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A Rikers Island Doctor Speaks Out to Save Her Elderly Patients from the Coronavirus

We do have testing capacity on the island. They’re getting flu-swabbed. We have the capacity to test for other respiratory viruses, because there are lots of illnesses that are going around, and not everything that looks like COVID is COVID.

What happens to someone if you suspect they have the coronavirus?

They’re currently in the C.D.U. [Communicable Disease Unit], which is where we have capacity to take care of patients who have any kind of respiratory illness. People who have the flu also go there. It’s the unit that was built for TB outbreaks.

What is the Communicable Disease Unit?

There are these military sprungs [aluminum structures with a white plastic covering] that were built to have capacity to take care of TB patients and other patients who needed to be in isolation during prior jail eras. They have rooms that are actually a little bigger than the average cell. And they have some negative pressure rooms that have these antechambers, so you don’t just open the door and have air mixing. It’s a little bit more of a clinical unit. There is nursing and medical staff.

I have read that there are seventy cells in the Communicable Disease Unit. Is that accurate?

I’m not positive about it. Whatever there is, if there was an outbreak, we’re going to have more patients than we can house there. What are we going to do when we exceed our capacity? They’re talking about it all the time—how we would identify additional areas to house people.

What are you doing to protect your patients who are at such a high risk if they do get infected?

For the last two weeks, we have been using the term ‘bubble wrap.’ That’s not an official public-health term. What we mean is, to the best of our abilities, we want to try to preventively protect the people we are most worried about getting sick. That means that, instead of having sixty- and seventy- and seventy-five-year-old guys—or people who have serious illness—spread all over in G.P. [the general population], we are trying to find them, make sure that they are not sick now, test them if we can, make sure that they are negative, and then put them together so we can have some sort of increased surveillance about what is going on in those dorms specifically, and try to protect those units, limiting what staff are going to go into those buildings, screening staff even more stringently there.

I walked around last week and talked to patients in our infirmary about COVID, and we had these sort of dorm meetings. They are smart and logical and know how at risk they are. They said, “You’re coming in and out. Officers are coming in and out. How do we know you don’t have it?” And they’re right. We know that there is likely an asymptomatic spread of this disease. So when staff and officers and others are coming in and out, we just cannot make a commitment that we can protect them. It’s not a fortress.

What was the mood like in those meetings you had with your patients?

Incredible anxiety and fear. You cannot implement effective social distancing in a room that sleeps forty men. You cannot implement effective social distancing when those forty men are using two or three sinks and one of them may be broken. You cannot implement effective social distancing when the staff interacts with all of them and has to touch all of them in the course of a day.

They know that better than I know that. So when I was talking to them, I was sort of feebly saying, “We want to try to encourage people to be even more diligent about hand-washing, etc., etc.” They were, like, “O.K., we don’t have our own cleaning supplies.” They can’t wipe down their own surfaces. They have to wait for someone to come in and do that for them.

Visits were cut off, which was an important public-health intervention that only under the most extraordinary circumstances would I be supportive of. But there aren’t yet alternatives for people to be able to connect with their communities, and it’s the most stressful time for both them and their family. There are one or two phones in a lot of these areas, and these men are lining up to use them and all touching the same phone receiver.

Does anything happen to the phone receiver between each caller?

In theory, we should be wiping that down. But does it happen consistently? And are there supplies readily available that can be easily replenished if they run out? That is the kind of thing that jail is not great at on the best of days.

Earlier this week, you and some of your fellow-doctors on Rikers took to Twitter to urge officials to shrink the city’s jail population. Activists and public defenders had made the same arguments, but for medical staff on Rikers to push for this publicly seemed unprecedented. What prompted you to speak out?

We have been having incredibly sober conversations for weeks about what to do. And we started, behind the scenes, sort of pushing where we could. And as time has gone on and the crisis has escalated, we have, I think, as a group, come to a place where we have thought that the moral calculus has changed and our voices needed to be heard on this issue. It’s totally unprecedented for any of us to speak publicly about our work this way. It’s an absolute reflection of the degree of concern that we all share.

Depopulating in this case is not letting a dozen guys out or two dozen guys out. It means pushing as hard as possible for hundreds of people to get out so that the jail population is decreased enough that you don’t just benefit the people who are released but you also benefit those who are left behind—and the staff who take care of them and the officers who take care of them.

How did you find out that an individual on Rikers had been infected with the coronavirus?

My general understanding is he was in G.P. He self-reported some symptoms. He was immediately isolated, masked, taken to the C.D.U., tested, cared for in the C.D.U., which is appropriate for him. He’s not unstable. He doesn’t need to be in the hospital. I think his symptoms were not that severe, but then the test came back positive.

What are you most worried about happening in the weeks and months ahead?

I have been kept awake at night every night for the last two weeks, incredibly anxious about viral spread throughout the jails that makes many people sick at one time. It’s a microcosm of what we’re worried about in society. Too many people get sick at one time. It overwhelms our capacity to take care of them. It penetrates the bubble wrap, and my guys who are at high risk start getting sick. That really overwhelms our capacity to take care of them on the island, and they end up going to the hospitals that are already overwhelmed.

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