The Human Experiment in Herd Immunity Ohio Is Unintentionally Running at Marion Prison
Given shortages on testing, there have been just a few populations exposed to coronavirus in the US that have all been tested. Among the first cruise ships to be tested, up to 19% of those on board tested positive. 660 members of the crew of the USS Teddy Roosevelt have tested positive, about 13% of the crew. At the Kirkland Life Care Center, 67% of residents tested positive by March 27.
In Marion Prison in Ohio, two months into this crisis, an astounding 1828 — around 73% — of prisoners have tested positive, per Ohio’s official numbers.
I have no reason to believe that Ohio’s Governor Mike DeWine conducted this experiment intentionally — or even considers it an experiment at all. This is data the state needs to understand how to deal with COVID. His medical officer, Amy Acton, has been first rate. I assume that as Ohio considered the areas where their aggressive response hasn’t succeeded in stopping the spread of COVID, the prisons in the state were one of the most obvious failures (the federal prison at Elkton, Ohio has an official count of 50 inmates who have tested positive, with 6 who have died, though federal prisons aren’t testing everyone). And so the state decided to test everyone at three different institutions.
*DRC has taken an aggressive and unique approach to testing, which includes mass testing of all staff and inmates at the Marion Correctional Institution, the Pickaway Correctional Institution, and the Franklin Medical Center (which is Ohio’s medical facility for inmates). Because we are testing everyone – including those who are not showing symptoms – we are getting positive test results on individuals who otherwise would have never been tested because they were asymptomatic. The total tested and total pending are part of the large mass testing currently underway. Pickaway staff testing will begin the week of April 19, 2020. Once all of those results are received, these columns will be filled. Positive and negative results are still being reported and are current as of this posting.
Thus far, the positive rates in the other two facilities are lower than at Marion. While I’m not convinced all the Marion prison cases get included in the Ohio count right away, as of now, almost 16% of the Ohio’s cases are in Marion prison.
Whether intentionally or not, Ohio will soon begin to understand what happens when COVID spreads in an enclosed space with a younger population and — in the weeks ahead, what percentage of those men will weather the exposure without deathly symptoms, and then, what percentage of those men have antibodies that suggest they might be able to leave in a prison rampant with the virus with some kind of immunity.
At a minimum, the Marion prison experience shows that — even with two months of warning — without testing, spread of the disease inside closed quarters, will outrun any attempt to generate herd immunity, presumably because the lag between getting the disease, exhibiting symptoms, and developing immunity is too long.
Ohio is collecting necessary data. Better to collect it and identify all the people that might need medical treatment, then pretending the problem is not as bad as it is, which is what virtually all other prisons are doing. The data will help Ohio understand what’s happening at all of its prisons and make informed decisions as a result. One reason DeWine’s response in Ohio has been so good is that he has followed the data.
But having it will create ethically fraught policy questions, particularly in places where those making policy decisions have already shown an inclination to put economic decisions over health considerations.
It poses some pretty troubling policy considerations. While 109 guards at Marion have also tested positive (244 guards in state prisons across Ohio, as well as 38 at Elkton), it’s not yet clear whether the guards have contributed to clusters in surrounding communities — though that’s another thing Ohio will learn as it tests all the Marion population. No prisoner at Marion has yet died (one staffer has). Effectively — again, I’m not saying that this was at all intentional — Ohio is testing whether it’s possible for certain, younger enclosed populations to just weather this illness.
The thing is, I suspect something similar may be happening in other clusters where entire populations will be tested, one where ethical considerations won’t be aired publicly. Will meatpackers, for example, decide that their workers are so expendable that losing ten or so, but then reopening a plant with an immune workforce, is worth the human cost? if they do, we’re unlikely to find out they’ve made that decision anytime soon.
