Michigan officials will likely never know if the cases of 115 state prisoners who tested positive for COVID-19 for a second time were instances of reinfection.
That’s because the state doesn’t have the samples to perform genomic sequencing, an analysis to confirm whether someone has had COVID-19 twice or if a subsequent positive test result is the detection of leftover virus. The technique requires specimens from a person’s initial and subsequent positive tests, but labs don’t typically preserve samples for the long term.
“We do not have first and second positive samples for any of the MDOC inmates and are not able to confirm information about these cases,” Lynn Sutfin, spokeswoman for the Michigan Department of Health and Human Services, said in an email. “Although the MDHHS lab does not discard samples, this is not a requirement for commercial labs which is where MDOC samples were sent for testing.”
As of late November, the Michigan Department of Corrections had identified 115 prisoners who were diagnosed with COVID-19 once and later tested positive again after 90 days or longer.
Reinfection means a person was infected once, recovered and became infected again. The Centers for Disease Control and Prevention says it is possible, but rare, to get COVID-19 again 90 days after an initial infection. A subsequent positive test before the 90-day mark would likely be lingering infection, experts say.
The time frames between the 115 prisoners’ tests ranged from 91 days to 246 days, according to information provided by MDOC.
Sutfin said MDHHS has heard anecdotes about reinfections in the state, “but does not have samples or case information to confirm this information.”
MDHHS started a review of the prisoners’ cases, and as of late December, officials were seeking a partnership with the CDC, Sutfin said.
Dr. Amish Talwar, a medical officer at the CDC, said his agency learned about Michigan’s potential reinfection cases in correctional facilities the first week of January.
“Given the current evidence relating to these possible reinfection cases, it is challenging to establish whether these are reinfections and what are the viral transmission chains, if any, among prisoners and staff,” Talwar said.
COVID-19 samples being run in the lab.
The CDC “is now exploring additional ways by which it can support [MDHHS’s] ongoing investigations into similar cases moving forward,” Talwar said.
Potential avenues for support include performing genomic sequencing and viral culture tests, Talwar said.
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A viral culture test, which requires only the most recent positive specimen, can determine if someone has a virus that can still infect other people. A positive viral culture result would suggest, but not confirm, reinfection, said Dr. Matthew Akiyama, assistant professor of medicine at the Albert Einstein College of Medicine in the Bronx.
Genomic sequencing is said to be the gold standard for confirming reinfection. But that process would require access to both positive samples, meaning labs contracted by MDOC would need to save positive results for an indeterminate period of time.
Sutfin did not respond to a question asking whether MDHHS is requesting that private labs store samples to try to confirm possible cases of reinfection going forward. MDOC spokesman Chris Gautz said MDHHS has not given the department any instruction on whether to save positive samples for later comparison.
NxGen MDx, a private lab in Grand Rapids that has contracted with MDOC to test nasal swabs, typically retains all positive samples for 60 days, irrespective of their source, said Jacqueline Peacock, director of laboratory operations.
Peacock did not comment specifically on the lab’s storage of MDOC swabs. She said the lab would be willing to “expand our capacity to retain samples” based on clients’ needs.
MDOC did not provide the Free Press with a complete list of labs that it contracts with to process COVID-19 tests.
Dr. Adam Lauring, associate professor of infectious diseases and microbiology and immunology at the University of Michigan, previously told the Free Press that prisons would be among the most likely settings to see reinfections because of the potential for re-exposure.
Ernest Hall, who is incarcerated at Thumb Correctional Facility in Lapeer, first tested positive for the virus in mid-May with a number of COVID-19 symptoms, including nausea, headaches and loss of sense of smell and taste. Hall said he tested positive again in early October, but was asymptomatic.
“This is like a test tube or a petri dish,” he said. “Everybody’s on top of each other, so this is the perfect environment for people to be reinfected.”
Hall said he is frustrated by the fact that he’ll never know for sure if he was reinfected with the virus and if he remains at risk.
