Prison cell spatial density and infectious and communicable diseases: a systematic review

Increased Mortality of Black Incarcerated and Hospitalized People: a Single State Cohort Analysis

OBJECTIVE

To quantify racial disparities in mortality and post-hospitalization outcomes among incarcerated individuals that were hospitalized during their incarceration period.

METHODS

We designed a retrospective cohort study using administrative and hospital data collected from a preferred healthcare referral center for all Massachusetts jails and prisons between January 2011 and December 2018 with linkage to Massachusetts Vital Records and Statistics. We identified 4260 incarcerated individuals with complete data on race/ethnicity that were hospitalized during the study period. The primary study indicators were age, race, ethnicity, length of hospital stay, Elixhauser comorbidity score, incarceration facility type, and number of hospital admissions. The primary outcome was time to death.

RESULTS

Of the incarcerated individuals that were hospitalized, 2606 identified as White, 1214 identified as Black, and 411 people who identified as some other race. The hazard of death significantly increased by 3% (OR: 1.03; 95% CI: 1.02-1.03) for each additional yearly increase in age. After adjusting for the interaction between race and age, Black race was significantly associated with 3.01 increased hazard (95% CI: 1.75-5.19) of death for individuals hospitalized while incarcerated compared to White individuals hospitalized while incarcerated. Hispanic ethnicity and being incarcerated in a prison facility was not associated with time to mortality, while increased mean Elixhauser score (HR: 1.07; 95% CI: 1.06-1.08) and ≥ 3 hospital admissions (HR: 2.47; 95% CI: 2.07-2.95) increased the hazard of death.

CONCLUSIONS

Our findings suggest disparities exist in the mortality outcomes among Black and White individuals who are hospitalized during incarceration, with an increased rate of death among Black individuals. Despite hypothesized equal access to healthcare within correctional facilities, our findings suggest that incarcerated and hospitalized Black individuals may experience worse disparities than their White counterparts, which has not been previously explored or reported in the literature. In addition to decarceration, advocacy, and political efforts, increased efforts to support research access to datasets of healthcare outcomes, including hospitalization and death, for incarcerated people should be encouraged. Further research is needed to identify and address the implicit and explicit sources of these racial health disparities across the spectrum of healthcare provision.

Effects of the COVID-19 pandemic on people experiencing incarceration: a systematic review

OBJECTIVE

To assess the effect of the COVID-19 pandemic on people experiencing incarceration (PEI), focusing particularly on clinical outcomes compared with the general population.

DESIGN

Systematic review with narrative synthesis in accordance with the Centre for Reviews and Dissemination's good practice guidelines.

DATA SOURCES

Medline, Social Policy and Practice, Criminology Connection, ASSIA, EMBASE, SCOPUS, Web Of Science, CINAHL, Cochrane Library, Cochrane COVID-19 reviews, COVID-19 Evidence Reviews and L*OVE COVID-19 Evidence databases were searched up to 21 October 2022.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included studies presenting data specific to adults ≥18 years experiencing incarceration, with exposure to SARS-CoV-2 infection. All studies with a comparison group, regardless of study design and country were included. Studies with no comparison group data or not measuring clinical outcomes/health inequalities were excluded. Studies focussing on detained migrants, forensic hospitals, prison staff and those not in English were also excluded.

DATA EXTRACTION AND SYNTHESIS

Two reviewers extracted data and assessed risk of bias. Data underwent narrative synthesis using a framework analysis based on the objectives, for infection rates, testing, hospitalisation, mortality, vaccine uptake rates and mental health outcomes. There was no scope for meta-analysis, due to the heterogeneity of evidence available.

RESULTS

4516 references were exported from the databases and grey literature searched, of which 55 met the inclusion criteria. Most were from the USA and were retrospective analyses. Compared with the general population, PEI were usually found to have higher rates of SARS-CoV-2 infection and poorer clinical outcomes. Conflicting data were found regarding vaccine uptake and testing rates compared with the general population. The mental health of PEI declined during the pandemic. Certain subgroups were more adversely affected by the COVID-19 pandemic, such as ethnic minorities and older PEI.