Given the disproportionate impact of this disease on the poor and those who live or work in confined spaces, especially people of color in both populations, given the political stakes Republicans are placing on proceeding as if a pandemic doesn’t change ordinary politics, as more populations like the one in Marion do tests of the entire population, will present ethical questions that our society is in no way prepared to handle.
Good info. Thanks EW. Even Faucci commented about how breathtaking the inter human transmission of this virus displays and reminded how it is not anything like HIV and SARS because of this easy-rapid transmission capability.
I live in Ohio and have been impressed with the response to the virus here.
I hope that this experiment will be done to high scientific standards with results published in the scientific literature.
As Marcy noted, Mike DeWine did not plan this experiment, but if it is a scientifically valid effort, it could be one of the most important things he has done as governor. And it could be an important part of what is being learned during the pandemic.
It is like a cruise ship parked on land with the crew able to leave every day and infect those on shore,
While not a perfect analog, a school has similarities to a prison: A young population in close quarters with a smaller population of older adults mixed in. Could have some use in thinking about opening schools in the Fall.
The one obvious difference is that students get to go home at night, too. But the impact of the guards’ infection on their families and communities would give some insight into the impact of students’ getting sick.
https://www.theatlantic.com/science/archive/2020/04/immunity-divide/610054/
Informative, thanks, I found this where immunity to Yellow Fever had a direct link to employment in 1847 New Orleans. At the time it was called the “Baptism of Citizenship” and “even the president of the New Orlean’s Board of Health once proclaimed in a speech, “The VALUE OF ACCLIMATION IS WORTH THE RISK!” As the protest movements demonstrate, human beings don’t change over time. At the time “Employers were loath to train an employee who might succumb to an outbreak. Fathers were hesitant to marry their daughters to husbands who might die.” Even with knowledge and modernity, human responses to crisis remain the same.
Without a doubt there are those out there urging that the only way to get herd immunity is to catch it. Since no coronavirus has a vaccine, that may be correct. The vulnerable will have to do their best to survive in an environment with a target on their chests. A friend of mine has told me she is not intending to go out without a mask, ever again. She’s a lady determined to survive.
TY
re:
It seems M. Bezos has already made that decision for Amazon USA. In France they forced Amazon to close the WHs to decontaminate them. There is no treatment for the workers (anywhere): it’s live or die.
Using prisoners for experimentation has a long and nasty history even in the USA. They are the most reviled with least protections, least resources and vulnerable to coercion.
M. Bmaz might clarify but iirc no prisoner can give “informed consent” to such experimentation and such work must be viewed with extreme skepticism. It is a convenient claim that such things are “beyond control”. Typhus, small pox, skin trials and all the rest of the prisoner experiments have ethical considerations that reach far beyond the immediate results.
A failure to care for these persons under their control and protection, is still a failure.
ht tps://en.wikipedia.org/wiki/Typhus
ht tps://en.wikipedia.org/wiki/Smallpox
ht tps://en.wikipedia.org/wiki/Unethical_human_experimentation_in_the_United_States
(url fractured to prevent autorun)
“Will meatpackers, for example, decide that their workers are so expendable that losing ten or so, but then reopening a plant with an immune workforce, is worth the human cost?”
Trump’s screwed up refusal to set up testing in the DC area for federal employees is another scary wrinkle on this issue.
While Trump can’t force governors to reopen, he can roll back telecommuting and start sending hundreds of thousands of federal empoyees back and forth to DC and suburban Virginia and Maryland every day.
I am sure that lower level management will oppose this, but it is harder to imagine department secretaries willing to put their own jobs on the line.
Do Pompeo and Esper decide to order State and DOD employees to start attending meetings in potential hotspots in places like Rio and Manila? Does Barr tell DOJ employees to resume regular interactions with prisons? And then do these employees return to office buildings around DC without proper testing and tracing procedures?
Esper has announced an extension of DOD employee travel restrictions for now, but I don’t know if this type of thing will last. At least, until the next wave hits.
