail. Fears about patients possibly being violent were only exacerbated by news reports of high COVID-19 numbers.
Shanna Benson, a medical assistant who has been working in the barracks since March 30, said she felt compelled to go to the jail after hearing that not a lot of medical staff was stepping up.
“I felt like, we are public servants,” she said, leaning against the wall. “That was reminding me to step up and do my role.”
Outside the barracks, a gym normally used for programming such as drum circles and photography classes was filled with 128 cots and temporary beds. And there were three sand-colored tents, each with about 20 cots marked with the Cook County seal.
But on a recent day, all the rooms were all empty. As it turned out, they were never needed.
Back in February, no one was sure what to expect at the jail, including Sheriff Dart.
Major preparation began in late February and early March, officials said. Meanwhile, a coordinated effort to reduce the jail’s population of 5,700 was underway in the courts through expedited bond reduction hearings and a decision by Cook County State’s Attorney Kim Foxx to not prosecute low-level drug crimes.
The population started dropping, giving officials more room to work with.
Newly arrived detainees, potentially bringing the virus into the jail, began to be housed apart from the general population in the receiving tiers to monitor potential symptoms. Officials had already started a massive assessment of the jail complex to see how they could shift and separate the population to allow for social distancing and create space for isolation and quarantine areas.
“It’s like Tetris,” said Dr. Jane Gubser, the assistant executive director of programs at the sheriff’s department said, referring to the tile-shifting computer puzzle game, as she walked through the jail’s buildings on a recent day.
Before relocating a detainee or changing a tier’s population, Gubser said staff had to consider existing placement considerations, including any security concerns and mental and medical health needs.
In the end, the sheriff opened up 615,000 square feet of shuttered space, including eight buildings — some of which had been closed for three years.
In one tier, the population of a 38-person open-style dorm was halved so that detainees did not have to sleep immediately next to each other.
On a recent day, some detainees sat in close quarters, but officials stressed they can’t force them to remain apart or even wear the masks that are now supplied daily.
On a quarantine tier in Division 11, detainees were assigned to single cells, reducing the population from 48 to 24. Detainees are allowed, 12 at a time, into the common area in four-hour shifts, restricted to one person at each of the stainless steel tables anchored to the floor, which during the recent visit were streaked with white bleach.
A chess game, the pieces turned over, rested on one table. Detainees now play standing up and across from each other about a foot back from the table’s edge.
Dart and Cermak officials are very careful about how they describe the turnaround in the numbers. They will not call it a success. Or even say they are proud.
“We did a remarkable job in containing this, identifying it and treating it,” Dart said recently, hours after leaving a funeral for one of the correctional officers. “(But) when you are sitting there feeling happy about taking on something so horrible, you are still left very humbled by the fact that you lost two correctional officers and you had seven detainees die.”
Since the onset of the pandemic, advocates and attorneys have called for mass releases, but they’ve also been highly critical of how much the county was doing to prevent the virus from spreading.
They’ve cited continued reports from inmates about unsanitary conditions and the impossibility of consistent social distancing.
After the lawsuit was filed last month in Chicago’s federal court, U.S. District Judge Matthew Kennelly entered an 87-page emergency order which mandated, among other things, social distancing measures, including banning double-inmate cells and group housing in most cases.
Despite the recent positive numbers reported by the county, attorneys were in federal court as recently as Thursday asking Kennelly to force officials to turn over more records to assure conditions were safe.
The lawsuit remains a sore point for Dart and other health leaders, who insist nearly all of the practices Kennelly demanded were already in motion.
Standing outside the barracks, Dart and Mennella reflected on what they said was nonstop planning and pivoting to respond to an evolving crisis, insisting there was always enough supplies.
And he scoffed at the idea that he was shorting anyone on supplies.
“A guy who is doing all of this is going to save a couple of bucks on a 6-cent bar of soap?” Dart asked.
Outside a quarantine tier in Division 11, two glass doors open onto an open-air basketball court.
A random collection of disinfectant bottles lined the window sill on a recent day. A gentle breeze flowed as the sound of cars whizzed by on a nearby street.
Detainees were allowed outside to get some air, but the basketballs were still locked away, with much of the programming and activity inside the facility remaining at a standstill.
Jail officials said precautions must remain in effect to guard against a second-wave outbreak — especially with warmer days ahead and the jail population likely to spike as Chicago deals with its normal rise in gun violence.
Dart said he has one more living unit that can be opened, but it has fewer than 150 beds.
So the empty gym and emergency tents will remain ready. Detainees will continue to be held in receiver tiers when they arrive, making sure they don’t develop symptoms.
And the COVID-19 testing at intake will continue — both the cringe-inducing swab and health information and advice about the virus that Furlow and other health care professionals try to weave into conversation with inmates.
“You have to talk to them and let them know the risk,” said Furlow, who for now is separating herself from her own young daughter by allowing her to stay with relatives.
“We don’t understand a lot about this COVID-19. We just all have to be careful.”
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