Updated at 7:21 p.m.
More than a month after a major Covid-19 outbreak at the Northern State Correctional Facility in Newport began, Human Services Secretary Mike Smith offered two possible scenarios at a Friday press conference for how the virus had spread so thoroughly through the prison.
The first was that it came in from the outside, “through correctional officers that were coming in on various shifts.” That is how most prison outbreaks have begun, both in Vermont and nationwide.
“The other theory,” Smith said, “is that it’s being passed inmate-to-inmate, mouth-to-mouth thorough diverted narcotics and diverted drugs, medicated drugs that they have.”
Smith noted that medically-assisted treatments prescribed to inmates struggling with drug addiction are sometimes not swallowed and instead sold to other inmates. These transactions, he said, often happen with mouth-to-mouth exchanges that could perhaps spread Covid at the same time.
Smith emphasized that both possibilities were just “working theories” and that one or the other could prove incorrect. Speaking at the same press conference, Gov. Phil Scott said, “I think we have some theories, but nothing substantiated.”
Infectious disease experts, however, say the second theory couldn’t be more wrong.
“We have essentially no evidence that MAT [medication-assisted treatment] is a mode of transmission,” said Anne Sosin, policy fellow at the Dartmouth College Nelson A. Rockefeller Center. “I’ve never heard of such a claim made in any context. I was kind of shocked that it was even stated.”
Anne Spaulding, an infectious disease researcher at Emory University in Atlanta, said the mouth-to-mouth swapping of diverted narcotics would “certainly be an unusual route of transmission” — if that was, in fact, the case.
“Usually a more mundane process is responsible — close contact in the same airspace as an infected individual,” Spaulding said.
Al Cormier, facilities director for the corrections department, said Monday that medication diversion is something that his agency “battles every day.” He said the one unit of the prison where Covid has continued to spread in recent weeks is the same unit where the staff recently found an “excessive amount” of prescription medication that had been diverted.
Cormier said even though the facility is on lockdown, there are still communal bathrooms and rooms without doors where he said these transactions could take place. He said during the investigation, prison officials looked at phone calls and tablets and learned that residents were concerned that medication swapping may be causing viral spread.
“We know that that’s a prime conduit to spread the virus,” he said.
Cormier said the idea that the virus is largely airborne wouldn’t stop the spread through saliva.
“If it goes in your mouth, it’s going to get in your lungs, plain and simple,” he said.
However Josh Barocas, an infectious disease specialist at the Boston Medical Center, said that’s a “preposterous theory” that only serves to blame inmates.
“We have a year of information and data behind us to suggest that we could have had a much more informed answer to that question,” Barocas said of Smith’s theory. “Yet he decided to choose one that is incredibly implausible and unrealistic.”
Barocas said there is some MAT diversion in prisons, but “it’s not very common.” He said if there is a widespread diversion problem, that’s almost more concerning, because it means the people incarcerated at that facility aren’t getting the help they need.
“I think a big thing to ask ourselves is, if there is diversion, why are people diverting their medications for opioid use disorder within a correctional facility anyways? The answer is because the people there need treatment,” he said.
“(Covid-19) spreads through the air really readily in poorly ventilated indoor environments, and prison is sort of the optimal environment for transmission, really,” Sosin said.
She said the fact that the prison keeps reporting new cases is a sign that the virus is being poorly controlled at the prison, and preventive measures aren’t very effective. (Three new positive tests came back Monday, bringing the total up to 178 since the outbreak began.)
“I think it’s not only a scientifically bankrupt theory, it’s also a totally stigmatizing claim that really undermines efforts to address substance use in highly vulnerable populations,” Sosin said.
Tim Lahey, an infectious disease expert at UVM Medical Center, said he’s not upset that the Department of Corrections came up with a hypothesis like this, based on the information its staff had. In fact, he said, you need those kinds of hypotheses to do good science. But he said in this case, it seems like the Department of Corrections is going “straight from hypothesis to conclusion without data.”
“There’s a real danger in attributing a transmission event to a behavior that could lead to a sense in blame and a reduction in sympathy or measures of protection,” Lahey said. “People say, ‘Oh, he had a heart attack because he smoked, or liver problems because he was a drunk.’ We don’t want to play that role here when this population is so at risk.”
But Lahey said the more important question to him, rather than how Covid spreads in prisons, is when the people living there will get vaccinated.
“There’s good scientific evidence that prisoners are at high risk of contracting Covid-19, and it’s a good idea to take steps to mitigate that, starting with vaccination,” Lahey said.
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