CONCLUSION

PEI have poorer COVID-19 clinical outcomes than the general public, as shown by largely low-quality heterogenous evidence. Further high-quality research of continuing clinical outcomes and appropriate mitigating interventions is required to assess downstream effects of the pandemic on PEI. However, performing such research in the context of incarceration facilities is highly complex and potentially challenging. Prioritisation of resources for this vulnerable group should be a focus of national policy in the event of future pandemics.

PROSPERO REGISTRATION NUMBER

CRD42022296968.

An analysis of published study designs in PubMed prisoner health abstracts from 1963 to 2023: a text mining study

BACKGROUND

The challenging nature of studies with incarcerated populations and other offender groups can impede the conduct of research, particularly that involving complex study designs such as randomised control trials and clinical interventions. Providing an overview of study designs employed in this area can offer insights into this issue and how research quality may impact on health and justice outcomes.

METHODS

We used a rule-based approach to extract study designs from a sample of 34,481 PubMed abstracts related to epidemiological criminology published between 1963 and 2023. The results were compared against an accepted hierarchy of scientific evidence.

RESULTS

We evaluated our method in a random sample of 100 PubMed abstracts. An F1-Score of 92.2% was returned. Of 34,481 study abstracts, almost 40.0% (13,671) had an extracted study design. The most common study design was observational (37.3%; 5101) while experimental research in the form of trials (randomised, non-randomised) was present in 16.9% (2319). Mapped against the current hierarchy of scientific evidence, 13.7% (1874) of extracted study designs could not be categorised. Among the remaining studies, most were observational (17.2%; 2343) followed by systematic reviews (10.5%; 1432) with randomised controlled trials accounting for 8.7% (1196) of studies and meta-analysis for 1.4% (190) of studies.

CONCLUSIONS

It is possible to extract epidemiological study designs from a large-scale PubMed sample computationally. However, the number of trials, systematic reviews, and meta-analysis is relatively small - just 1 in 5 articles. Despite an increase over time in the total number of articles, study design details in the abstracts were missing. Epidemiological criminology still lacks the experimental evidence needed to address the health needs of the marginalized and isolated population that is prisoners and offenders.

Automatic Extraction of Research Themes in Epidemiological Criminology From PubMed Abstracts From 1946 to 2020: Text Mining Study

BACKGROUND

The emerging field of epidemiological criminology studies the intersection between public health and justice systems. To increase the value of and reduce waste in research activities in this area, it is important to perform transparent research priority setting considering the needs of research beneficiaries and end users along with a systematic assessment of the existing research activities to address gaps and harness opportunities.

OBJECTIVE

In this study, we aimed to examine published research outputs in epidemiological criminology to assess gaps between published outputs and current research priorities identified by prison stakeholders.

METHODS

A rule-based method was applied to 23,904 PubMed epidemiological criminology abstracts to extract the study determinants and outcomes (ie, "themes"). These were mapped against the research priorities identified by Australian prison stakeholders to assess the differences from research outputs. The income level of the affiliation country of the first authors was also identified to compare the ranking of research priorities in countries categorized by income levels.

RESULTS

On an evaluation set of 100 abstracts, the identification of themes returned an F1-score of 90%, indicating reliable performance. More than 53.3% (11,927/22,361) of the articles had at least 1 extracted theme; the most common was substance use (1533/11,814, 12.97%), followed by HIV (1493/11,814, 12.64%). The infectious disease category (2949/11,814, 24.96%) was the most common research priority category, followed by mental health (2840/11,814, 24.04%) and alcohol and other drug use (2433/11,814, 20.59%). A comparison between the extracted themes and the stakeholder priorities showed an alignment for mental health, infectious diseases, and alcohol and other drug use. Although behavior- and juvenile-related themes were common, they did not feature as prison priorities. Most studies were conducted in high-income countries (10,083/11,814, 85.35%), while countries with the lowest income status focused half of their research on infectious diseases (47/91, 52%).

