BySally Robertson, B.Sc.Sep 1 2020

Researchers at the University of North Carolina at Chapel Hill and Cornell University have conducted a study showing that many states across the US are not reporting fully on the number of people being tested for coronavirus disease 2019 (COVID-19) in prisons, with some also not reporting on cases of fatalities.

Lauren Brinkley-Rubinstein and colleagues also say that among the prison systems that are reporting on COVID-19 testing data, the number of people being tested varies widely between states and as compared with the general population.

However, overall, the deployment of more testing does lead to more cases being identified, with most state prisons having higher rates of infection than in the general population.

The team says the findings highlight the need to implement long-term testing strategies to accurately assess the impact COVID-19 is having in prisons across the US. Mitigation and surveillance strategies are also needed to flatten the COVID-19 curve in prisons across the nation, they add.

A pre-print version of the paper is available on the medRxiv* server, while the article undergoes peer review.

Study: COVID-19 Cases and Testing in 53 Prison Systems. Image Credit: Robert V Schwemmer / Shutterstock

The pandemic has quickly affected US prison systems

The COVID-19 pandemic has impacted on prison systems in the US at an alarming rate. In fact, correctional settings have become epicenters of disease, with nine of the ten largest single-site outbreaks having occurred in these environments.

Prisons are sites of congregate living, where it is impossible to practice common prevention activities such as social distancing, and most prisons have instead relied on incremental measures such as suspending visits, distributing masks, and reducing recreation time.

The communities that incarcerated individuals tend to come from and return home to are also disproportionately burdened by COVID-19.

“Black Americans are both overrepresented in the CJ [criminal justice] system and are more likely to live in areas with higher poverty rates, have limited health care access, and have higher rates of jobs in service industries where they are less able to work from home, which increases exposure to COVID-19,” explain the researchers.

The authors say that given the continued outbreaks in prisons across the country and the vulnerability of incarcerated individuals, it is essential to understand the impact of COVID-19 in these settings more fully by obtaining comprehensive data on testing, test positivity, and case fatality.

“While this is a pressing national issue, this data must be assessed at the state level as each state’s Department of Corrections collects data independently and independently determines their COVID policies,” writes the team.

What did the current study involve?

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Now Brinkley-Rubinstein has gathered data from the COVID Prison Project on testing, test positivity, and mortality by state across 53 prison systems and compared the findings with data on each state’s general population using information from the Johns Hopkins Coronavirus Resource Center.

The researchers found that many states were not fully reporting information on COVID testing in prisons and that some were also not reporting on case fatality.

As of July 15, 2020, 10 states and Puerto Rico were not reporting any testing information.

Testing varied widely between states that were reporting data

Among prisons that were reporting data, testing varied widely. For instance, Hawaii was testing 6 per 1,000 incarcerated individuals, while Minnesota was testing 1,531 per 1,000.

The team says previous studies have estimated national prevalence of various state and federal prison systems, but that it is important to understand the impact of the pandemic on prison systems at a more granular level. Pooling information on low incidence settings with information on those where outbreaks are occurring, for example, masks the local effect that COVID-19 is having on some states and communities across the country.

The team’s findings showed that generally, more testing results in more cases being identified, but between-state variation in testing rates clouds understanding of COVID-19 incidence among prison settings in some states.

More tests within prisons than among the general population

The majority of prison systems had tested more incarcerated individuals than the state had the general population.

However, eleven prisons were testing fewer incarcerated people per 1,000 than had been tested in the state’s general population.

Among incarcerated individuals who were tested, the proportion who tested positively varied by state, from 0 to 42%.

On average, prison systems with the highest rate of test positivity had only tested a small proportion of the incarcerated population.  

The rate of test positivity was, on average, also higher in prison systems than among the general population.

However, the rate was lower than among the general population in some prison systems, which included those in states where outbreaks had recently occurred in the general population, where very few incarcerated individuals had been tested, and where mass testing had been conducted.

Long-term testing and mitigation and surveillance strategies urgently needed

The researchers say that to assess COVID-19’s impact in US prisons accurately and to flatten the curve in these settings, long-term testing and mitigation and surveillance strategies must be urgently implemented.

“It is only through implementing these strategies and continually documenting COVID testing, cases, and fatalities that we will know the spread of COVID in our prison and the injustices it has created and perpetuated,” they write.

“We call for future research to build on this data from the COVID Prison Project to protect the health of our nations’ often forgotten residents,” concludes the team.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

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