Richmond City Health District Archives

With Pfizer and Moderna vaccines reaching increasing numbers of Virginians, the commonwealth is eager to be through the worst of the COVID-19 pandemic. However, it’s become clear in recent weeks that we still have a long road ahead.

As Virginia grapples with record numbers of COVID-19 cases, overwhelmed hospitals and medical staff, and lagging vaccine distribution – there is still a long road ahead before a return to what feels like normal life.

After the FDA authorized the distribution of the Moderna and Pfizer vaccines in mid-December, a sense of optimism spread throughout the country as the federal government announced 20 million Americans would be vaccinated by the end of the year.

But once again, the pandemic brought its own set of unexpected challenges and by the time the ball dropped on Dec. 31, only a little over 2 million people had received shots.

Virginia wasn’t exempt from this nationwide lag. As of Jan. 10, the state received about 510,000 vaccine doses from the two manufacturers. But only 177,945 doses were administered to people in the Commonwealth. The significant gap between the doses received and administered has been attributed to a combination of a temporary glitch in the state’s recording system, some facilities holding onto second doses, the ongoing surge of COVID-19 cases, and challenges faced by facilities administering the vaccine.

Despite the lags, Richmond and Henrico Health Director Danny Avula, recently tapped by Governor Ralph Northam to lead the state’s vaccination effort, remains confident that all Virginians should have access to the vaccine by summertime.

“I think this is probably the most hopeful time that we have seen since the pandemic began last March, because now there’s actually a potential way out,” Dr. Avula says. “If we just get to a place where we have enough of the population vaccinated, we will slow transmission enough to see the pandemic start to subside. Now that question is, can we get enough people vaccinated?”

Systems built by the federal government through the CDC have not worked as smoothly as they needed to, Dr. Avula says, explaining the reasons behind the statewide lags. While the CDC is now revising these systems, so is Virginia.

Right now, the Commonwealth is getting about 110,000 doses of vaccine a week, between the Pfizer and Moderna vaccines – and that number is expected to increase.

As the production and delivery of vaccines ramp up, so will the weekly vaccine allocation. At a press conference on Jan. 6, Governor Northam announced a new initial goal of 25,000 vaccinations a day – expecting that goal to increase to 50,000 as they get more supply. If the state manages to reach that goal, all Virginians could have access to the vaccine by summertime.

“It’s still going to take some time to get everyone who wants the vaccine,” Gov. Northam said, during a virtual co-event featuring Dr. Anthony Fauci on Jan. 8. “We’re committed to getting there as expeditiously and accurately as possible. And I hope the majority of Virginians will get vaccinated. The vaccine is the way to stop this virus. It’s our path forward to recovery. And it’s the clearest way we’re going to get back to something that feels like normal.”

*A staffer at Central State Hospital in Petersburg receives a vaccine. Photo via Virginia Department of Behavioral Health and Developmental Services/Twitter*

But there is still a long – social distanced and masked-up – road ahead. The distribution and administration of the vaccine is complex, as both vaccines require two doses, which must be spaced out. The Pfizer vaccine requires a second dose, also called a boost, 21 days after the first shot, while the Moderna vaccine requires a boost 28 days after the first dose.

Studies show that effectiveness is highest 14 days after the second dose, explains Amy Popovich, nurse manager of the Henrico County and Richmond City Health districts.

“If you increase that timeline to when the general public will have access to the vaccine … it details how important it will be for everyone to wear masks for some months to come,” Popovich says.

Many questions remain unanswered. While scientists know the vaccines are effective protecting people from getting sick from COVID-19, Lisa M. Lee, an epidemiologist at Virginia Tech explains, it is still unknown whether it will protect us from getting infected, or from transmitting the virus to others.

This difference is key as we attempt to reach herd immunity – having at least 70 percent of the population immune from the virus.

“I think of it kind of like a doughnut. In the middle are people who can’t get vaccinated, and around that middle are all the people in the community who have immunity. They’ve either had the disease or … they got the vaccine, however they got it. But they have immunity,” Dr. Lee says. “And then … if a new infection comes into the community, it bounces off the edge of the doughnut and can’t get to the people in the middle. And that way, it protects them. And that’s the doughnut part, is the 75 to 85 percent.”

As long as that determinant remains unknown, experts are unanimous: continuing to wear masks and social distance will be critical to reach herd immunity.