CONCLUSIONS

The identification of research themes from PubMed epidemiological criminology research abstracts is possible through the application of a rule-based text mining method. The frequency of the investigated themes may reflect historical developments concerning disease prevalence, treatment advances, and the social understanding of illness and incarcerated populations. The differences between income status groups are likely to be explained by local health priorities and immediate health risks. Notable gaps between stakeholder research priorities and research outputs concerned themes that were more focused on social factors and systems and may reflect publication bias or self-publication selection, highlighting the need for further research on prison health services and the social determinants of health. Different jurisdictions, countries, and regions should undertake similar systematic and transparent research priority-setting processes.

Respiratory pandemic preparedness learnings from the June 2020 COVID-19 outbreak at San Quentin California State Prison

PURPOSE

This study aims to characterize the June 2020 COVID-19 outbreak at San Quentin California State Prison and to describe what made San Quentin so vulnerable to uncontrolled transmission.

DESIGN/METHODOLOGY/APPROACH

Since its onset, the COVID-19 pandemic has exposed and exacerbated the profound health harms of carceral settings, such that nearly half of state prisons reported COVID-19 infection rates that were four or more times (and up to 15 times) the rate found in the state's general population. Thus, addressing the public health crises and inequities of carceral settings during a respiratory pandemic requires analyzing the myriad factors shaping them. In this study, we reported observations and findings from environmental risk assessments during visits to San Quentin California State Prison. We complemented our assessments with analyses of administrative data.

FINDINGS

For future respiratory pathogens that cannot be prevented with effective vaccines, this study argues that outbreaks will no doubt occur again without robust implementation of additional levels of preparedness - improved ventilation, air filtration, decarceration with emergency evacuation planning - alongside addressing the vulnerabilities of carceral settings themselves.

ORIGINALITY/VALUE

This study addresses two critical aspects that are insufficiently covered in the literature: how to prepare processes to safely implement emergency epidemic measures when needed, such as potential evacuation, and how to address unique challenges throughout an evolving pandemic for each carceral setting.

Self-Reported Personal Hygiene Practice and Associated Factors among Prison Inmates in Gondar City, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

The growing prevalence of communicable diseases in prison is significantly attributed to poor hygiene practices and insufficient sanitary conditions. The aim of this study was to assess self-reported personal hygiene practice and its associated factors among prison inmates in Gondar, northwest Ethiopia. An institution-based cross-sectional study was conducted from December 1, 2018, to February 30, 2019. Data were gathered using a structured, interviewer-administered questionnaire and observational checklists. The mean age of the inmates was 36 years (±12.4) and the mean months spent in prison was 98.2 ± 15.4 months. The overall adherence to good personal hygiene practices among Gondar City Prison inmates was 54.3%, with a 95% CI of (49.4, 59.1). The number of prisoners per cell [adjusted odds ratio (AOR), 0.31; 95% CI, (0.16, 0.62)], daily water consumption [AOR, 6.78; 95% CI, (2.84, 16.15)], and good knowledge (AOR, 1.50; 95% CI, (1.23, 5.61)] were found to be significant predictors of personal hygiene practice among prison inmates. More than half of the study participants had good personal hygiene practices. Knowledge, daily water consumption, and the number of prisoners per cell were all found to be significantly associated with prisoners' personal hygiene practices. Improving the availability of water would be the best alternative way to improve the personal hygiene practices of the prisoners. Furthermore, prison inmates should be educated on proper hygiene measures and personal cleanliness to prevent the transmission of communicable diseases.

Rethinking standards on prison cell size in a (post)pandemic world: a scoping review

OBJECTIVE

To describe the current international, regional and national standards on prison cell spatial density and the evidence for the association between COVID-19 transmission and prison crowding measures to provide recommendations on prison cell spatial density standards for a (post) pandemic world.

DESIGN

Scoping review.

DATA SOURCES

PubMed, ProQuest, Informit, Criminal Justice Abstracts, Cochrane, Web of Science, Scopus, EMBASE, Google Scholar and Google were searched up to November 2021.

ELIGIBILITY CRITERIA

Guidelines were included provided they described standards of prison accommodation with respect to prison cells. Studies were included provided they examined an association between COVID-19 cases and a crowding measure.

