To Marie Neba, an inmate at FMC Carswell, coronavirus concerns have made talking on the phone feel dangerous. During a call from the Fort Worth prison in early April, she was concerned about the germs from somebody using the phone before her. And no more than two feet away, other inmates were talking and sending emails. They were not wearing masks, she said.

Because of a recent lockdown, Neba has been spending 22 hours a day in a nine-person cell. The beds are three feet apart. One of the women in her cell, she said, had a fever but was not tested for coronavirus.

These concerns, which would rattle anyone during a pandemic, are particularly distressing to Neba: She has stage four breast cancer and diabetes. “I’m full of anxiety,” she said.

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At FMC Carswell, the United States’ lone federal medical prison with a female-only population, many of the 1,600-plus incarcerated women, like Neba, are nonviolent offenders with severe illnesses and underlying health conditions. They are among the most vulnerable to sustaining complications from COVID-19 in the United States prison system, which, with high turnover and cramped quarters poses danger for inmates and employees. Yet because the Bureau of Prisons has been slow to release inmates who could be eligible for temporary home confinement and the federal court system has been reluctant to allow the coronavirus to prompt emergency relief hearings, Neba and fellow inmates have little chance of being released or having their sentences reduced.

Two cases of coronavirus have been confirmed at Carswell. One woman was isolated at the prison, and the other, a pregnant woman, was hospitalized at John Peter Smith Hospital, according to court filings. Outbreaks have occurred at other federal and state prisons. The federal prison system, as of Wednesday, had reported 446 cases of coronavirus among inmates, 248 cases among staff and 14 inmate deaths. Six of the deaths occurred at Oakdale in Louisiana with 56 cases among staff and inmates. In Arkansas, a state prison tested an entire unit after one inmate contracted coronavirus and discovered that 43 of the unit’s 46 inmates also tested positive.

Inmates at Carswell say the prison has not conducted mass testing. In a letter sent to Warden Michael Carr by several inmates, they asked him to release all elderly and sick nonviolent offenders to home confinement and said a single case of coronavirus could have the effect of lighting a match on a book of matches. “If there was ever a time to show mercy and compassion, this is it,” they wrote. (An interview request to Carr was not returned).

Concerns about Carswell are not new: The administrative security prison has been accused of enabling sexual abuse of inmates and failing to provide adequate medical care.

In February, shortly before coronavirus became a major concern in the United States, Billie Winner-Davis, the mother of inmate Reality Winner, visited her daughter at Carswell. She said the prison had sustained an influenza outbreak, but inmates were not being provided with enough soap. Her daughter told her the hot water had also been turned off, forcing inmates to take freezing showers for days.

Beginning March 31, Carswell was placed on lockdown with the rest of the federal prison system to help prevent the spread of coronavirus. Inmates, who normally work jobs and can move with relative freedom throughout the prison grounds, must now spend nearly the entire day in cells that typically house between four to 10 people — a situation some have described as worse than before the lockdown because it is harder to social distance.

“We are breathing on each other,” said Sandra Shoulders, who has been at Carswell for two years and has four years left on a drug offense. “It’s four people in a room. It’s very overcrowded, it’s very nasty here.”

Most meals are sack lunch bologna sandwiches. Neba said not all of the staff and inmates wear masks, and many of the inmates lack soap or don’t use it.

In addition to the lockdown measures to prevent coronavirus spread, Carswell has been ordered by the Bureau of Prisons to suspend all visits, increase screening for new inmates and maximize social distancing. Many of the inmates doubt the prison can be made into a safe environment, absent a reduction in population.

“They are trying to separate us but there is no way to (be) separated because of the overcrowding,” said inmate Kimberli Himmell, via email, who has stage five kidney failure and stage three breast cancer.

To alleviate crowding in response to the coronavirus, Attorney General William Barr directed the Bureau of Prisons on March 26 to identify and release inmates to temporary home confinement if they have COVID-19 risk factors. “We want to make sure our institutions don’t become petri dishes,” he wrote. As of Wednesday 1,022 of 173,000 federal inmates — less than 1% — had been sent home, and about 4,000 were being reviewed for potential release. Each prison’s warden also has power to release inmates on furloughs for up to 30 days.

Sue Allison, a spokeswoman for the Bureau of Prisons, said the bureau did not have information on the number of inmates released to home confinement from Carswell or specific facilities. Records indicate the inmate count at Carswell had declined by seven since late March, to 1,657 from 1,664.

Inmates are also finding it difficult to seek relief through the court system. Winner, Neba and Shoulders are among hundreds of inmates nationally who have filed for compassionate release or hearings to expedite previous compassionate release filings, based on coronavirus concerns.

Compassionate release is a seldom-granted reduction of a prison sentence that can be applied to inmates who are of advanced age, suffer from a terminal illness or have some other compelling reason to be released. The application process requires an inmate to first file with a warden and then wait 30 days before filing with the court. Months of back-and-forth motions typically follow.

Despite the attorney general’s directives to increase home confinement, the 30-day waiting period has not been adjusted. Mary Price, general counsel of the criminal justice advocacy organization Families Against Mandatory Minimums, said the federal government doesn’t want COVID-19 to be “a get out of jail free card” or to set a legal precedent. But the long process is not ideal given the concerns about the spread of disease at crowded prisons.

“What we’re seeing is there’s tons and tons of people who could have gone home already, who are living cheek to jowl with people who are ill. It’s heartbreaking to see,” she said. “I hope we can both think about improving compassionate release and look at the criminal justice system overall.”

For now, these complicated processes for release and home confinement are the only way Carswell’s population will be reduced.

Shoulders, who has diabetes and issues with her kidneys, believes she cannot be protected from coronavirus at the prison. Her sister, Ashunda Harris, a psychologist, wants her home. She has a six-bedroom house in Chicago with plenty of space for Shoulders. She said releasing her sister would be a logical decision — for Shoulders’ health and for stopping spread of the disease in society.

“Prison is not meant to be a slavery camp, where they’re fearful of this disease that is killing people in rapid numbers,” Harris said. “(Release) is the best option, it’s the most humane option to those who are there.”

Mark Dent was a reporter for the Fort Worth Star-Telegram who covered everything from politics to development to sports and beyond. His stories previously appeared in The New York Times, Texas Monthly, Vox and other publications.