“They don’t take it serious because we are convicted felons,” he said. “They don’t value us. Period.”
Gautz said the department leaves it up to experts to determine whether a second positive result is a new infection or a continuation of a previous infection. Prisoners who test positive for a second time are treated as a new COVID-19 case and handled the same as other prisoners who are positive.
“I think knowing is important, which is why we do so much testing, and … obviously we can make sure we’re providing the appropriate care,” he said.
William Motten, who tested positive in mid-May and then again in late October at Thumb Correctional, said it feels like MDOC “is using us like guinea pigs.”
Motten said he has doubts about his possible reinfection due to unsubstantiated rumors that possible cases of reinfection are actually false positives.
Experts say false positive results from polymerase chain reaction (PCR) tests are rare. When false positives do occur, they are thought to be due to lab contamination or other problems during testing, according to an article by the publishing division of Harvard Medical School.
“By me not knowing for certain, it has kept me in a state of ‘OK, maybe I don’t got it, I can’t have it,’” Motten said.
That uncertainty added a layer of stress to his 10-day quarantine at Carson City Correctional Facility with other prisoners who’d tested positive.
“People were falling out, going to the hospital, and I’m sitting up there right next to them,” Motten said.
Akiyama said if MDOC’s data are correct, “it just appears to be indisputable that there are a large number of reinfection cases occurring in the Michigan prison system” because the false positive rate for PCR tests is very low.
Sutfin, citing the CDC, said reinfection happens in “exceedingly rare circumstances.”
Scientists have confirmed reinfection cases in Hong Kong, the United States, Belgium, Ecuador and India.
As of Jan. 12, there were 33 cases worldwide of confirmed COVID-19 reinfections, and 2,387 cases of suspected reinfection, according to the COVID-19 reinfection tracker run by Netherlands-based BNO News. Thirty of the 33 cases were confirmed through genomic sequencing. The average interval between reinfection of those cases is 87 days, just shy of the CDC’s 90-day threshold. Per the CDC’s recommendation, MDOC does not test people as part of its mass testing efforts for 90 days after their initial positive test.
Greater numbers of suspected reinfections are popping up around the world, from Brazil to Sweden to Qatar. But due to the resource-intense process of confirming reinfections, they remain suspected cases. ESPN recently reported that multiple NBA players have tested positive for a second time.
“We’ve had a suspicion that there are more reinfection events occurring than we’re accounting for,” Akiyama said. “I think the main reason for that is we’re not testing enough, or at least we’re not testing enough to capture these reinfection events.”
Infectious disease experts have said that they would expect someone who becomes infected with COVID-19 for a second time to be asymptomatic, as was the case with the 115 prisoners, according to MDOC. The vast majority of reinfection cases are likely going unnoticed, Akiyama said.
But prisons, like other congregate settings where COVID-19 can spread quickly, typically have a more robust testing schedule than the general population. Michigan prisoners and staff are tested weekly at facilities that have active positive cases.
Akiyama said prioritizing incarcerated populations for the COVID-19 vaccine would be the next step in tackling suspected ongoing transmission. Since March, 23,347 state prisoners — 58% of all people incarcerated at MDOC facilities throughout the pandemic — have tested positive for COVID-19, and 124 have died.
Michigan prisoners are included in the initial phases of the state’s plan for the vaccine rollout if they are 65 and older or have a pre-existing medical condition that puts them at high risk of a negative COVID-19 outcome, according to MDOC. The rest of the prisoner population will be offered the vaccine when it is made available to the general public.
A coalition of groups that advocate for prisoners and civil rights is calling for the state to prioritize all incarcerated people. On Wednesday, eight organizations signed on to a letter with the ACLU of Michigan urging Gov. Gretchen Whitmer and MDHHS Director Robert Gordon to prioritize prisoners “just as you prioritize those living in other congregate living settings and correctional staff.”