DATA EXTRACTION AND SYNTHESIS

Data were extracted by one reviewer and cross-checked by another. Quantitative and qualitative data on prison cell standards and characteristics of studies examining an association between COVID-19 and prison crowding were collected.Findings were synthesised qualitatively.

RESULTS

Seventeen reports and six studies met eligibility criteria. International and regional standards on cell spatial density were mostly qualitative, with two quantifiable international standards located (3.4 m² and 3.5 m² per person for multiple occupancy cells), and two quantifiable regional standards located (4 m² per person (Europe) and 5.75 m² or 4 m² per person (Australia and New Zealand)). Country-based standards varied substantially, ranging from 1.25 m² per person (Pakistan) to 10 m² per person (Netherlands). Consideration of airborne transmission of disease in prisons were mostly overlooked or absent to rationalise standards. There was consistent evidence that prison crowding measures were associated with COVID-19 transmission/cases.

CONCLUSION

Considering the physics of respiratory emissions, we recommend prison cell spatial density standards be updated to reflect graded levels of risk that consider other factors that combine to inform airborne transmission risk. Decarceration strategies should be considered and become vital if standards are not met.

Prevalence of skin diseases in Taiwan prisons: a population-based study

BACKGROUND

The prevalence of skin diseases among prisoners in Taiwan has rarely been investigated. This study aimed to estimate the prevalence of skin diseases by sex in a sample of prisoners in Taiwan.

METHODS

We included 83,048 participants from the National Health Insurance Program. The outcomes were measured using the clinical version of the International Classification of Diseases, Ninth Revision. For prevalence, we presented absolute values as well as percentages. We also conducted an X² test to assess sex differences and age group differences in the percentages of skin and subcutaneous tissue diseases.

RESULTS

The prevalence of skin diseases was 42.25%, higher than that in the general population. The prevalence of skin diseases among male prisoners was higher than that among female prisoners (p < 0.001), and the prevalence of skin diseases among prisoners who were ≤ 40 was higher than that among prisoners who were > 40. Among all cases diagnosed with skin disease, the top three diseases were contact dermatitis and other types of eczema, cellulitis and abscess, pruritus, and related conditions. Male prisoners had a significantly higher prevalence of all types of skin diseases than female prisoners.

CONCLUSIONS

Skin diseases are common in prisoners in Taiwan. Therefore, early prevention and appropriate treatment are needed. Male-specific skin products are also needed, given the differences in the prevalence of skin diseases among male and female prisoners.

A scoping review of the impacts of COVID-19 physical distancing measures on vulnerable population groups

Most governments have enacted physical or social distancing measures to control COVID-19 transmission. Yet little is known about the socio-economic trade-offs of these measures, especially for vulnerable populations, who are exposed to increased risks and are susceptible to adverse health outcomes. To examine the impacts of physical distancing measures on the most vulnerable in society, this scoping review screened 39,816 records and synthesised results from 265 studies worldwide documenting the negative impacts of physical distancing on older people, children/students, low-income populations, migrant workers, people in prison, people with disabilities, sex workers, victims of domestic violence, refugees, ethnic minorities, and people from sexual and gender minorities. We show that prolonged loneliness, mental distress, unemployment, income loss, food insecurity, widened inequality and disruption of access to social support and health services were unintended consequences of physical distancing that impacted these vulnerable groups and highlight that physical distancing measures exacerbated the vulnerabilities of different vulnerable populations.

An Analysis of PubMed Abstracts From 1946 to 2021 to Identify Organizational Affiliations in Epidemiological Criminology: Descriptive Study

BACKGROUND

Epidemiological criminology refers to health issues affecting incarcerated and nonincarcerated offender populations, a group recognized as being challenging to conduct research with. Notwithstanding this, an urgent need exists for new knowledge and interventions to improve heath, justice, and social outcomes for this marginalized population.

OBJECTIVE

To better understand research outputs in the field of epidemiological criminology, we examined the lead author's affiliation by analyzing peer-reviewed published outputs to determine countries and organizations (eg, universities, governmental and nongovernmental organizations) responsible for peer-reviewed publications.

