Dr. Scott Bauer normally treats veterans at the San Francisco Veterans Affairs Medical Center. When the internist heard of an opportunity to volunteer at San Quentin State Prison during the coronavirus outbreak, he raised a hand.
San Quentin, a Bay Area-based men's prison and the oldest of its kind in California, has seen an amazing Covid-19 outbreak in recent months. About two-thirds of inmates have tested positive for the coronavirus and 25 people have died. Now, about two months after the outbreak, the infections are slowing down. Internal prison data shows there have only been 37 confirmed active cases of the virus and only three positive tests in the past two weeks.
While San Quentin and other prisons have seen their worst outbreak, it is not over for the men and staff imprisoned. It has been months for some patients since they first tested positive. And the road to recovery is stilted and slow.
Bauer had never been in a prison before. On his first visit in mid-July, he was accompanied by a correctional officer when he saw inmates on death row and in the medical clinic on death row. In other blocks he could move more freely. Many of the patients reminded him of the veterans he treats as they tend to be older and have comorbidities, meaning they have other medical conditions that could put them at higher risk of death if they get Covid-19.
Earlier this summer, several doctors from Amend, a group at UCSF and the University of California at Berkeley working to change the culture of correction, wrote an urgent memo about vulnerabilities in San Quentin. What these doctors saw alarmed them. That memo called for more local resources and a plan to combat overcrowding to contain the outbreak.
"We saw an incredibly fast transmission there," said Dr. David Sears, Director of Health Care Quality at Amend, in a July interview.
The group recommended some immediate reforms, including better ventilation, more quarantine rooms, and increased testing with a faster turnaround.
"The urgent resources San Quentin needs range from human capital to reducing environmental risks to rapid testing," the group wrote in the June 15 memo. "Failure to meet these urgent needs will have serious consequences for the health of those detained in San Quentin, custody, staff and health capacity of hospitals in the Bay Area."
Some of the measures appeared to have had an impact, including the release of around 1,000 inmates to reduce overcrowding. The prison also increased its testing program. However, the changes weren't made in time to prevent the virus from spreading rapidly and eventually infecting more than 2,000 people.
Bauer has now worked about a dozen shifts in prison, where he usually gets on at 8 a.m. and leaves at 5 p.m. A big part of the work is examining those who were treated in community facilities such as local hospitals and then returned to San Quentin after their symptoms were relieved.
Lots of Covid-19 patients outside of San Quentin I told him that for months after recovering from the coronavirus, they were still suffering from fatigue, muscle pain, shortness of breath and other symptoms.
Many patients still have persistent coughs, persistent fatigue, and a limited ability to exercise weeks after testing positive. Recently, Bauer said, San Quentin opened access to the farms.
He's also seen evidence of cognitive impairment, developmental delays, depression, anxiety, and some evidence of post-traumatic stress disorder in ventilated patients. It's hard for volunteers who have only been there for a few months to tell how much of this was from Covid-19 and how much was there before the infection.
"There is a very robust mental health system in prison and I know everyone has worked very hard," he said.
For Bauer, the experience was an "eye opener" because it helped him understand more generally how countries can have difficulty dealing with large numbers of people who still have symptoms in the long run, especially those with limited resources . He suspects it might weigh Health systems and providers outside prisons. One recommendation is to seek out pulmonologists who specialize in treating lung disease in places like San Quentin and share best practices for treatment for Covid-19.
Outside the prisons, hospitals set up specialized clinics for those who are still having problems. Doctors across the country are still learning why certain people have symptoms for so long while others regress faster.
"More direct access to people with expertise in dealing with symptoms would be helpful," said Bauer.