When patient rotations for medical students were canceled due to the coronavirus pandemic, UND third-year medical student Brenna Espelien was left feeling a little sidelined. So when she saw an opportunity to return to patient care, she jumped at the first chance.

Espelien was one person on three four-person immunology teams to conduct mass testing at the North Dakota State Penitentiary two weeks ago. About half of those teams are made up of medical student volunteers, said John Hagan, a UND School of Medicine professor who also oversees medical care in Department of Corrections and Rehabilitation facilities. Espelien had worked in the prison one other time, on a mental health rotation as part of her education, but her latest task at the penitentiary - donning full-body personal protective equipment and administering COVID-19 tests to state prisoners in their pods - was unlike any she'd been asked to do before as a medical student.

"I was really excited to be able to talk to patients and do hands-on patient care for the first time in months," she said. "It was good to get back in the swing of things, and I really enjoyed talking to the residents there. A lot of them were joking and in fairly good spirits, with the whole thing going on."

It's widely acknowledged that prison and jail populations are particularly vulnerable to COVID-19. Due to the confined space, prisoners' inability to practice social distancing, and staff's limited ability to isolate sick inmates, once the virus is introduced to a prison population, it has been found to spread efficiently.

DOCR took quick steps early in the pandemic to prevent the spread of the virus in their facilities. They closed their doors to new intakes on March 13, and Hagan said North Dakota's prisons have reduced their population by about 15% - but mass testing is still essential for protecting those populations, he said.

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Two weeks ago, Hagan put out a call to his medical students and residents looking for volunteers for the immunology teams in the prisons.

"We've actually had more requests to come out than we have slots," Hagan said. "I love the fact that these are adults who are in advanced learning, and they're eager to get out and take care of sick people. I'm pretty proud of them."

Espelien, an Albuquerque native who completed her undergraduate studies in San Diego, was drawn to North Dakota by the quality of UND's medical school and family ties in Park River, and, going into her fourth year of medical school, she aims to apply for an OB/GYN residency. Her work in the penitentiary was part of Hagan's internal medicine rotation. She said she's not aware of any other medical school that offers rotations in state prisons.

Her work with the immunology team began Wednesday, May 13, and lasted three days, the time it took to complete the mass tests in the North Dakota State Penitentiary. Mass tests also were completed in four other DOCR facilities, but only the testing event in the NDSP yielded any positive test results - four people in custody reportedly tested positive for the virus, according to the DOCR website.

"That'll be good information for them to know, and they'll be able to isolate those residents and, hopefully, keep all the fellow residents and staff members safe," Espelien said. "I think it's important to keep doing this epidemiologic testing at the penitentiaries to make sure that we can keep any outbreaks controlled and make sure that this vulnerable patient population is protected."

Four positive results were initially reported in the Missouri River Correctional Center in Bismarck as well, but the case count in MRCC was updated to zero after the North Dakota Department of Health reported that malfunctioning testing equipment yielded 82 false positives statewide last week.

Espelien said tasks were split among the team members. One person screened patients' temperatures and asked questions about symptoms, and another team member ensured samples were labeled properly and the correct paperwork was filled out. Espelien was one of the team members who administered the swab tests.

Residents of the penitentiary had the option to either take the test or decline the test and isolate for 14 days. Espelien said that, though a few people weren't happy about the tests, which can be uncomfortable to take, she said everyone was pleasant and had generally positive attitudes.

"I think that there are just some questions about how things are going outside of the penitentiary, since they only get to see what's on the news or what they hear from family members and staff," Espelien said. "So some of them were asking me questions about when antibody tests will be available, or how the throat swab is different from the nasal swab, and if one is better than the other. So I guess there was an air of curiosity, more than fear or worry or things like that."