Evaluation of Correctional Facility COVID-19 Outbreaks With Layered Mitigation Strategies Including Vaccination: Colorado, 2020-2021.

In 2020-2021, a Colorado corrections facility experienced four COVID-19 outbreaks. Case counts, attack rates (ARs) in people who are detained or incarcerated (PDI), and mitigation measures used in each outbreak were compared to evaluate effects of combined strategies. Serial PCR testing, isolation/quarantine, and masking were implemented in outbreak 1. Daily staff antigen testing began in outbreak 2. Facility-wide COVID-19 vaccination started in outbreak 3 and coverage increased by the end of outbreak 4 (PDI: <1% to 59%, staff: 27% to 40%). Despite detection of variants of concern, outbreaks 3 and 4 had 97% lower PDI ARs (both 1%) than outbreak 2 (29%). Daily staff testing and increasing vaccination coverage, with other outbreak mitigation strategies, are important to reduce COVID-19 transmission in congregate settings.

COVID-19 control measures in correctional facilities of selected countries - A literature overview.

INTRODUCTION: The COVID-19 pandemic is one of the most significant public health challenges for this generation. Governments have been forced to undertake different measures to constrain the spread of the virus and protect the people. Restrictive and other measures have also been taken in correctional facilities to control the epidemiological situation. OBJECTIVE: The aims of this review are: 1) to contribute to knowledge by providing an overview of anti-COVID-19 measures that have been undertaken by the proper authorities in a few selected countries to control the epidemiological situation in prison; 2) to demonstrate proposals made in this respect by international organizations and scientific institutions and 3) to complete the most important bibliographical items for further studies. REVIEW METHODS: A literature review was carried out of international scientific and grey literature published between 30.01.2020 and 30.07.2021 (with some exemptions). In every correctional system in the countries under scrutiny, the proper authorities introduced many measures to control the epidemiological situation from the very beginning of the pandemic. SUMMARY: The COVD - pandemic impacts almost all aspects of social and individual life. Governments were forced to undertake different measures to constrain the spread of the virus. Restrictive and other measures also had to be taken in correctional systems, where more than ten million people are held worldwide. The measures introduced differed regarding details such as time, scope and range, but were generally similar to solutions proposed by organisations such as the WHO or CDC. In most countries, the discussion regarding the reform of the legal system have been observed. One of the most discussed issues was the problem of decarceration.

Evaluation of antibody response to SARS-CoV-2 variants after 2 doses of mRNA COVID-19 vaccine in a correctional facility.

The SARS-CoV-2 pandemic has posed a challenge for correctional facilities worldwide. People in such settings are more vulnerable to severe forms of infection and it is impossible to completely isolate inmates from the outside world. This study aimed to assess the antibody-mediated immune response in terms of neutralizing antibodies against Alpha, Beta, Gamma and Omicron (sub-lineage BA.1) variants of concern after two doses of mRNA vaccine in correctional officers and inmates from an Italian correctional facility. Most of the correctional officers (56.5%) and inmates (52.3% and 63.6%) retained their neutralizing activity toward the Alpha and Gamma variants, respectively. By contrast, the most striking reduction in comparison with the ancestral virus was found in the antibody response toward the Beta and Omicron variants, in both correctional officers (91.2% and 93.9%) and inmates (85.1% and 92.8%). In addition, subjects who had undergone primary vaccination and had previously been naturally infected had higher neutralizing antibody titers toward the 4 variants than negative subjects. Overall, our findings indicate that primary mRNA vaccination is able to induce neutralizing antibodies toward the ancestral virus, while titers toward variants may vary, depending on the mutations harboring by the variants. Although the correctional setting is often considered distinct or isolated from the wider society and sanitary system, the health of correctional workers and prisoners is inexorably linked to the public health of the country as a whole and it is of paramount importance to monitor the antibody response in these settings.

Vaccine Effectiveness during Outbreak of COVID-19 Alpha (B.1.1.7) Variant in Men's Correctional Facility, United States.

