The porous boundaries between communities and correctional facilities: The introduction of a medical recovery site resulting in reduced COVID-19 household transmission tied to recently incarcerated individuals

ABSTRACT

Background: In April 2020, a COVID-19 outbreak at a rural, resource-limited Department of Corrections on a Native American reservation in Arizona led to multiple epidemiologically linked cases to household contacts of recently incarcerated individuals. We describe the role of a medical recovery site for isolation of recently released inmates with active COVID-19 infection in reducing household transmission of cases tied to the correctional facility. Methods: On April 16th, an individual was contact traced to the correctional facility and was laboratory-confirmed positive, an asymptomatic index case in the jail. Testing of all inmates continued from April 16th-30th. On April 24th, decarceration began. All inmates released from facility April 24th-April 30th were contact traced for 14 days to monitor for new household cases. On April 30th, the tribe opened a medical recovery site for isolation. After opening, all individuals with active infection agreed to go to site after release. Results: Between April 24th-30th, 16 inmates were released from facility, seven were laboratory-confirmed positive. Secondary infections only occurred in households of positives. Of the seven households, four experienced secondary transmission of virus. There were 27 household contacts, six secondary infections (secondary attack rate of 30.0%). There were four hospitalizations and one death, though cause of death was not due to COVID-19 despite incidental finding. After opening of medical recovery site, all individuals with active infection (12 cases) agreed to isolation at site. This intervention resulted in no further epidemiologically linked cases from recently released incarcerated individuals to community. Conclusion: Prior to establishment of a medical recovery site on a Native American reservation, a significant burden of disease in the community was linked to recently incarcerated individuals. After opening, all actively infected individuals agreed to isolation at site, resulting in no further household transmission of COVID-19 from an actively infected recently incarcerated case. This outbreak highlights porous boundaries between correctional facilities and surrounding communities, requiring attention and resources to limit transmission of disease to protect local populations. (Figure Presented).