I keep coming back to the import of a handful of GOP governors. And in the DMV pact, Hogan has gotten increasingly vocal about the problems with Trump’s approach. It may lead to an interesting face-off, though Hogan has thus far avoided calling out Trump personally.
I would not put it past Trump to be triggered by bile at Hogan and Northam to decide to expose hundreds of thousands of their constituents in retribution.
Well, they’re Trump’s constituents too, but he doesn’t see it that way.
We have to hope there are enough well placed federal employees with connections to Departmental leadership, White House staff, and the pressure points of the DC elite like prep schools and think tanks to stop anything premature.
Looks like infection rates are ugly and varying between meat packing plants, cruise ships, different aircraft carriers and different prisons. When there were 619 positive out of 3711 persons on the Diamond Princes, only 89 of 1109 in the 20 to 49 year old age group were positive. Infection rates peak at that time of test were 59 percent in the 70 to 79 age group. One of the first workers to die at Smithfield South Dakota was 64.
IANAS (scientist) but I wonder what the effects or relevance of each human hosts’ genotyping vs. phenotyping in determining their predisposition to asymptomatic survival rates against corona virus(es).
Last week, all the homeless at the Pine Street Inn in Boston, MA were tested. Of the 397 people tested, 146 people tested positive. Not a single one had any symptoms.
https://www.boston25news.com/news/cdc-reviewing-stunning-universal-testing-results-boston-homeless-shelter/Z253TFBO6RG4HCUAARBO4YWO64/
That’s another data point for our global whole species (homo sap sap, the sap) experiment.
More of a Marion prison scenario. They removed 15 positives with symptoms to another location before sampling the remainder. This was all in late March before the CDC finally fessed up that wearing masks in public was a good thing. Any loosening of ppe and social distancing will result in repetitions of this scenario. Would be nice to see how many developed symptoms etc.
The vast majority in the US have stopped gatherings and are even wearing masks in public now. The washing hands and don’t touch face was good to know but not sufficient and gave many a false sense of security. The deadly GOP political narrative of herd immunity is criminal. NYC already experimented killing their teachers near New Rochelle by having such a small quarantine. Sweden, Denmark and Germany are now conducting the same death experiments. The GOP is dancing on graves talking about comorbidities. 5.8 percent of deaths in NY are under 50, 9.8 percent between 51 and 59.
I’m sorry to be a rude newcomer, but this is just flat out wrong. Yes, Sweden is pursuing the herd immunity strategy, and is (rightfully, IMHO) being criticized for this. Denmark and Germany on the other hand have had strict measures in places (like my native Norway). Both Norway and Denmark have seen Reff reduced so much that we are starting to roll back some of the measures.
Thanks for that. The numbers don’t lie — see the chart dd 21 APR 2020 on COVID-19 deaths by country:
https://www.theguardian.com/world/2020/apr/21/coronavirus-map-which-countries-have-the-most-cases-and-deaths-covid-19
It’s not the entire picture, though; Norway appears nearly as bad as Sweden because it has half of Sweden’s population. Change in death rate over time tells a different story, dropping off once measures were tightened after an early spike. Compare the number of confirmed cases between countries over the last 14 days:
https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases
Finland is about the same size population as Norway and Denmark, half that of Sweden, and it has much fewer deaths. It’s not taking the laissez-faire attitude Sweden has toward social distancing and the numbers show positive results.
Numbers don’t lie, but statistics can be misinterpreted. For the numbers I personally prefer WorldOMeters for numbers. As of April 20th , Sweden is listed with 1,580 deaths (156 pMp), Denmark with 7,515 (63 pMp), Germany with 4,862 (58 pMp) and Norway with 181 (33 pMp).
Based on those numbers I don’t see how you can say Norway appears nearly as bad as Sweden because it has half of Sweden’s population. While we have half the population, we also have only a tenth of the deaths. Much has been made that Sweden is reporting everyone who dies with covid-19, but similar measures are also in place in Norway. While some additional reported deaths are to be expected, I doubt it will come even close to Wuhan’s recent 50% revision.