In April 2021, a COVID-19 outbreak occurred at a correctional facility in rural Virginia, USA. Eighty-four infections were identified among 854 incarcerated persons by facilitywide testing with reverse transcription quantitative PCR (qRT-PCR). We used whole-genome sequencing to link all infections to 2 employees infected with the B.1.1.7α (UK) variant. The relative risk comparing unvaccinated to fully vaccinated persons (mRNA-1273 [Moderna, https://www.modernatx.com]) was 7.8 (95% CI 4.8-12.7), corresponding to a vaccine effectiveness of 87.1% (95% CI 79.0%-92.1%). Average qRT-PCR cycle threshold values were lower, suggesting higher viral loads, among unvaccinated infected than vaccinated cases for the nucleocapsid, envelope, and spike genes. Vaccination was highly effective at preventing SARS-CoV-2 infection in this high-risk setting. This approach can be applied to similar settings to estimate vaccine effectiveness as variants emerge to guide public health strategies during the ongoing pandemic.

Inclusive health: modeling COVID-19 in correctional facilities and communities.

BACKGROUND: Mass incarceration, commonly associated with overcrowding and inadequate health resources for incarcerated people, creates a fertile environment for the spread of the coronavirus disease 2019 (COVID-19) in U.S. correctional facilities. The exact role that correctional facilities play in enhancing COVID-19 spread and enabling community re-emergence of COVID-19 is unknown. METHODS: We constructed a novel stochastic model of COVID-19 transmission to estimate the impact of correctional facilities, specifically jails and state prisons, for enhancing disease transmission and enabling disease re-emergence in local communities. Using our model, we evaluated scenarios of testing and quarantining infected incarcerated people at 0.0, 0.5, and 1.0 times the rate that occurs for infected people in the community for population sizes of 5, 10, and 20 thousand people. RESULTS: Our results illustrate testing and quarantining an incarcerated population of 800 would reduce the probability of a major outbreak in the local community. In addition, testing and quarantining an incarcerated population would prevent between 10 to 2640 incidences of COVID-19 per year, and annually save up to 2010 disability-adjusted life years, depending on community size. CONCLUSIONS: Managing COVID-19 in correctional facilities is essential to mitigate risks to community health, and thereby stresses the importance of improving the health standards of incarcerated people.

Incarcerated individuals' experiences of COVID-19 in the United States.

PURPOSE: This study aims to examine steps taken by correctional staff to prevent COVID-19 from spreading through correctional facilities and explores strategies used by incarcerated individuals to reduce their own risk of contracting COVID-19 during confinement. DESIGN/METHODOLOGY/APPROACH: Data were drawn from interviews with 327 individuals incarcerated after March 16, 2020, in Midwest1, Midwest2 and Southeast state using a questionnaire developed for this purpose. All study participants were actively involved in a randomized controlled trial of a behavioral health reentry intervention and the human subjects board approved the supplement of this study on COVID-19; interviews were conducted from April 15 to November 19, 2020. FINDINGS: Overall, 9.89% of participants contracted COVID-19. Most (68.50%) individuals learned about COVID-19 from television compared to official correctional facility announcements (32.42%). Participants wore face masks (85.02%), washed hands (84.40%) and practiced physical distancing when possible (66.36%). Participants reported that facilities suspended visitation (89.60%) and volunteers (82.57%), provided face masks (83.18%), sanitized (68.20%), conducted temperature checks (55.35%) and released individuals early (7.34%). SOCIAL IMPLICATIONS: Longitudinal observational study on the implementation and effectiveness of public health guidelines in prisons and jails may identify best practices for containing the infectious disease. Maximizing transparent communications, as well as COVID-19 prevention and mitigation efforts, are critical to achieving universal best practices for virus containment and amplifying public health. ORIGINALITY/VALUE: Data presented indicate the early adoption of many Centers for Disease Control guidelines by individuals and correctional facilities, although broad variation existed. Data support the identification of containment strategies for feasible implementation in a range of correctional spaces.

COVID-19 in corrections: Quarantine of incarcerated people.

