This is not a nursing home, not in any traditional sense. It is California’s death row at San Quentin State Prison, north of San Francisco. Its 670 residents are serial killers, child murderers, men who killed for money and drugs, or shot their victims as part of their wasted gangster lives. Some have been there for decades, growing old behind bars. , and more than 100 are 65 or older.

Executions have been on hold in California since 2006, stalled by a series of legal challenges. And they won’t resume anytime soon: In 2019, two months after taking office, Gov. Gavin Newsom declared a moratorium on executions and ordered that San Quentin’s death chamber be dismantled. But death has come to San Quentin nonetheless.

In recent days, five death row inmates have died after contracting COVID-19. Almost 200 others are thought to be ill with the virus, according to a Newsom administration official not authorized to speak publicly. Scores more are refusing to be tested. For now, there is no clear remedy and no end in sight.

“San Quentin’s staff — especially medical staff — is simply drowning among the chaos,” State Public Defender Mary McComb said in a letter last week to the state Senate Public Safety Committee. “San Quentin desperately needs a significant number of additional personnel, and quickly.”

Correctional officers are working double and even triple shifts. Doctors have been working 12-plus-hour days, seven days a week, for the past six weeks, McComb wrote: “Men (including some who have tested positive) report not having access to doctors, not receiving medication for symptoms such as coughs, and not receiving regular oxygen-level or blood pressure checks.”

San Quentin’s coronavirus outbreak could prove to be the worst at any prison in the nation. It began in mid-June, shortly after the California Department of Corrections and Rehabilitation transferred 121 inmates to San Quentin from the state prison in Chino, east of Los Angeles, in a failed effort to stem an outbreak there. At least 20 of the Chino transfers subsequently tested positive for the disease.

Now, more than 1,400 San Quentin inmates have the virus, or more than a third of the prison’s 4,000 inmates. And death row has been hit particularly hard. Of the six inmate deaths that prison authorities have formally attributed to the coronavirus, three were on death row. Two more death row inmates who died in recent days also tested positive for the virus, though the official cause of death is pending.

San Quentin, which opened in 1852, is renowned for its rehabilitative programs. Most San Quentin inmates are classified as minimum or medium security risks and will be released one day. They take college courses and participate in job-training programs. Some work on the prison’s and .

An additional 670 at San Quentin are condemned, and ineligible for release, no matter how old or infirm.

About 500 of them are housed in East Block, a hangar-size structure that is . They live one to a cell, 10.5 feet by 4.75 feet. The doors are steel mesh. They cannot help but breathe one another’s air. Sixty-four of the best-behaved inmates are housed on the traditional death row, known as North Seg. There’s a Mickey Mouse clock in the officers’ area emblazoned with the words “The Happiest Place on Earth.” North Seg, East Block and a third unit for condemned inmates, Donner, were built in 1934, 1930 and 1913, none with a pandemic in mind.

COVID-19 has infiltrated 20 of California’s 34 prisons, though it has been especially bad at nine. As of Tuesday, more than 5,300 inmates statewide had tested positive for the virus and 29 had died.

The plague raging inside San Quentin’s walls is spreading into the outside world. Dozens of San Quentin inmates are being treated in community hospitals, including at least 20 death row inmates as of last week. Each is guarded by two correctional officers round-the-clock.

The exact number of death row inmates who have the virus is not known. Complicating matters, about 40% have refused to be tested, McComb and others said. By law, they cannot be compelled to undergo the test unless they are deemed mentally incompetent.

McComb addressed the refusals in her letter, saying some of the condemned inmates worry they will be moved to a segregated unit typically reserved for discipline if they test positive, while others fear the procedure is unsafe.

“And third, a general hopelessness has set in among the population; there is no reason to be tested when medical staff, despite their best efforts, are stretched too thin to respond to those in need of care,” McComb wrote.

One who refused to be tested was Richard Stitely. He was found dead in his cell the night of June 24. The Marin County coroner found he was infected with the coronavirus, though the exact cause of death is still to be determined.

