As the COVID-19 pandemic began to hit Virginia two years ago and medical providers scrambled to obtain resources, not every provider was treated the same.
For Thedra E. Nichols, director of medical health services at the Albemarle-Charlottesville Regional Jail and a certified family Nurse Practitioner, the first year of the pandemic was a series of escalating challenges as she and her dwindling medical staff worked to keep those incarcerated at the jail healthy and safe.
Though many in the area were caught off guard by the onset of the pandemic, Nichols said she had been following news about the virus since December 2019, spurred by fears her daughter could get sick during a planned spring trip to Europe.
The stress still weighs heavily on Nichols but when the virus hit locally the jail was more prepared than most.
“My team started wearing masks around two weeks before CDC suggested it and the whole jail started wearing masks a day before, just based on me researching and learning about prevention and trying to understand how it was going to affect us,” Nichols said. “I don’t like to talk too much about it because it was the worst time of my entire life.”
As medical director and a certified family nurse practitioner with nearly three decades of experience, Nichols was responsible for the health and safety of around 350 incarcerated people and around 150 jail employees.
That led to long hours of researching and collaboration with her coworkers and staff, working to develop safety plans as reality changed rapidly around them.
Although then-Gov. Ralph Northam declared a state of emergency in March 2020, Nichols said the jail would not see its first positive case amongst the incarcerated population until August of that year. By that point the jail officials had developed a quarantining process and reduced the incarcerated population through home electronic monitoring, but Nichols said they still could not get tests.
“The thing that makes me the most frustrated and upset is that there was zero guidance, nothing from the Department of Corrections, nothing from the state, nothing from the government,” she said. “I would call and ask to order some masks and other PPE and was told ‘You can’t, you’re not a frontline worker.’ And I was like, I’m a nurse practitioner, you bet your ass I’m a frontline worker.”
Nichols was forced to call for assistance from the University of Virginia Medical Center and her colleague Dr. Preston Reynolds to get the jail’s first possible COVID case tested, a time-consuming and complicated process. Throughout the pandemic Nichols said Reynolds and other medical colleagues have been an indispensable resource, helping each other pick up a perceived slack from larger institutions.
Nichols said the lack of guidance, resources and attention made her and her colleagues feel forgotten and neglected, a feeling that hasn’t subsided much in the intervening months.
“It’s very, very hard to work here. There are many challenges and the people are often sick because they don’t have access to good health care and they’re not educated about health care in general,” Nichols said.
“You have just multiple problems associated with the job already, even before the pandemic and so to get told just by so many people that we weren’t considered frontline workers was really rough,” she said.
Throughout the first year, Nichols said a bright spot was the unfettered support of the jail’s superintendent and Authority Board and cooperation from the security staff, all of whom she said listened to her guidance and took necessary precautions.
The cooperation among the staff was inspiring, she said, and for a long time the masks worn at the jail were obtained by the security team.
“We really pulled together and it was amazing to see people I’d hardly ever interacted with come up and say ‘Hey, I found this resource,’ or ‘could you use this?’” Nichols said. “We were forced to work together to keep ourselves and each other safe and that was the biggest plus from the whole experience.”
Despite their best efforts, Nichols said it was inevitable that a congregate setting like the jail would experience outbreaks. The first one came during a local surge of the delta variant and was likely contracted by an inmate while visiting one of the local courthouses.
Throughout the few outbreaks the jail has experienced — including a significant one earlier this year prompted by the highly contagious but comparably mild omicron variant — Nichols said a combination of quarantining, masking and vaccines helped prevent significant harm to the jail population and staff.
There have been no COVID deaths at the jail and only one major hospitalization, she said, and the origin of all positive cases are from outside the facility.
The jail fared much better than other jails in the state, Nichols said, and she has on many occasions been asked for guidance by other jail officials.
“We had the support of the administration, we had the support of the courts so that we could limit the number of people in here and we literally have a whole wing that we use just for COVID,” she said.
As with the rest of the country, Nichols said the jail is relaxing some of its safety guidelines, including reducing the quarantine time from 14 days to 10. However, as a self-described realist, Nichols said she continues to tell her colleagues at the jail to remain vigilant.
“I tell the staff all the time that they need to stop talking about what it was like before [the pandemic] because it will never be what it was like before,” she said. “If you keep bemoaning the way it used to be, you’re only going to let yourself down. You have to accept where we are now and know that it’s evolving and changing, but know that this sort of thing is never gonna go away.”
On a personal level, Nichols said she is feeling the same burnout that many in the medical field are experiencing. Although only six years away from retirement, she said she’s not sure she’ll make it there. She hopes she can.
“Everybody knows that I’m burned out, but they also know I wouldn’t leave them because we’ve got to plod through and continue to figure it out together,” she said. “People who work in corrections have this certain connection and we know the cost associated with keeping people safe is dramatic but we do it anyway.”