Carceral settings in the United States have been the source of many single site COVID-19 outbreaks. Quarantine is a strategy used to mitigate the spread of COVID-19 in correctional settings, and specific quarantine practices differ state to state. To better understand how states are using quarantine in prisons, we reviewed each state's definition of quarantine and compared each state's definition to the Centers for Disease Control's (CDC) definition and recommendations for quarantine in jails and prisons. Most prison systems, 45 of 53, define quarantine, but definitions vary widely. No state published definitions of quarantine that align with all CDC recommendations, and only 9 states provide quarantine data. In these states, the highest recorded quarantine rate occurred in Ohio in May 2020 at 843 per 1,000. It is necessary for prison systems to standardize their definitions of quarantine and to utilize quarantine practices in accordance with CDC recommendations. In addition, data transparency is needed to better understand the use of quarantine and its effectiveness at mitigating COVID-19 outbreaks in carceral settings.

Efficacy of the Measures Adopted to Prevent COVID-19 Outbreaks in an Italian Correctional Facility for Inmates Affected by Chronic Diseases.

Background: COVID-19 outbreaks in prisons and jails may affect both inmates and correctional workers. An observational study has been performed to investigate the efficacy of specific procedures and of a serial testing approach adopted for the COVID-19 prevention in an Italian correctional facility (Bari, Apulia) for inmates affected by chronic diseases. Methods: Two SARS-CoV-2 antigen testing campaigns were carried out for all the prisoners and correctional workers, including correctional officers (CO), administrative staff (AS), correctional health care workers (HCW), and operators working with people completing their sentence outside the prison (OOP). Antigen testing was conducted on nasopharyngeal swab specimens, using a fluorescence immunoassay for the qualitative detection of nucleocapsid SARS-CoV-2 antigen. All subjects positive to the antigen test underwent confirmation by rRT-PCR test. Results: In total, 426 new and residential inmates were tested during the first campaign and 480 during the second campaign. Only two new inmates resulted positive at the first campaign, while no positive cases were observed at the second campaign or outside of the testing campaigns. In total, 367 correctional workers were tested at the first campaign and 325 at the second. At the first, 4 CO and 2 HCW showed positive test results, while no new positive cases were observed at the second. Moreover, 1 CO and 1 HCW resulted positive outside of the testing campaigns for the onset of symptoms while at home. Conclusion: The implementation of a full risk management plan in a correctional facility, including both a strict protocol for the application of preventive measures and a serial testing approach, seems to be able to prevent COVID-19 outbreaks in both inmates and correctional workers.

The epidemic burden on prisons in Lombardy (Italy) during the first wave of the COVID-19 pandemic: the transmission and measures of prevention in detention facilities.

PURPOSE: Early on in the COVID-19 pandemic, the scientific community highlighted a potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released, and containment measures were quickly implemented in prisons. This paper aims to describe the spread of COVID-19 in detention facilities within the Lombardy region of Italy during March to July 2020, and the impact of the prevention and control measures implemented. DESIGN/METHODOLOGY/APPROACH: A descriptive retrospective analysis of case distribution was performed for all COVID-19 cases identified among people in detention (PiD) and prison officers (POs). A comparison of the epidemic burden affecting different populations and a correlation analysis between the number of cases that occurred and prevention measures implemented were also carried out. FINDINGS: From this study, it emerged that POs were at a high risk of contracting COVID-19. This study observed a delay in the occurrence of cases among PiD and substantial heterogeneity in the size of outbreaks across different prisons. Correlation between reported cases among PiD and registered sick leave taken by POs suggested the latter contributed to introducing the infection into prison settings. Finally, number of cases among PiD inversely correlated with the capacity of each prison to identify and set up dedicated areas for medical isolation. ORIGINALITY/VALUE: Prevention and control measures when adopted in a timely manner were effective in protecting PiD. According to the findings, POs are a population at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the critical importance of including prison settings within emergency preparedness plans.

Correctional Nurses on the Front Lines of the COVID-19 Pandemic: Omaha System Guidelines Documentation Case Study.