I don’t have much experience with the German measures, but the situation in Denmark and Sweden is compared daily. Denmark has more or less the same measures in place as Norway, usually implemented a day or two ahead of us. Finland has also been discussed, and one point that needs to be made is that they have kept their cold-war supply stores, leaving them much more prepared with respirators and PPE. We are all watching closely what happens in Sweden, and are very thankful for the experiences that are transferable. Our re-opening of kindergardens (this week) and schools (partially from next week) is partially based on the lack of transmission seen in Swedish schools. Note that neither Denmark nor Norway has been in a complete lock-down, with only certain businesses where social distancing was hard to enforce being forced to close.
Norway did look like one of the hardest hit countries in early March, in part because we did proper exposure tracing. More could have been done at this early stage though. At one point we had more cases tracking back to Austria than Austria had recorded in total. As the measures were put in place March 13th, so did the testing criteria change to conserve testing materials. More details about testing are available in the daily reports (unfortunately only available in Norwegian), but we also publish daily modeling reports in English. I think some here might find them interesting.
Addendum: As I was writing this post, it was announced that the outbreak is officially under control here in Norway, but some measures are expected to remain in place for a long time still.
I made my comment because Denmark and Germany are re opening schools for young children. Sweden has had their schools for young children remain open while I understand high school and university have gone to on-line. In the US childcare and schools have been clusters of infection, not for the young who rarely test positive, but for the teachers and parents. https://www.nytimes.com/2020/03/27/nyregion/new-rochelle-coronavirus.html
https://www.washingtonpost.com/national/missouri-virus-cases-up-to-90-including-5-tied-to-preschool/2020/03/22/48023db0-6c60-11ea-a156-0048b62cdb51_story.html
I hope people are not risking lives on the Swede who said he was glad everyone had common sense not to be armchair epidemiologists. For sure we all should not distract or disturb the professionals. No one is beyond criticism or correction. “No risk” is a might big statement for a place where they do so little testing they only have 10 positives for every fatality.
Sweden has barred gatherings of more than 250, traffic is down, people are working from home. Not quite the darling of US open everything back up advocates. One estimate of the effective R of Sweden is 1.5. https://mrc-ide.github.io/covid19estimates/#/details/Sweden
I wish the US had been as successful as Norway. At one point with about 3000 positive tests 1/3 were from foreign travel, I think about 1/6 were from contacts with those travelers, 1/6 from contact with known cases and 1/3 unexplained. The US was not giving any in person advice or warnings to people coming back to the US much less doing any tracking.
It wasn’t clear that the death experiments you refered to was re-opening of schools and kindergardens, which I feel is very hyperbolic. Finland (mentioned earlier as a country under control) never closed school for the youngest either. Germany, Denmark and Norway are noe re-opening based in part on this experience, and also in part because we need some more controlled spread. It is very unfair to group these countries together with Sweden, as we are pursuing radically different strategies.
On a different note, a factor that struck me earlier today is the role of shoes as transmission. In the Nordic countries it’s customary to take off your shoes when you’re inside a private home, and the Asian countries that got it under control early all had some variation of decontamination station for shoes.
I fail to communicate. I called for non essential workers to stay home on March 11.
Workers are dying, Bus drivers, grocery workers, transit workers, 7 dead out of 600 cases at a packing plant.
Assume the young are not harmed and don’t transmit the virus back home, still the school workers, teachers, school bus drivers, and all are at risk when schools are open. Recent changes in Norway, ages 0 to 9, from 89 to 96 cases, 10 to 19 327 to 338, 20 to 29 1103 to 1123. total 7250 to 7345.