METHODS

We used a semiautomated approach to examine the first-author affiliations of 23,904 PubMed epidemiological studies related to incarcerated and offender populations published in English between 1946 and 2021. We also mapped research outputs to the World Justice Project Rule of Law Index to better understand whether there was a relationship between research outputs and the overall standard of a country's justice system.

RESULTS

Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest research outputs proportional to their incarcerated population, followed by Australia. University-affiliated first authors comprised 73.3% of published articles, with the Karolinska Institute (Sweden) being the most published, followed by the University of New South Wales (Australia). Government-affiliated first authors were on 8.9% of published outputs, and prison-affiliated groups were on 1%. Countries with the lowest research outputs also had the lowest scores on the Rule of Law Index.

CONCLUSIONS

This study provides important information on who is publishing research in the epidemiological criminology field. This has implications for promoting research diversity, independence, funding equity, and partnerships between universities and government departments that control access to incarcerated and offending populations.

How secured and safe is the sanitation and hygiene services in a maximum-security correctional facility in Southwest Nigeria: a descriptive cross-sectional study

Poorly maintained living conditions and infrastructure are the banes of Nigerian prisons. The study investigated its environmental conditions and the prevalent diseases among inmates.The descriptive, cross-sectional study enrolled 420-inmates through a multistage sampling technique. Pre-tested instruments were administered and results presented with descriptive and logistic regression to identify predictors of toilet-cleaning and handwashing practices at P_∝0.05.The mean(±SD) age and modal inmates/cell were 30±7.2 years and 36. Most inmates were males (97%), await-trial (79%) and lives in overcrowded cells (58%). Sixty-nine percent of free-cells has pour-flush toilets and 36% waits for 2-5 minutes before accessing toilets.Fifty-three percent of inmates clean latrines with water and soap, 71% burn solid waste while handwashing period-prevalence was 36%. Religion, toilet-cleaning, and education were predictors of handwashing while types of toilets and access predict toilet-cleaning behaviour. Malaria (81.1%) and scabies (7.3%) were endemic. The prison rehabilitation shall satisfy basic life needs and promote prisoners' health.

Modeling scenarios for mitigating outbreaks in congregate settings

The explosive outbreaks of COVID-19 seen in congregate settings such as prisons and nursing homes, has highlighted a critical need for effective outbreak prevention and mitigation strategies for these settings. Here we consider how different types of control interventions impact the expected number of symptomatic infections due to outbreaks. Introduction of disease into the resident population from the community is modeled as a stochastic point process coupled to a branching process, while spread between residents is modeled via a deterministic compartmental model that accounts for depletion of susceptible individuals. Control is modeled as a proportional decrease in the number of susceptible residents, the reproduction number, and/or the proportion of symptomatic infections. This permits a range of assumptions about the density dependence of transmission and modes of protection by vaccination, depopulation and other types of control. We find that vaccination or depopulation can have a greater than linear effect on the expected number of cases. For example, assuming a reproduction number of 3.0 with density-dependent transmission, we find that preemptively reducing the size of the susceptible population by 20% reduced overall disease burden by 47%. In some circumstances, it may be possible to reduce the risk and burden of disease outbreaks by optimizing the way a group of residents are apportioned into distinct residential units. The optimal apportionment may be different depending on whether the goal is to reduce the probability of an outbreak occurring, or the expected number of cases from outbreak dynamics. In other circumstances there may be an opportunity to implement reactive disease control measures in which the number of susceptible individuals is rapidly reduced once an outbreak has been detected to occur. Reactive control is most effective when the reproduction number is not too high, and there is minimal delay in implementing control. We highlight the California state prison system as an example for how these findings provide a quantitative framework for understanding disease transmission in congregate settings. Our approach and accompanying interactive website (https://phoebelu.shinyapps.io/DepopulationModels/) provides a quantitative framework to evaluate the potential impact of policy decisions governing infection control in outbreak settings.