“We want you all to get vaccinated for your own protection, for that of your family and for your community,” Dr. Fauci said during the Jan. 8 event with Governor Northam. “However, we must remember that this is not a substitute, because until we get the overwhelming majority of the population in this country … there still will be the danger lurking in the community about transmitting viruses. And for that reason we need to continue to adhere to public health measures, until we get this outbreak completely crushed.”

A return to normalcy feels further and further away as the state attempts to speed up vaccine distribution. As many local health districts still remain focused on vaccinating eligible citizens in Phase 1a, the Virginia Department of Health announced that 11 health districts would begin Phase 1b vaccinations the week of Jan. 11.

Governor Northam announced that 1.2 million people will be eligible for the vaccine in Phase 1b – a group that will include frontline essential workers, people age 65 and older, and people living in correctional facilities, homeless shelters, or migrant labor camps.

“I think people ought to recognize that this is an extraordinarily complex logistical challenge — to do vaccination at this scale across the state, with this many different communities, with different capacities, with different needs, with different philosophies,” Dr. Avula says.

All areas of the Commonwealth are expected to move to Phase 1b before the end of January, according to VDH. As for a potential beginning date for Phase 1c, which would include 2.5 million Virginians, the timeline becomes blurry. VDH announced it will take between several weeks and multiple months to vaccinate Virginians who fall into Phase 1b.

Just as Virginia needed some time to hone its testing infrastructure, the trajectory on vaccines is going to follow a similar curve, as the state moves through its phases. In two to three months, we might witness a flip, where the supply of vaccines will exceed the demand, Dr. Avula says.

*A Virginia Department of Corrections employee receives a vaccine. Photo via VADOC/Twitter*

Then, there will only remain one challenge: overcoming the skepticism toward the vaccine, especially within minority groups.

“I think it’s important [in] public health to understand that there’s legitimate hesitancy, particularly in our Black and brown communities,” Nurse Manager Popovich says. “And it’s our role as public health to ensure that there is equitable access to facts and to the information that’s coming out from reliable sources.”

To address vaccine hesitancy within her own health district, teams connected with individuals and communities through listening sessions, “vaccine town halls,” where health district staff answer questions. But Popovich recognizes that to overcome the hesitancy, knowing someone who got the vaccine will be the most efficient to increase trust.

“Then my hope is that that’s what happens in the general population as we start to open up other phases,” said Dr. Avula. “You’re gonna have people who are just more hesitant, and want to see it and want to make sure that the people they know aren’t harmed. So they’re gonna wait, and they’re gonna watch. And hopefully, as they see that people are having good success with vaccination, they will want to get vaccinated themselves.”

In just a couple of weeks, we can expect to see new vaccines entering the playing field: the Janssen vaccine, manufactured by Johnson & Johnson, and the AstraZeneca vaccine — which has already been approved in the UK, Mexico, and other countries, but still needs to complete the US approval process.

“There is definitely a light at the end of the tunnel,” Popovich says. “Also, we are in the highest number of cases of COVID-19 across our nation, and we hit the devastating mark of one in 1,000 Americans having passed because of COVID-19. And so [there is] a sense of urgency to continue to be diligent, as exhausting as it is. To wear masks, to social distance, to make the safest choice possible given the situation. Because lives are at stake.”

Top Photo via Schott.com

In the Richmond City Jail, COVID safety protocols look a lot like torture.

If anyone doubts how little the City of Richmond values the emotional well-being of incarcerated people, they should look no further than the Richmond City Jail’s harsh (and unacknowledged) quarantine measures. Over the course of five months, from June through October, Theresa Young spent a total of two and a half months locked for 23 hours per day inside a small cell. She was not put in isolation because she had done something wrong. (In fact, she says, staff recognized her as cooperative and dependable, asking her to clean as a volunteer.) Nor was her confinement an anomaly or a violation of jail policy. Young’s torturous months of medical isolation were simply incarceration-as-usual in RCJC during the era of COVID-19.

Even more than some other jails in the area, RCJC has been aggressive in using solitary isolation to combat the coronavirus. Though numerous lawyers, activists, and incarcerated people confirm that RCJC’s stated “two-week quarantine” policy means two weeks of emotionally trying and legally inconvenient isolation, the Richmond City Sheriff’s Office (RCSO), which runs the Richmond jail, has failed to publicly acknowledge the details of its quarantine procedures. This failure — perhaps a success in the minds of some — has effectively obscured from judges, prosecutors, medical officials and the public the profound callousness that underlies the jail’s response to COVID-19.

“It’s hard for us as advocates,” Young’s lawyer, Lauren Whitley said. “Our clients are telling us things, and we have no reason not to believe our clients, and then nobody will verify it. It’s this weird form of gaslighting.”