Stitely, 71, was sentenced to death in 1992 for the murder of Carol Unger, a 47-year-old mother. The two had met in a San Fernando Valley bar, and he offered to drive her home. Her body was found in the valley in January 1990.

Andrew R. Flier was a 28-year-old L.A. County deputy district attorney who prosecuted Stitely for the rape and murder of Unger, and for the previous rape of a 16-year-old girl. Now in private practice, Flier said evidence suggested Stitely could have choked Unger for five minutes, first with a cord and then with his hands. He sees Stitely’s apparent death from a disease that deprives victims of their breath as “poetic justice.”

“A terrible disease is infecting our world, and it found someone terrible to infect,” Flier said. “I shed no tears. Evil is evil, and I thought he was evil.”

Over the years, the California Supreme Court had upheld the death sentences of Stitely and the four other condemned inmates who died after contracting the virus. Two of the men had killed , including a 75-year-old convicted of a . Three of the inmates were in their late 50s.

No matter their crimes, some people say, inmates don’t deserve to die of COVID-19, especially after it likely was introduced by the ill-fated decision to transfer infected inmates from Chino to San Quentin.

“It is the death penalty by other means. It is a miscarriage of justice,” said Assembly member Marc Levine, a Democrat whose district includes San Quentin.

In a hearing last week, U.S. District Court Judge Jon S. Tigar in San Francisco, presiding over a long-running suit challenging California prison conditions, urged the state to release elderly and infirm inmates who pose no public safety threat — and are not on death row — to free up cells so infected prisoners could be isolated and the COVID-19 spread slowed.

“These releases need to happen immediately. There simply is no time to wait,” Tigar said, directing his comments at Newsom.

On Monday, Newsom said San Quentin’s population would be reduced to about 3,000 in coming weeks. “We’ve been working on this every single day for the last three weeks,” he said.

Corrections spokesperson Terry Thornton said the department has installed six tents to treat San Quentin inmates and “is working closely with health care and public health experts on all isolation and quarantine protocols recommended by the Centers for Disease Control and Prevention to address COVID-19 in correctional settings.”

While the virus infects death row, California’s capital punishment law is in a state of limbo. With executions on hold, Levine last year introduced legislation to place a measure on the statewide ballot to abolish capital punishment. That measure has stalled.

Last month, the California Supreme Court indicated it is weighing the legality of one aspect of the state’s death penalty statute: Must jurors agree on aggravating factors that led them to recommend death? As it is, jurors need not be unanimous.

The justices posed the question based on a single case involving , though a decision could set a precedent that would affect the sentences of scores of condemned inmates. Any decision is likely months away, presumably after the COVID-19 rampage has run its course on San Quentin’s death row.

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The new state budget taking effect July 1 authorizes $13.1 billion for California’s 34 prisons, housing 114,000 inmates, more than three times what any other state spends. That sum includes $3.6 billion for medical and dental services and mental health care — roughly to run its entire 140,000-inmate prison system.

And, yet, despite the extraordinary dedication of resources, California prison officials are struggling to contain the COVID outbreaks, let alone prevent them. On March 25, there was just one confirmed COVID-19 case among California’s inmates. Three months later, more than 4,600 inmates have contracted the disease, an infection rate of about — more than seven times higher than the infection rate for the state’s population as a whole. Twenty-one inmates have died. More than 730 staffers have tested positive, and two have died.

Prison systems in several other states . In Ohio, at least 84 inmates have died. In Michigan prisons, 68 inmates have died. In Texas, at least 79. But given what it spends on prison health care, and its history, California might have seen the scourge coming.

Prisoner rights attorneys in California for years have waged high-profile court challenges alleging inadequate health care delivery behind bars. As a result of their efforts, federal judges in San Francisco and Sacramento oversee the state’s prison health care system. A special office, known as the California Correctional Health Care Services, has a staff of 57 to monitor the delivery of care.

“Every year, there is a major outbreak,” said San Francisco attorney Michael Bien, who for 30 years has wrangled with the state over conditions for inmates diagnosed with varying levels of mental illness. Hepatitis, HIV and are common in prisons. “Prisons are like nursing homes,” Bien said. “They’re very dangerous for infectious diseases.”