This tweet thread explains the problems with achieving herd immunity with this virus.
https://twitter.com/CT_Bergstrom/status/1251999295231819778
Reported deaths per million in New York state are 788/million as of April 21. 15302/19.4. Rough numbers for the age deciles are 50 to 59 606, ( 9.8 percent of fatalities), and 60 to 69 1288.
Deaths and injuries are systematically under estimated and under reported. Lots of energy was spent talking about 7 or 8 fatalities from the Diamond Princess. Some weeks later the death count is 13 in Japan, 1 in Australia and unreported in the US. 59 were in Hospital on March 26th. 15 on April 16th, of the Japan count of 702 positives. Roughly a case fatality rate of 2 percent of wealthy, healthy, not going to die this year that way people.
I think we are in agreement that Sweden’s experiment is problematic, but they are an extreme outlier in Europe. Norway has not seen any excess mortality (with the usual caveat of reporting time) yet. Most hospitals are now back in “green” readiness, and never had to go through the extreme triage phase seen elsewhere. We still have shortages of PPE and while test-equipment is still being rationed there is now a priority on testing those involved with schools and kindergardens.
I really, sincerely, empathize with the situation in the US, but situation can’t be compared with Denmark, Germany and Norway. The first measure taken in Norway was quarantining travelers from designated outbreak areas (mainly Italy) for 14 days, with full sickpay, and the ability to claim sickpay on your own declaration was expanded. I can’t quite remember how much, but it’s something like 3 weeks. This means that any worker that felt sick had the option of staying at home and claiming full wages, without having to consult their doctor.
When the main “shutdown” hit not much after, it was not the complete shutdown we’ve seen elsewhere. Most normal businesses have been open, although many have moved to telecommuting or reduced hours in shops, and people have been asked to stay in their normal geographic area. Public transportation has been available the entire time, but the front-door of buses have been closed in order to keep distance to the drivers (most payment is by app these days). All of this combines to a situation that is much more manageable than what you see in most of the US. There has been resistance to the Norwegian shutdown as well, but it has mainly taken the form of discussion, not civil disobedience.
Maybe good news for you. In the preschool case the parent attended a social event at the complex so adult to adult transmissions now seem to me to be the easiest explanation with the children not being involved.
One of the issues not being highlighted in the discussions about testing is the large percentage of false negatives. You can find articles on this quite easily, but most of the discussion has been about the lack of testing availability. I’m curious as to how this will affect the safety of my fellow citizens if you cannot safely say they are not a carrier. Having a bunch of Typhoid Mary people wandering about seems to me to increase the probability of a second wave of infections.
As the article states, and my wife’s doctor also said, if you have COVID symptoms, assume you have the disease.
https://www.healthline.com/health-news/false-negatives-covid19-tests-symptoms-assume-you-have-illness
“If you have covid symptoms assume you have the disease” is unacceptable for any American to have to hear
We are country rich with resources including an abundance of brilliant minds that can think and create our way out of this mess.
No one should have to live “as if” because our leader doesn’t want to get his hands dirty because it may spoil his re- election chances.
My son started showing symptoms on Saturday, my mom (high risk) is able to live semi-independently in a house around the corner because I can get over there at least once a day to fill in her gaps. My son has limited his time with her to her standing on the porch bossing him around as he does yard work.
We are fortunate, Saturday my son son scheduled a screening call for this morning (Monday) and was able to get tested at a drive up site a few hours later.
We started Saturday and we will be living “as if” for 2-3 more days.
I can deal with making all the adjustments we need to quarantine for as long as needed, what I would find impossible to accept is if I had to make all the adjustments for the required 2-3 weeks if I didn’t know if it was needed.
We are lucky, and equally lucky are the people that because of the stay at home order WON’T be getting a call from me telling them that because we were in contact, they too have to act “as if”
That people can have it without even realizing it is what makes living “as if” necessary.
Follow up.
My son called for his results and Thursday and was told it may now be a week before he gets his them.