"It was there when I came home": young adults and jail reentry in the context of COVID-19

In this study, the authors explore how young adults navigated the dual challenges of the COVID-19 pandemic and jail reentry in a large urban environment. Fifteen young adults (aged 18-25) participated in up to nine monthly semi-structured interviews to discuss their experiences of reentry during the height of the COVID-19 pandemic (i.e., spring and summer 2020). Participants held mixed attitudes and beliefs about COVID-19. Several participants viewed the pandemic as a hoax, while others took the pandemic more seriously, particularly if their friends and family members had contracted the virus. Yet nearly all participants viewed the pandemic as having a relatively minimal impact on their lives compared to the weight of their reentry challenges and probation requirements. Young adults described COVID-19 stay-at-home orders as limiting their exposure to negative influences and facilitating compliance with probation requirements. However, resource closures due to COVID-19, including schools, employment programs, and social services presented barriers to reentry success. The authors draw upon these findings to pose implications for interventions supporting young adult reentry.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12103-022-09683-8.

Health Management in Italian Prisons during COVID-19 Outbreak: A Focus on the Second and Third Wave

The SARS-CoV-2 spread is a threatening and challenging issue for correctional systems worldwide because of many factors, particularly overcrowding and of the intrinsic characteristics of the population. The prevention measures adopted by the Italian Government were aimed to protect and preserve both inmates' and prison workers' health. The present study aimed to evaluate the efficacy of the adopted strategies.

METHODS

Data regarding Italian prisons' occupation and prisoners' population from January 2019 to June 2021, as well as the cumulative weekly increase of confirmed cases and the number of doses of vaccine administered among the population of inmates, the prison workers, and Italian population from November 2020 to the end of June 2021, were collected.

RESULTS

Prisons' occupation dropped from 120% to 106% after the beginning of the pandemics. The confirmed cases between inmates were consistently lower than among the Italian population and prison workers. A time-series chart showed a time lag of one week between the peaks of the different population.

CONCLUSIONS

The containing strategies adopted by the Italian correctional system have proved their effectiveness in terms of the prevention and protection of both inmate and staff health.

Locking out the virus: management of a SARS-CoV-2 outbreak in an Italian prison

PURPOSE

In this paper, the authors present insights and findings drawn from the authors' experiences of containing a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a large prison in northern Italy.Within penitentiaries, close-quarter living is ripe terrain for outbreaks of disease among detainees and staff. If left unchecked, these outbreaks can easily spill over the prison walls to threaten the general public. Moreover, these risks are heightened by preexisting environmental conditions, especially overcrowding. It is thus paramount to establish effective protocols for prevention, early detection and outbreak management. The purpose of this article is to document a strategy that been at least partially successful in reducing the damage that could potentially be caused by a sustained SARS-CoV-2 outbreak within a correctional facility.

DESIGN/METHODOLOGY/APPROACH

The authors conducted a retrospective analysis on patients' and health-care workers' medical records to obtain demographic and clinical information. Descriptive data analysis was then carried out.

FINDINGS

In total, the authors tested 453 people with oropharyngeal swabs from March 15, 2020, to June 30, 2020. Of these people, 58 were positive and 395 were negative, with a prevalence of 12.8%.Of the 453 patients, 60 were health workers: 24 tested positive for SARS-CoV2 ribonucleic acid (RNA); 18 developed symptoms; and three needed hospitalization.Among patients in detention, 34 resulted positive for SARS-CoV-2 RNA. Two were hospitalized and later died. Both had severe preexisting conditions; they were aged 76 and 59 years old, respectively.

ORIGINALITY/VALUE

In this study, the authors describe the design and effective implementation of prevention and containment measures against SARS-CoV-2 within the walls of a correctional facility. The authors describe how they rapidly created clean confinement sections to isolate cases in an environment designed for security at the expense of virus containment and how educational efforts have played a vital role in their strategy.

Association Between Prison Crowding and COVID-19 Incidence Rates in Massachusetts Prisons, April 2020-January 2021

IMPORTANCE

COVID-19 incidence and mortality are higher among incarcerated persons than in the general US population, but the extent to which prison crowding contributes to their COVID-19 risk is unknown.

OBJECTIVE

To estimate the associations between prison crowding, community COVID-19 transmission, and prison incidence rates of COVID-19.

