The Cummins Unit in Lincoln County had a reported 348 positive yesterday with more expected as further results come in. Gov. Asa Hutchinson said yesterday that most of those with positive tests were asymptomatic. To put this in context, let’s look at a timeline of the outbreak (as best we can with limited information) and compare that to other outbreaks in congregate settings.
First, the timeline:
The number of positive cases in Lincoln County (population 13,695) is 10. Fifty people had been tested, showing that 20% of the tests came back positive. This percent positive rate was about 13% higher than the state’s percent positive rate. It is unknown how many, if any, of these early cases were linked to the Cummins Unit.
One new case in Lincoln County is reported, bringing the county total to 11.
Gov. Hutchinson announced that 43 out of 45 prisoners in one barracks at Cummins had tested positive for Covid-19. These tests were done by the Arkansas Department of Health, which has a turnaround time of around 1 day. Therefore, we can assume that there were 43 positive inmates on April 12. Dr. Nate Smith would later say that several inmates from the infected barracks had transferred to other barracks before the first case was identified. The county as a whole reported 45 positive cases on April 13, leaving 2 cases that may or may not have been connected with the Cummins Unit.
Gov. Hutchinson said that the state was continuing to test within Cummins, but there were no new positives to report. Dr. Nate Smith, director of the Department of Health, said 10 staff had tested negative.
No new updates are given on the Cummins Unit, however Lincoln County reports 3 new cases. These are likely from Cummins as Dr. Smith would say the next day that 46 inmates had tested positive – an increase of 3.
Dr. Smith said that 46 inmates at Cummins had tested positive. He said the state was awaiting further test results. No staff had tested positive.
Dr. Smith said there were 83 new positive cases at Cummins, bringing the total to 129. He estimated that around 300 prisoners had been tested. The Little Rock Veterans’ Affairs Hospital was assisting with testing prisoners from Cummins as the VA had extra capacity in its lab. Of the 83 new cases noted, only 33 new cases were listed for Lincoln County in the state database. Dr. Smith said this discrepancy was due to the need for manual entry of the positive tests from the VA. A team from the Arkansas Department of Health developed a plan to help segregate the prison into infected and non-infected barracks.
It was reported there were 230 positive inmates and no positive staff at Cummins. Gov. Hutchinson said that the 44 new cases statewide did not include cases from Cummins. Sixteen new cases were announced in Lincoln County.
An additional 118 inmates were reported positive for a total of 348. In addition, six staff at Cummins tested positive – the first positive cases among staff.
The Governor said the state has tested almost 1,400 inmates at Cummins, comprising all of the inmates who are housed in the main facility. Around 974 tests were done between April 17-18 with assistance from the AEL Lab in Memphis. The state has received a total of 634 results, 348 of which were positive.
The prison had been segregated into 8 positive barracks and 7 negative barracks. Gov. Hutchinson said almost all of the prisoners were asymptomatic, and only 3 had been hospitalized. The state database listed one new case for Lincoln County.
The first cases specifically linked to Cummins were reported on April 13 (43 out of 45 in one barracks). We don’t know how long the virus had been spreading within the barracks. There had to have been at least one symptomatic case that led officials to begin testing in the first place. Since it takes, on average, 5 days for symptoms to develop after exposure, we can say the spread began at least before April 8. In a normal setting, one would think the spread began quite a bit before that to reach a 93% infection rate in that barracks. However, in a congregate setting with no immunity among the confined, spread would be rapid.
A full 55% of inmates whose tests have been returned were positive. Most of the cases were asymptomatic as of April 19. Three people had been hospitalized. Here’s how this compares with studies in other congregate settings.
The Boston Healthcare for the Homeless Program conducted universal testing at a homeless shelter in Boston and found that 36% of the 408 residents tested were positive for the virus. Only 7% had a cough, 1% had shortness of breath, and less than 1% had a fever. However, there was no follow up on this study to determine what percentage developed symptoms over time.
A study from a nursing home in Washington State showed that 30% of the residents were positive. While initially 57% of the positive cases were asymptomatic, a majority of those developed symptoms over the next week. However, it was a small study (only 23 participants), and the residents of a nursing home have different expected outcomes than a prison with a more varied population.
On the Princess Cruise Ship, 21% of those tested were positive. Fifty-one percent of the people testing positive were asymptomatic at the time they were tested. It’s estimated that 60% of these went on to develop symptoms, leaving just 18% truly asymptomatic throughout the course of the virus.
Based on this, we can expect to see large numbers of inmates develop symptoms over the coming weeks. This virus is a marathon, not a sprint, for many people. It has a fairly long period before symptoms develop (up to 2 weeks). The first week tends to be pretty mild for most – something akin to the flu. The second week of symptoms is the real kicker. That’s when it settles in the lungs of people with severe cases and the course of the illness deteriorates. Hospitalization can be lengthy, with many patients on a ventilator for weeks.
So much is unknown about this virus, and there are few instances of universal testing of both symptomatic and asymptomatic people. With its universal testing, Cummins provides an opportunity for a snapshot into how the virus spreads. However, the first priority is on protecting the inmates and staff, who are likely in a for a long haul.