Surveillance of COVID-19 outbreaks in prisons in the US South: The role of economic distress in the communities surrounding prison facilities

Abstract

Introduction: The US South is the epicenter of the epidemic of mass incarceration. Prisons have experienced substantial challenges in preventing COVID-19. Incarcerated individuals and prison staff are at a high risk for infection due to minimal available preventive measures. Prisons are not closed systems and many staff come from communities in close proximity to the facility. Characteristics of the communities immediately surrounding prisons are an overlooked but critical factor to better understand the role prisons play in pandemics. Methods: We used facility-level COVID-19 data from the COVID Prison Project to identify the number of unique outbreaks between May 2019 and May 2020. We used a county-level composite indicator of economic distress (DCI score) to identify the environment surrounding each prison (2015–2019). We modeled the number of outbreaks to DCI scores using negative binomial regression, adjusting for race/ethnicity (African American and Latino/Hispanic), age (65 and older), and rurality level. Results: Our sample included 570 prisons in 368 counties across 13 Southern states. We found that score was positively and significantly associated with prison COVID-19 outbreaks (aRR, 1.012; p < 0.0001), and rurality was potentially a stronger surrogate measure of economic distress (aRR, 1.35; p, 0.02). Economic stability is a key precursor to physical health. Poorer communities have been disproportionately impacted by the pandemic, and we found that prisons located in these communities were more susceptible to recurring outbreaks. Prison-based disease prevention interventions should consider the impact that the outside world has on the health of incarcerated individuals.

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

“…Although the incidence of COVID-19 was greater among PEI than in the community, some subgroups of incarcerated residents were at greater risk of seropositivity and COVID-19 incidence. Risk factors for contracting COVID-19 in PEI included Hispanic ethnicity,36 45–47 being of non-Hispanic black ethnicity,36 38 44 46–48 Asian ethnicity,38 partaking in prison labour,44 49 being in high occupancy prisons,32 unstable housing prior to incarceration44 shared meal consumption44 and older age 47 50. Higher security prisons had lower per capita rates of infection 37.…”

“…A rise in staff cases was associated with a rise in cases among PEI 52. Areas of rurality and with higher economic distress scores had higher rates of COVID-19 outbreaks in local prisons 48. One study noted time lagged an average of 1–2 weeks between peaks of infection rates in the general population and the prison population 40…”

“…Certain minoritised groups including non-Hispanic black, black ethnic minority groups and older PEI had poorer outcomes following COVID-19 infection 47 48 50 64. The burden of COVID-19 in prisons in rural and socio-economically disadvantaged areas was also higher 48. Mitigation strategies are required for these vulnerable groups and areas.…”

“… 47 48 50 64 The burden of COVID-19 in prisons in rural and socio-economically disadvantaged areas was also higher. 48 Mitigation strategies are required for these vulnerable groups and areas.…”

“…52 Areas of rurality and with higher economic distress scores had higher rates of COVID-19 outbreaks in local prisons. 48 One study noted time lagged an average of 1-2 weeks between peaks of infection rates in the general population and the prison population. 40 The overall quality of evidence about infection rates of COVID-19 in the prison population was low.…”