ABSTRACT
BackgroundSARS-CoV-2 can spread rapidly within correctional facilities. On, following identification of a confirmed COVID-19 case in a prisoner in Prison A (UK), an Outbreak Control Team was convened consisting of prison staff and public health experts from Public Health England and the UK National Health Service. MethodsAt the start of the outbreak, four prisoners and 40 staff were isolating with COVID-19 symptoms. An outbreak was declared and full prison lockdown implemented. Prompt implementation of novel outbreak control measures prevented an explosive prison outbreak, specifically establishment of dedicated isolation and cohorting units, including (i) Reverse Cohorting Units (RCUs) for accommodating new detainees; (ii) Protective Isolation Units (PIUs) for isolating symptomatic prisoners (new detainees and existing residents), and (iii) Shielding Units (SUs) to protect medically vulnerable prisoners. FindingsIn total, 120 probable and 25 confirmed cases among prisoners and staff were recorded between. Among prisoners, there were six possible, 79 probable, and three confirmed cases. Among staff, there were 83 possible, 79 probable, and 22 confirmed cases. Testing of symptomatic prisoners was limited for most of the outbreak, with only 33% of probable cases tested. This explains the low number of confirmed cases (three) among prisoners despite the large number of probable cases (n=81; 92%). Over 50% of the initial cases among prisoners were on the two wings associated with the index case. InterpretationRapid transmission of SARS-COV-2 was prevented through proactive steps in identifying and isolating infected prisoners (and staff), cohorting new admissions and shielding vulnerable individuals. These novel and cost-effective approaches can be implemented in a wide range of correctional facilities globally and proved effective even in the absence of mass testing. Funding Sourcenone Research in contextO_ST_ABSEvidence before this studyC_ST_ABSA systematic literature search on Pubmed from database inception to October 2020 was conducted. The broad terms included were "COVID-19" OR "SARS-COV-2" OR "coronavirus" AND "prison" OR "correctional facility" OR "place of detention" OR "penitentiary" OR "detention centre". There were no language restrictions. We reviewed reference lists and forward citations of all articles pertinent to the study objectives. We identified 122 results. Only two prison outbreak reports were identified, both focusing on prisons in the USA. Outbreak guidance identified during the literature review was typically adapted from other institutional settings such as care homes and hospital, with a focus on self-isolation, social distancing, reduced admissions and rapid testing. Many of these features form the basis of CDC, WHO and ECDC prison outbreak guidance. However, these measures have not proven effective in many countries, resulting in major and sustained COVID-19 outbreaks in regions such as the USA and South America. Therefore, alternative and cost-effective approaches need to be considered to reduce the transmission of SARS-COV-2. Added value of this studyThis study outlines novel outbreak control measures (not reported elsewhere in the literature), that were clearly efficacious in preventing the rapid transmission of SARS-COV-2 in a large UK prison. These include: (1) the timely establishment of "Reverse Cohorting Units" to accommodate new prison admissions, allowing emergent infectious cases to be detected before entering the general population; (2) "Protective Isolation Units" for accommodating confirmed / suspected cases and (3) "Shielding Units" to protect prisoners most at risk from COVID-19. Implications of all the available evidenceThe innovative and cost-effective interventions presented here proved effective in controlling the spread of SARS-COV-2, even in the absence of mass testing. The best defence against incursions of future infection into global prisons is implementation of strict outbreak control measures, specifically the screening and quarantining of new prison admissions.