DESIGN, SETTING, AND PARTICIPANTS

This was a longitudinal ecological study among all incarcerated persons in 14 Massachusetts state prisons between April 21, 2020, and January 11, 2021.

EXPOSURES

The primary exposure of interest was prison crowding, measured by (1) the size of the incarcerated population as a percentage of the prison's design capacity and (2) the percentage of incarcerated persons housed in single-cell units. The analysis included the weekly COVID-19 incidence in the county where each prison is located as a covariate.

MAIN OUTCOMES AND MEASURES

The primary outcome was the weekly COVID-19 incidence rate as determined by positive SARS-CoV-2 tests among incarcerated persons at each prison over discrete 1-week increments.

RESULTS

There was on average 6876 people incarcerated in 14 prisons during the study period. The median level of crowding during the observation period ranged from 25% to 155% of design capacity. COVID-19 incidence was significantly higher in prisons where the incarcerated population was a larger percentage of the prison's design capacity (incidence rate ratio [IRR] per 10-percentage-point difference, 1.14; 95% CI, 1.03-1.27). COVID-19 incidence was lower in prisons where a higher proportion of incarcerated people were housed in single-cell units (IRR for each 10-percentage-point increase in single-cell units, 0.82; 95% CI, 0.73-0.93). COVID-19 transmission in the surrounding county was consistently associated with COVID-19 incidence in prisons (IRR [for each increase of 10 cases per 100 000 person-weeks in the community], 1.06; 95% CI, 1.05-1.08).

CONCLUSIONS AND RELEVANCE

This longitudinal ecological study found that within 14 Massachusetts state prisons, increased crowding was associated with increased incidence rates of COVID-19. Researchers and policy makers should explore strategies that reduce prison crowding, such as decarceration, as potential ways to mitigate COVID-19 morbidity and mortality among incarcerated persons.

Locked up While Locked Down: Prisoners’ Experiences of the COVID-19 Pandemic

Worldwide, the COVID-19 pandemic has had a devastating impact on prisoners. The prison environment and prisoner health put prison populations at a higher risk of contracting COVID-19. As a result, prison systems have adopted mitigation strategies to reduce the transmission of the virus into and within prisons. These strategies, however, have had an unintended impact on prisoners and their living conditions. In this article, we explore prisoners’ lived experiences of the pandemic in English and Welsh prisons, captured through correspondence with prisoners throughout 12 months of regime restrictions, from April 2020 to April 2021. Drawing on prisoner narratives, the analysis reveals how the restricted regime has exacerbated the pains of imprisonment and had a detrimental impact on prisoners.

Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020

We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.

Preparedness and Readiness Against COVID-19 Pandemic in Prison Institutions and Detention Centers in Southwest Ethiopia

BACKGROUND

Prisons and detention centers in Ethiopia lack adequate hand washing, personal protective equipment, and quarantine areas. As a result, they are vulnerable to the expansion of the COVID-19 pandemic. Despite its high risk for the COVID-19 pandemic, no study has been made to assess the preparedness and readiness in prison institutions and detention centers.

METHODS

A cross-sectional study design mixed with a qualitative approach was conducted from May 1 to June 30, 2020. A total of four prison institutions and 17 detention centers were included in the study. A simple random sampling technique was employed to select the institutions. The data were entered into the EpiData and exported to SPSS Windows version 22 for data management and analysis. Descriptive statistics was employed for the quantitative section and content analysis was used to analyze the qualitative data.

RESULTS

Five out of 17 detention centers and three out of four prison facilities did not fulfill the standards related to human rights. Almost all detention centers and prison facilities did not implement recommended activities of risk assessment and management of COVID-19. In addition, none of the prison facilities and detention centers had quick access to laboratory tests for suspected cases. Neither the prison facilities nor the detention centers had a contingency plan for the COVID-19 pandemic. Moreover, all staff working in prison facilities and detention centers mentioned that training regarding COVID-19 had not yet been given. However, in all prisons and detention centers, preventive measures such as physical distancing, utilization of hand washing facilities, wearing masks, and keeping respiratory hygiene were not practiced.