I mentioned in another post that I know damn well every person who comes near the President is being tested daily (as they should) how dare this administration wash their hands (accidental pun sorry) of solving this national testing crisis.
The rules say I won’t be cleared to leave my house for two weeks after the last day he shows symptoms.
I feel fine, how many Americans would be willing and able to do that?
Another consideration of course is weighing the possibility that HAVING the virus may be a better use of my downtime.
Singapore reports most in country cases are from migrant workers barracks. Smithfield blames immigrant worker living conditions. High infection rates are reported from homeless shelters, war ships, cruise ships, prisons, long term care homes and assisted living centers. Close gatherings and communal dining seem common factors, both in the work place at Smithfield for example. The parties of hate rancorously twist this into a racial and xenophobic rant. Almost half of Queens is foreign born and all the rest don’t you know.
I’d say get ready for some twisted revenge when in 2-3 weeks those “give me freedom or give me covid” fools become a statistic people just can’t seem to get enough of.
The crux could be, (even if they are disposed and capable of intelligently managing inmates/virus based on contagion information), if they have the space to safely quarantine inmates and the ability and available staff to screen every single person who comes in the door, every time, and use that information well. The information that comes of this should indeed be informative.
“Herd immunity hopes dealt blow by report suggesting only 2%-3% of people have been infected”
https://www.theguardian.com/society/2020/apr/20/studies-suggest-very-few-have-had-covid-19-without-symptoms
OF course it is the WHO and who will believe them now?
Who else is there to believe at this point? And how much of the WHO’s lack of credibility has been deliberately created, while WHO must walk a very careful path with ALL governments and NGOs to obtain any data at all?
Not sure where to leave this post. NYT article this morning which sounds like an important update on the hypoxia vs pneumonia discussion.
Richard Levitan MD: the focus is on “silent” hypoxia, which could conceivably be easily and cheaply monitored well before the situation cascades into a pulmonary failure with one of those fingertip pulse oximeters your PCP uses as soon as you sit down in the office.
https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html
They also were available in pharmacies, along with BP monitors and glucose monitors.
I’ve had one since my first heart surgery, when I had an issue with fluid in my lungs. They’re very inexpensive and incredibly easy to use. I got it out when this mess hit, dumped the corroded batteries, cleaned the contacts and fired it up. I check every day or two just to make sure things are okay. I sensed early on this would be a leading indicator at least for me with already damaged lungs. I had no idea it would be so important for the general population.
Anyone who is moderate to high risk for the virus should have one of these on hand if they have a way of getting hold of it. They should check regularly even if they feel well.
not so cheap or easily available at this moment, like everything else associated with the virus business. but still, probably a good idea for a household.
Yeah, we have one as well. I have had asthma since was a kid, so it is kind of a critical metric, especially right now. My oxy level is not quite as high as I would like (usually 95-96) but not bad and quite stable. I’ll take that.
Thanks for the reminder!
My mom is high risk for a long list of reasons and does not own an oximeter.
I spent 15 minutes online and it looks like these are almost as hard to find as thermometers.
I did just score one at a distant Target that i will send my neighbor kid (who is going our errand boy for a while) go to go pick up for her.
I just had a thought. I wonder if those small pharmacies that do compounding have a lead on any of these items? The chains get them in weekly and they are gone immediately.
Dee-lusional.
The owner of Gold’s Gym was just on CNN.
“And if the states require masks our members will wear masks.”
Seriously this guy is going spend time and money doing whatever it takes to reopen his clubs and the thought hasn’t crossed his mind that a mask requirement will present a real problem when working out?
I wonder if there will be camera crews out there on day one so we can watch all the dedicated A types passing out on treadmills (spaced a perfect 6 feet apart) while watching Fox and Friends?
Ok now I have to go research masks that will make working out possible.
You can thank Trump’s pal and mega-donar Steven Ross (owner of Soul Cycle and Equinox) for health clubs being by far, the most ridiculous business to make the list of Trump’s phase one