The psychological risk of isolation

Over the course of her life, Theresa Young has been diagnosed with both paranoid schizophrenia and bipolar depression. She suffers from claustrophobia and has a history of childhood trauma. Not surprisingly, she described her time in medical isolation as a painful, retraumatizing experience. “I’m one of those that can’t be confined in one spot. I even kind of flip out when I’m in an elevator,” Young said. “This has been the roughest time being locked up.”

Young first entered solitary confinement in June after a court appearance in Henrico. Unlike some other local and regional jails, RCJC requires that all incarcerated people returning from court spend roughly two weeks in a quarantine pod. According to Young, she has been in solitary medical isolation for 15 days on three occasions, twice after returning from court; and for a full month on another. All of these confinement periods meet the UN criteria for torture.

“Just being in isolation is a horrible experience,” said Yohance Whitaker, an organizer with the Legal Aid Justice Center, who works with incarcerated individuals. “It’s taxing psychologically and emotionally and physically.”

During her periods of solitary confinement, Young struggled to keep in contact with her four-year-old daughter. “It’s not like being in isolation you can be on the phone whenever you want,” Young said. “When you’re on the fifteen days, you only come out for an hour, or half an hour. You have to choose if you want to be on the phone, shower, [or] do whatever on the time out.”

Court appearances mean a lose-lose decision

RCJC requires all defendants who choose to appear in person to undergo a two-week lockdown after returning to the jail, despite the fact that they appear dressed from head-to-toe in Tyvek coveralls. As a result, Young and many like her must weigh the trying, potentially traumatizing experience of solitary against the probable legal cost of appearing before the judge on a video monitor, dressed in jail clothes. As one might expect, studies show that judges tend to be less sympathetic to defendants who attend trial remotely.

“There’s something to be said for looking someone in the face when you’re going to lock them up or sentence them to imprisonment,” said Richmond’s Head Public Defender, Tracy Paner. “When they are not present in the courtroom, when they’re just a fuzzy image on a screen, the sentencing is harsher; the bond decisions are less favorable.”

In October Paner told RVA Mag that, fearing isolation, none of her clients have chosen to appear in court since the policy began. “Folks who have mental health issues, pre-existing, suffer particular harm when they’re placed in isolation,” she said. “So I have folks who are like, ‘Ms. Paner, I can’t, I just can’t do it.’ I encourage them but I respect their wishes. I don’t want to hurt my clients.”

Defense lawyers handicapped by lack of transparency

Although RCJC’s use of isolation in quarantine is common knowledge among defense lawyers, activists, and people incarcerated in RCJC, the Sheriff’s Department has yet to acknowledge the jail’s widespread use of medical solitary confinement. An RCJC spokesperson ignored RVA Mag’s question and follow-up email regarding the use of solitary in medical quarantine, and both Richmond Commonwealth’s Attorney (CA) Colette McEachin and Danny Avula, Director of the Richmond City Health District — the top officials at two public entities that work closely with the jail to coordinate a pandemic response — told RVA Mag they were unaware that RCJC’s medical quarantine involved long periods of solitary confinement.

“I think one of the challenges of this work is that nobody has a sightline into what’s happening there,” Avula told RVA Mag.

For her part, CA McEachin was skeptical of claims that individuals in quarantine were kept in solitary. “I don’t believe people are actually locked in a cell for 23 hours,” she said. “Obviously, I don’t want anybody punished or treated in an unhealthy, non-judicial way so, yes, it would be concerning if I thought that people were literally being locked in a cell with no opportunity to stretch or walk around for 23 hours a day. If there is no other way to do two things at the same time — which is to keep people in the jail until the court releases them, and keep those people who are in the jail in a socially distant, hygienic manner — and this is the best the sheriff can come up with, that may be the best that she can come up with. But I literally don’t know.”

Young’s lawyer, Lauren Whitley, said what most frustrates her is the misinformation or lack of information about what is happening inside the jail. Although RCJC is currently reporting zero COVID cases, after a large outbreak in September, Sheriff Irving has not been transparent about whether widespread testing has continued inside the jail. The result, according to Whitley, is that prosecutors and judges assume the jail is a safe environment, when that may not actually be true.

“You go in front of a judge, you want to advocate for your client credibly, and effectively, but we can’t do that,” Whitley said, “because there’s no information, or just blanket statements that seem inconsistent with our client’s experiences.”

Top Photo via CGL Companies

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The Psychological Cost of RCJC Quarantine