In 2011, the U.S. Supreme Court concluded that California’s prisons were so crowded and the physical and mental health care so deficient that conditions amounted to cruel and unusual punishment. In response, California cut its prison population and now houses 114,000 inmates, down from a peak of 173,000 in 2006. Many health experts believe the prison system is still too crowded to keep the novel coronavirus from spreading.

The California Institution for Men in Chino, in the suburbs east of Los Angeles, was the first California lockup struck. It reports more than 890 cases involving inmates and 16 deaths. In an effort to contain the virus at the Chino prison, the California Department of Corrections and Rehabilitation (CDCR) on May 30 transferred 121 inmates considered especially vulnerable to infection 444 miles north to California’s oldest prison, San Quentin, just north of San Francisco.

Assembly member Marc Levine, a Democrat whose Marin County district includes San Quentin, said some Chino prisoners initially were housed on the upper tier of a San Quentin cellblock, . That allowed their droplets to descend on inmates below.

“Everything was preventable. Everything,” Levine said.

In a statement, CDCR spokesperson Dana Simas said inmates from Chino who had tested positive upon arrival at San Quentin “were not exposed to the general population” of the prison.

However the virus arrived, more than 830 San Quentin inmates since have tested positive. Chino inmates also were transferred to Corcoran State Prison, south of Fresno. Now, 155 Corcoran prisoners have the virus. In Lassen County, officials are blaming the transfer of prisoners from San Quentin to the California Correctional Center in Susanville for an outbreak that has .

Corrections officials say they now routinely distribute cloth masks to inmates and workers throughout the prison system, providing hand sanitizer in common areas, and have increased attention to disinfecting surfaces. Prisons are screening and taking the temperatures of staffers who enter the prisons.

“We have taken unprecedented steps to address the COVID-19 pandemic in all state prisons, including the cessation of visiting, volunteers, and group programs; developing comprehensive prevention and treatment protocols,” Simas .

California’s prisons were built to contain felons, not the coronavirus. Each of the state’s 34 prisons house 2,000 to 5,000 inmates. Many live in dorms, sleeping in double bunks and sharing showers and dining halls. Others live two to a 60- to 80-square-foot cell.

Earlier this year, to create more space, the state sped the release of 3,500 inmates who had less than six months to serve on their sentences. Starting July 1, the state once more will start speeding the release of prisoners who have six months or less left on their sentences, with caveats: They cannot have been convicted of violent or serious felonies, domestic violence or sex crimes.

They also must have plans for housing. That’s important for officials grappling with California’s other epidemic: homelessness.

It’s not clear whether COVID-related releases from state prisons have amplified the state’s homeless crisis. But El Dorado County District Attorney Vern Pierson, vice president of the California District Attorneys Association, predicts it’s a matter of time.

“We’re going to exacerbate an already bad situation,” Pierson said. “The numbers that will become homeless will be high. The supervision will be less and less. The likelihood of reoffending will likely go up.”

In Sacramento, Mayor Darrell Steinberg, co-chair of Newsom’s homelessness task force, said that since the start of the pandemic the capital city has moved 800 people from the streets into hotels, a hopeful sign.

But that gain has been more than offset because fewer people are in county jails. To limit the spread of the coronavirus in county lockups, jailers statewide have reduced the number of total inmates from 72,000 to 51,000, .

In part because of those releases, homeless encampments along the Sacramento River have “grown and grown in a very significant way,” Steinberg said. Similar spikes in homelessness are occurring across the state.

Releasing people, “if they do not present a real risk,” is not the problem, Steinberg said. “The problem is releasing them without any connection with housing and the support necessary for them to be successful.”

CDCR’s response to the pandemic will come under scrutiny in a July 1 oversight hearing to be convened by state Sen. Nancy Skinner, a Berkeley Democrat who chairs the Senate Committee on Public Safety.

“What are the biggest congregate facilities in the state? Prisons,” Skinner said. “They are exactly the type of facility no one wants to be in a pandemic.”

