A time-series analysis of testing and COVID-19 outbreaks in Canadian federal prisons to inform prevention and surveillance efforts

Abstract

Background: Approximately 14,000 adults are currently incarcerated in federal prisons in Canada. These facilities are vulnerable to disease outbreaks and an assessment of coronavirus disease 2019 (COVID-19) testing and outcomes is needed. The objective of this study was to examine outcomes of COVID-19 testing, prevalence, case recovery and death within federal prisons and to contrast these data with those of the general population. Methods: Public time-series outcome data for prisoners and the general population were obtained on-line from the Correctional Service of Canada and the Public Health Agency of Canada, respectively, from March 30 to May 27, 2020. Prison, province and sex-specific frequency statistics for each outcome were calculated. A total of 50 facilities were included in this study. Results: Of these 50 facilities, 64% reported fewer individuals tested per 1,000 population than observed in the general population and 12% reported zero tests in the study period. Testing tended to be reactive, increasing only once prisons had recorded positive tests. Six prisons reported viral outbreaks, with three recording over 20% cumulative COVID-19 prevalence among prisoners. Cumulatively, in prisons, 29% of individuals tested received a positive result, compared to 6% in the general population. Two of the 360 cases died (0.6% fatality). Four outbreaks appeared to be under control (more than 80% of cases recovered); however, sizeable susceptible populations remain at risk of infection. Female prisoners (5% of the total prisoner population) were over-represented among cases (17% of cases overall). Conclusion: Findings suggest that prison environments are vulnerable to widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Gaps in testing merit public health attention. Symptom-based testing alone may not be optimal in prisons, given observations of widespread transmission. Increased sentinel or universal testing may be appropriate. Increased testing, along with rigorous infection prevention practices and the potential release of prisoners, will be needed to curb future outbreaks.

The Risk of COVID-19 Infection in Prisons and Prevention Strategies: A Systematic Review and a New Strategic Protocol of Prevention

“…Health risks inside prisons, particularly in overcrowded and under-resourced ones, are well known. However, with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in 2019 (COVID- 19), they became a public health emergency [1]. To date, in fact, there are more than 10 million prisoners around the world; in most cases, the conditions are bad and health care is poor [2].…”

Recommandations pour une reprise équitable après la pandémie de COVID-19 au Canada

“…Il y a eu moins de dépistage du SRAS-CoV-2 dans les établissements de détention que dans les collectivités, même si les personnes incarcérées sont plus à risque; des taux élevés d'infection au SRAS-CoV-2 ont été observés dans la population carcérale 7 . Cela représente une occasion d'ajuster la prestation générale des soins de santé en fonction des besoins des personnes incarcérées, même si nous n'avons trouvé aucune étude sur la prestation générale des soins de santé dans cette population.…”

“…es iniquités en matière de santé, ou les différences évitables de l'état de santé de populations diverses, qui ont été révélées et exacerbées durant la pandémie de COVID-19 pourraient être corrigées par des interventions et des modifications de politiques qui ont fait l'objet d'études avant la propagation du SRAS-CoV-2 partout au Canada 1,2 . Les personnes racisées, les femmes, les personnes à faible revenu, les personnes vivant en situation d'itinérance ou éprouvant des problèmes de toxicomanie et les détenus ont tous été affectés de manière disproportionnée par la pandémie [3][4][5][6][7] . Cette dernière a mis en lumière notre interdépendance à mesure que la propagation du virus parmi les personnes défavorisées menaçait la santé de tous, y compris des privilégiés, et cela a suscité des appels à la lutte aux iniquités sous la forme d'aphorismes tels qu'« aucun d'entre nous n'est en sécurité tant que nous ne le sommes pas tous » 1 .…”

Recommendations for equitable COVID-19 pandemic recovery in Canada

“…80,81 There have been lower rates of testing for SARS-CoV-2 infection in prison facilities than in the community, even though incarcerated individuals are at increased risk; high rates of SARS-CoV-2 infections among the incarcerated population have been observed. 7 This suggests an opportunity to match the provision of health care generally to the needs of people who are incarcerated, although we did not identify studies addressing the general provision of health care in this population.…”

“…1,2 Racialized people, women, people with a low income, people experiencing homelessness, people who use substances and people who are incarcerated were disproportionately affected during the pandemic. [3][4][5][6][7] The pandemic revealed our interdependence as the spread of the virus among people experiencing disadvantages threatened the health of everyone, including those with privilege, and this has led to calls to address inequities under aphorisms such as "no one is protected until everyone is protected." 1 The current attention to inequities that have long persisted in Canada may fade as SARS-CoV-2 vaccinations roll out and the immediate harms of COVID-19 subside.…”