Prison Population Reductions and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence From the Texas State Prison System

Vest, Noel; Johnson, Oshea D.; Nowotny, Kathryn M.; Brinkley‐Rubinstein, Lauren

doi:10.1007/s11524-020-00504-z

Cited by 54 publications

(44 citation statements)

References 11 publications

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“…Furthermore, analysis of hospitalizations (Figure 3) reveals that older and medically vulnerable residents should receive additional protections beyond vaccine priority, such as lower occupancy housing and additional NPIs. Our study demonstrates the benefits of lower occupancy housing and points to the potential impact of depopulation (16), which other analyses have concluded is an important strategy to reduce transmission (34,35).…”

Section: Discussionsupporting

confidence: 60%

Outbreaks of Covid-19 Variants in Prisons: A Mathematical Modeling Analysis of Vaccination and Re-Opening Policies

Ryckman

Chin

Prince

et al. 2021

Preprint

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BackgroundResidents of correctional facilities have experienced disproportionately higher rates of SARS-CoV-2 infection and Covid-19-related mortality. To protect against outbreaks, many prisons and jails imposed heavy restrictions on in-person activities, which are now beginning to lift. Uncertainty surrounds the safety of these moves.Methods and FindingsWe obtained system-wide resident-day level data for the California state prison system, the nation’s third largest. We used the data to develop a transmission-dynamic stochastic microsimulation model that projects the impact of various policy scenarios on risks of SARS-CoV-2 infections and related hospitalization among residents after an initial infection is introduced to a prison. The policy scenarios vary according to levels of vaccine coverage, baseline immunity, resumption of activities, and use of non-pharmaceutical interventions (e.g., masking, physical distancing). The analyses were conducted across 5 types of prisons that differed in their residential layouts, security levels, and resident demographics.If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage, and has no baseline immunity, 23-74% of residents are expected to be infected over 200 days. High vaccination coverage coupled with use of non-pharmaceutical measures reduces cumulative infections to 2-54% of residents. In prisons consisting mostly of dormitory housing, even with high vaccine coverage and non-pharmaceutical interventions, resumption of in-person activities is associated with substantial risk, unless there is high baseline immunity (e.g., ≥50%) from prior outbreaks. In prisons consisting mostly of cell housing, <10% of residents are expected to become infected, even with no baseline immunity. However, hospitalization risks are substantial in prisons that house medically vulnerable populations, even for prisons consisting mostly of cells. Risks of large outbreaks are substantially higher if there is continued introduction of infections into a prison. Some findings may not be transportable to other carceral settings, and our assumptions regarding viral variants will not be accurate for all variants.ConclusionsBalancing the benefits of resuming normal in-person activities against the risks of Covid-19 outbreaks is a difficult challenge for correctional systems. The policy choices are not strictly binary. To protect against viral variants, prisons should focus on achieving both high vaccine coverage and maintaining widespread use of non-pharmaceutical interventions. With both in place, some prisons, especially those with lower room occupancy that have already had large outbreaks, could safely resume in-person activities, while continuing testing and measures to protect the medically-vulnerable.

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Section: Discussionsupporting

confidence: 60%

Outbreaks of Covid-19 Variants in Prisons: A Mathematical Modeling Analysis of Vaccination and Re-Opening Policies

Ryckman

Chin

Prince

et al. 2021

Preprint

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“…Our study shows the benefits of lower occupancy housing and points to the potential impact of depopulation, 18 which other studies have also highlighted. [30][31][32] Future work could include an assessment of other prevention measures, such as holding activities outdoors or limiting contact across yards or buildings within a prison.…”

Section: Discussionmentioning

confidence: 99%

Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies

Ryckman

Chin

Prince

et al. 2021

The Lancet Public Health

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Background Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities.Methods We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days.Findings If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23-74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2-54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced.Interpretation Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable.

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“…An observational study of Texas prisons described three profiles of COVID-19 outbreaks-low outbreak, high outbreak, and high death-and found that maintaining housing at 85% capacity reduced risk of COVID-19 infection and death. 4 A case study of the British Columbia prison system described successful prevention of COVID-19 outbreaks before the rollout of vaccines using a combination of education, screening, testing, isolation, quarantine, physical distancing, and sanitisation. 5 In The Lancet Public Health, Theresa Ryckman and colleagues 6 have added to this body of research by modelling COVID-19 public health policies in the California state prison system.…”

Section: Reducing Covid-19 Outbreaks In Prisons Through Public Health-centred Policiesmentioning

confidence: 99%

Reducing COVID-19 outbreaks in prisons through public health-centred policies

Henry

2021

The Lancet Public Health

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Prison Population Reductions and COVID-19: A Latent Profile Analysis Synthesizing Recent Evidence From the Texas State Prison System

Cited by 54 publications

References 11 publications

Outbreaks of Covid-19 Variants in Prisons: A Mathematical Modeling Analysis of Vaccination and Re-Opening Policies

Outbreaks of Covid-19 Variants in Prisons: A Mathematical Modeling Analysis of Vaccination and Re-Opening Policies

Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies

Reducing COVID-19 outbreaks in prisons through public health-centred policies

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