California’s efforts to stem the outbreaks matter beyond the prison gates, several experts noted. Prison workers go home at the end of their shifts. Inmates too sick to be cared for in prison infirmaries are sent to community hospitals. Ultimately, prison health and public health are inextricably intertwined.

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Growing up near the U.S. Military Academy at West Point in New York, he contracted polio in 1952 and couldn’t walk for two months. In medical school in Vermont 30 years later, he witnessed AIDS steal the lives of otherwise healthy gay men.

Now, Imbasciani, secretary of California’s Department of Veterans Affairs, and his staff are responsible for keeping the novel coronavirus away from the state’s eight veterans homes. California’s defenses are holding.

The explanation, many say, lies in CalVet’s intense preparation, quick response, attention to hygiene and leadership, starting with Imbasciani, a physician and retired colonel who not too many years ago could have been discharged from the military because he is gay.

“We created our own fortune,” Imbasciani said, looking to knock on wood.

Deaths are part of life in the state-run veterans homes. The homes are populated largely by frail men and women, some of them veterans of World War II and Korea, and many from the Vietnam War era. A quarter of the vets admitted to California’s homes in recent years had been living homeless.

COVID-19 has hastened the end for scores of retired soldiers in veterans homes in other states: have died of the disease at a “soldiers’ home” in Massachusetts; more than in New Jersey’s three homes; more than 60 residents of an Alabama and eight have died.

The California Department of Veteran Affairs, by contrast, is holding the beastly infection at bay. In its eight homes, where 2,100 veterans reside, three residents have contracted the disease, and two have died of it, one in his 90s and one in his late 80s.

“It’s all hands on deck,” state Sen. Bob Archuleta, a Los Angeles-area Democrat who chairs the Senate Veterans Affairs Committee, said of CalVet’s response. “It goes back to the staff. We have people who care about their veterans, and they will go the extra mile.”

Like Archuleta, Imbasciani credits the work of the front-line staff of nurses, nursing assistants and doctors who provide direct care. But leadership matters, and Archuleta and others also point to Imbasciani.

CalVet’s leader is a 73-year-old urologic surgeon who speaks six languages and has a master’s degree in musicology and a doctorate in philosophy. The son of a World War II tail gunner and grandson of a World War I vet, Imbasciani served 27 years in the Army Medical Corps. He deployed to war zones four times before retiring as a colonel in 2014.

For most of those years, Imbasciani had to hide his personal life because of President Bill Clinton’s “don’t ask, don’t tell” policy that sought to keep LGBTQ service people serving in the closet.

That changed when President Barack Obama signed . Two years later, Imbasciani introduced Obama at a fundraiser hosted by LGBTQ community leaders in Beverly Hills.

“The price of my service was to live a lie,” Imbasciani told the crowd of 600 when introducing the president, as quoted by . “But not anymore.”

Imbasciani was director of government relations at the Southern California Permanente Medical Group in September 2015 when Gov. Jerry Brown appointed him secretary of the California Department of Veterans Affairs. Gov. Gavin Newsom reappointed him in January, even as the novel coronavirus was starting its global spread.

Over the years, Imbasciani has tracked SARS (severe acute respiratory syndrome), Ebola and Zika, among other viral threats. In January, when scientists in China sequenced the DNA of a mysterious new coronavirus that had emerged in Wuhan, Imbasciani thought, “Here we go again.”

He assumed the virus would storm the West Coast, as did CalVet’s director of long-term care, Thomas Bucci. Based on the devastating events unfolding in Wuhan, they quickly recognized COVID-19 as a disease far worse than the flu.

Bucci, an Air Force veteran, spent 38 years as a health care administrator before going to work for the state in 2015. Knowing that older and immunosuppressed people are particularly vulnerable, Bucci said: “We had a big bull’s-eye on ourselves.”

By mid-February, a month before the World Health Organization declared COVID-19 to be a pandemic, Bucci was regularly communicating with directors of the eight homes about the threat, and, along with Imbasciani, implementing a 38-step plan.