American Corrections System Response to COVID-19: an Examination of the Procedures and Policies Used in Spring 2020

This article will explore the federal and state correction system responses to COVID-19 as of early May 2020. Current statistics of infection rates and policy responses will be discussed. In addition, adjustments to inmate activities and staff will be reviewed, as well as responses by community corrections agencies.

[Mental health care in French correctional facilities during the Covid-19 pandemic]

OBJECTIVE

The impact of the Covid-19 pandemic on the 11 million people currently incarcerated worldwide is the subject of many concerns. Prisons and jails are filled with people suffering from many preexisting medical conditions increasing the risk of complications. Detainees' access to medical services is already limited and overcrowding poses a threat of massive contagion. Beyond the health impact of the crisis, the tightening of prison conditions worries. On March 16, 2020, in France, the lockdown measures have been accompanied by specific provisions for prisons: all facilities have suspended visitations, group activities and external interventions. Over 10,000 prisoners have been released to reduce the prison population and the risk of virus propagation. These adjustments had major consequences on the healthcare system in French prisons. The objectives of this article are to describe the reorganization of the three levels of psychiatric care for inmates in France in the context of Covid-19 pandemic and to have a look at the impact of lockdown measures and early releases on mental health of prisoners.

METHODS

This work is based on a survey conducted in April 2020 in France among psychiatric healthcare providers working in 42 ambulatory units for inmates and in the 9 full-time inpatient psychiatric wards exclusively for inmates called "UHSAs" (which stands for "unités hospitalières spécialement aménagées", and can be translated as "specially equipped hospital units"). A review of the international literature on mental healthcare system for inmates during the Covid-19 epidemic has also been performed.

RESULTS

The Covid-19 epidemic has been rather contained during the period of confinement in French prisons but the impact of confinement measures on the prison population is significant. The three levels of psychiatric care for inmates have implemented specific measures to ensure continuity of care, to support detainees during Coronavirus lockdown and to prevent an infection's spread. Among the most important are: limitation of medical consultations to serious and urgent cases, creation of "Covid units", cancellation of voluntary psychiatric hospitalizations, reinforcement of preventive hygiene measures and reshuffling of medical staff. Prolonged confinement has consequences on mental health of detainees. Currently, mental health workers are facing multiple clinical situations such as forced drug and substance withdrawal (linked to difficulties in supplying psychoactive substances), symptoms of anxiety (due to concerns for their own and their relatives' well-being) and decompensation among patients with severe psychiatric conditions. Early releases from prison may also raise some issues. People recently released from prison are identified as at high risk of death by suicide and drug overdose. The lack of time to provide the necessary link between health services within prisons and health structures outside could have serious consequences, emphasizing the well-known "revolving prison doors" effect.

DISCUSSION

The current lockdown measures applied in French jails and prisons point out the disparities between psychiatric care for inmates and psychiatric care for general population. Giving the high vulnerability of prison population, public health authorities should pay more attention to health care in prisons.

How COVID-19's Disruption of the U.S. Correctional System Provides an Opportunity for Decarceration

The COVID-19 pandemic has amplified decades of vulnerabilities, disparities, and injustices within the U.S. correctional system. The spread of the coronavirus poses a particularly serious threat to those that comprise the system, including personnel, attorneys, prisoners, their families and extends into the communities in which facilities are located. These correctional facilities and communities were especially underprepared for the sudden onset of a highly contagious virus, which has resulted in an exceedingly high number of infections among those who work and are held in the facilities. Rampant overcrowding in the U.S. correctional system, an aging population, and a population exhibiting high rates of underlying health conditions are highly likely to exacerbate the spread of this highly contagious virus. This potentially dire set of interrelated circumstances necessitates rapid decarceration measures that effectively balance public safety and public health. Unfortunately, there has been unclear guidance as well as changing and even contradictory information coming from the federal government concerning rapid measures to mitigate the spread of infection to justice system personnel and federal prisoners. In this paper we summarize the federal response and how it has impacted those responsible for implementation. Furthermore, we discuss how systemic deleterious conditions of the U.S. correctional system serve as both accelerants to as well as effects of the pandemic. We end highlighting critical issues relating to early release due to COVID-19 that will necessitate future research.