During a pandemic, basic public health precautions must be taken across settings and populations. However, confinement conditions change what can be done in correctional settings. Correctional nursing (CN) care, like all nursing care, needs to be named and encoded to be recognized and used to generate data that will advance the discipline and maintain standards of care. The Omaha System is a standardized interprofessional terminology that has been used since 1992 to guide and document care. In 2019, a collaboration between the newly formed American Correctional Nurses Association and the Omaha System Community of Practice began a joint effort with other stakeholders aimed at encoding evidence-based pandemic response interventions used in CN. The resulting guidelines are included and illustrated with examples from CN practice.

Mass SARS-CoV-2 Testing in a Dormitory-Style Correctional Facility in Arkansas.

Objectives. To assess SARS-CoV-2 transmission within a correctional facility and recommend mitigation strategies.Methods. From April 29 to May 15, 2020, we established the point prevalence of COVID-19 among incarcerated persons and staff within a correctional facility in Arkansas. Participants provided respiratory specimens for SARS-CoV-2 testing and completed questionnaires on symptoms and factors associated with transmission.Results. Of 1647 incarcerated persons and 128 staff tested, 30.5% of incarcerated persons (range by housing unit = 0.0%-58.2%) and 2.3% of staff tested positive for SARS-CoV-2. Among those who tested positive and responded to symptom questions (431 incarcerated persons, 3 staff), 81.2% and 33.3% were asymptomatic, respectively. Most incarcerated persons (58.0%) reported wearing cloth face coverings 8 hours or less per day, and 63.3% reported close contact with someone other than their bunkmate.Conclusions. If testing remained limited to symptomatic individuals, fewer cases would have been detected or detection would have been delayed, allowing transmission to continue. Rapid implementation of mass testing and strict enforcement of infection prevention and control measures may be needed to mitigate spread of SARS-CoV-2 in this setting.

Does a Public Health Crisis Justify More Research with Incarcerated People?

Covid-19 has infected thousands and killed hundreds in prisons, jails, and immigration detention facilities across the United States. Responding to this crisis, leading medical researchers have called for expanding opportunities for people in prison to participate in vaccine trials. These calls, like current regulations, focus on individualized risk assessments around consent, coercion, and harm, while ignoring the unnaturalness of deprivation conditions in U.S. prisons. We need new frameworks of analysis that refocus on structural, rather than individual, risk assessments. Integrating structural perspectives-including skepticism of claims of scarcity, avoidance of representational distortions, and attention to institutional agency-into our existing, overly individualistic frameworks might permit the design of more ethical research projects involving people who are incarcerated. Still, the unnatural deprivations of incarceration might be so great that research subjects might need to be removed from prison entirely in order to ethically participate in research.

Time out of cell and time in purposeful activity and adverse mental health outcomes amongst people in prison: a literature review.

PURPOSE: The purpose of this study is to synthesise the available peer-reviewed literature on the impact of time out of cell (TOOC) and time in purposeful activity (TIPA) on adverse mental outcomes amongst people in prison. DESIGN/METHODOLOGY/APPROACH: The outcomes of interest of this literature review were mental health, suicide, deliberate self-harm (DSH) and violence. Exposures of interest were TOOC, TIPA or a partial or indirect measure of either. In total, 14 studies were included. An abbreviated review methodology was used because of time constraints. FINDINGS: There was consistent evidence of an association between lower TOOC and TIPA and worse mental health and higher suicide risk. Limited evidence suggests a link between TOOC and DSH. No evidence was identified regarding the relationship between TOOC/TIPA and violence. RESEARCH LIMITATIONS/IMPLICATIONS: A lack of longitudinal studies prevents conclusions regarding causality. Significant heterogeneity of mental health outcomes limits the comparability of studies. PRACTICAL IMPLICATIONS: These findings highlight the importance of considering the impact of TOOC and TIPA on adverse mental outcomes for prisoners when designing prison regimes, including during urgent adaptation of such regimes in response to Covid-19. They are likely to be of interest to practitioners and policymakers concerned with prison regime design. ORIGINALITY/VALUE: This paper is the first to synthesise the existing literature on the impact of TOOC and TIPA on mental health outcomes.