The protocol began with the basics. Directors of each home updated their emergency operations plans. They ensured they had enough surgical and N95 masks, gloves and gowns for the staff, and even disposable dinnerware, to minimize the chance of spread.

As of Feb. 26, all visitors were directed to sanitize their hands before entry, and staff began disinfecting common surfaces every 30 minutes. On March 4, as the infection killed the first of dozens of residents at the Life Care Center in Kirkland, Washington, Imbasciani discussed the coming onslaught at an executive team meeting. And by March 15 — four days before Newsom issued the — all visitors were barred, with the exception of family members paying respects to veterans in hospice.

Now, all staffers have their temperatures taken when they arrive for work and are sent home if they show symptoms. At four of the homes, all workers are encouraged to take tests for the virus, and all residents are tested. At the other four, employees who have been exposed to a known or suspected COVID-19 case are being tested, as are any residents who show symptoms.

All staffers wear masks, as do residents when not in their rooms. Residents are required to social-distance, meaning no congregating closely for conversation or card games. Meals are delivered to residents’ rooms.

The Veterans Home of California-Yountville opened in Napa Valley in 1884. How it withstood the 1918-19 influenza pandemic is for the most part . A century later, however, not a single COVID-19 case has been recorded among its nearly 1,000 residents.

Muriel Zimmer, 85, a Korean War-era Air Force veteran, has been living at the Yountville home for nine years with her husband, Dick. He needs more care and lives in the skilled nursing section of the facility, limiting her ability to see him. They’re allowed only brief conversations, and from a safe distance.

“I miss him,” she said.

She also misses seeing friends in the dining hall. But she remembers rationing during World War II, and knows others have it much harder. She is able to walk across the Yountville grounds, with its sweeping views of the Napa vineyards below, and notices small things, like the monarch butterfly that flitted by the other day.

“I almost get teary-eyed when I think about the staff,” she said. “We are blessed.”

At the Redding Veterans Home in Shasta County, Michael Vancleemput, a Vietnam-era Army veteran, spoke by phone through a mask, as a worker walked past disinfecting surfaces. “They’re personally motivated to serve us. It’s not like they’re doing a job,” said Vancleemput, 79.

He has to socially distance from his friends, not that it’s a problem. He lived alone for years in the small town of McCloud at the base of Mount Shasta before moving to the veterans home five years ago. A ham radio operator, he said he keeps in touch with other members of the home’s amateur radio operators club.

“I would invite you to visit our institution,” Vancleemput said, then paused. “Not now.” No visitors allowed.

The bulwark that CalVet has erected against COVID-19 builds on a series of improvements. When Imbasciani and Bucci arrived, the state-run homes used paper records. Now, medical records are tracked electronically. Each home once operated independently. Now, they are part of a system with standardized procedures.

CalVet’s nurses, nursing assistants and physicians are state civil servants with union representation and paid sick leave. One nursing assistant might be responsible for six or eight residents. At a private nursing home, an aide more typically handles 10 or 12. CalVet also has staff physicians on-site every day.

For many years, the federal government, which rates nursing homes, gave CalVet’s homes dismal marks. Now, among the homes that have been rated, four have the highest designation of five stars, and one has four stars.

“It does show that when there is strong and visionary leadership, it can make a big difference,” said Charlene Harrington, an expert on nursing home care and professor emerita at the University of California-San Francisco.

In the military, superiors give what are known as challenge coins to soldiers as an attaboy. The coins have a hierarchy. One bestowed by a two-star general carries greater bragging rights than, say, one given by a one-star general.

Imbasciani’s challenge coin is one of his most prized possessions. It’s a little larger than a silver dollar and is stamped with the presidential seal and the name of the 44th president. Obama gave it to him, and no one outranks the commander in chief, Imbasciani noted.

At California’s eight veterans homes, the walls are holding, so far. But Imbasciani knows an asymptomatic carrier could cause a breach any day. He is, after all, someone who has been battling viruses since he was a boy. He can even imagine the epitaph on his tombstone:

“Here lies Vito. He hated viruses.”

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