A new analysis of COVID-19 in prisons in the United States finds that the number of cases is five times higher, and the number of adjusted deaths is three times higher than in the general population.

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Close confinement and overcrowding make prisons the ideal ‘breeding ground’ for infectious disease.
Image credit: Sandy Huffaker / AFP.

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In many ways, prisons are an ideal ‘breeding ground’ for contagious diseases, due to conditions of close confinement, shared facilities, and overcrowding.

According to an older article in Clinical Infectious Diseases, newly incarcerated prisoners have higher rates of viral infections, such as HIV and hepatitis. They are also at a higher risk of contracting an infectious disease while they are in prison, including airborne infections, such as tuberculosis (TB) and influenza.

The COVID-19 pandemic has brought these issues into focus. The close conditions, lack of personal protective equipment (PPE), and high rates of respiratory and cardiac diseases among inmates place them at a higher risk of developing a severe form of COVID-19.

Prisons in California have seen particularly high rates of the disease. For example, more than one-third of inmates and staff at San Quentin Prison tested positive for the virus. As a result, California is to release thousands of prisoners early from state prisons to help slow the spread of COVID-19.

A new analysis of COVID-19 in federal and state prisons in the U.S. finds that the rate of cases and deaths are significantly higher than in the general population.

The analysis highlights the need for infection control in prisons and appears in the Journal of the American Medical Association (JAMA).

Researchers at Johns Hopkins Bloomberg School of Public Health, in Baltimore, MD, analyzed COVID-19 cases and deaths among federal and state prisoners between March 31 and June 6, 2020.

The data were collected as part of the UCLA Law COVID-19 Behind Bars project and comes from publicly available sources, such as websites, news reports, and press releases.

In combination with data from the Centers for Disease Control and Prevention (CDC) and the US Census Bureau’s American Community Survey, the researchers compared rates of COVID-19 cases and deaths for prisoners and the overall U.S. population.

The first thing they found was that the disease spread more rapidly within the confined conditions of the prison system.

Although the rate of COVID-19 cases in prisons was initially lower than at the national level, prison cases soon overtook those in the general population. The average daily growth rate of COVID-19 cases during the study period was 8.3% in prisons, compared with 3.4% in the general population.

By June 6, there were 42,107 cases of COVID-19 in prisons, among a total of 1,295,285 prison residents.

This is equivalent to 3,251 cases per 100,000 prisoners, which is more than five times higher than the national case rate of 587 cases per 100,000 people.

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The researchers used information from departments of corrections, and external medical examiner reports to assess the number of COVID-19 deaths in prisons.

During the study period, there were 510 deaths among prison residents. This is equivalent to 39 deaths per 100,000 prisoners, which is higher than the U.S. average of 29 deaths per 100,000 people.

However, when accounting for demographic differences, the death rate was three times higher in prisons than in the general population.

This largely comes down to age. Just 3% of the prison population is 65 years old or above compared with 16% of the U.S. population. This age group accounted for the majority of deaths from COVID-19 in the general population.

The authors say case rates in prisons are likely to be even higher than reported here, as many prisons only tested people with symptoms of COVID-19, and some did not test their inmates at all.

“While these numbers are striking, we actually think the disparities within prisons is much greater,” says lead author Brendan Saloner, Ph.D., associate professor in the Department of Health Policy and Management at the Bloomberg School.

“Some prisons are not reporting any cases; others are not even testing inmates, so the need for policies to protect incarcerated populations is more important than ever.”

The authors suggest that prisons implement more effective infection control measures to contain outbreaks of COVID-19.

Other possible solutions to relieve the problem include widespread testing and the early release of low-risk inmates — as California has announced they will do — to stem the spread of COVID-19 in the prison system.

“Prisoners have a right to adequate protection of their health while incarcerated. The reality of these findings shows that we aren’t coming anywhere close to meeting their basic needs. Ultimately, it creates a dangerous situation for the inmates, prison staff, the communities that prisons are located in, and in our overall effort to contain the crisis.”

– Brendan Saloner, Ph.D.

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