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COVID-19 Cases and Deaths in Federal and State Prisons

Our take —

This study used one of the most robust datasets created through aggregation of publicly available data to investigate the rate of COVID-19 cases and mortality among people currently incarcerated across the United States, including state-level prison facilities, Washington DC, and federal prisons from March 31 to June 6, 2020. The study found that there were 42,107 cases of COVID-19 and 510 deaths, with a case rate of 3,251 per 100,000 people incarcerated, and 39 deaths per 100,000 people in community. The standardized mortality rate was 3-fold in prisons than that in community. The study supplemented data from departments of corrections with news reports and press releases, however there is likely still underreporting of cases because not all prisons are testing incarcerated people or reporting. However, this highlights the increased risk for COVID-19 in correctional facilities despite prior mitigation efforts over the time period.

Study design

Ecological

Study population and setting

The study objective was to describe the number of cases in prison facilities and compare whether cases and mortality in prisons from COVID-19 was higher than that in the US community. From March 31 to June 6, 2020, presumed and confirmed deaths were abstracted from departments of corrections websites, news reports, and press releases, across all states, Washington DC, and the Federal Bureau of Prisons. Prison population data were obtained in May 2020 from departments of corrections reports. US community case counts were taken from CDC reports and the US population data were obtained from the American Community Survey.

Summary of Main Findings

There were 42,107 cases of COVID-19 and 510 deaths in prisons, with a case rate of 3,251 per 100,000 people incarcerated. The case rate was 5.5 times higher than the US population case rate for the same time period. Currently incarcerated people also had 39 deaths per 100,000 people, compared to 29 deaths per 100,000 in the community. Because of the different age distributions between the prison and community populations, the mortality rate was standardized for age and sex, and found to be 3 times higher in prisons than expected from the US community. The study also displays cumulative trends in confirmed COVID-19 cases for the study period, with a mean daily growth rate of 8.3% per day in prisons compared to 3.4% per day in the community and consistent upward trend.

Study Strengths

Given the difficulty to obtain accurate reporting of COVID-19 in prisons, the continued monitoring of departments of corrections sites, and supplementation with other reports, makes this some of the most robust prison data obtained through passive surveillance measures. The data for number of infections per 100,000 people were presented over time, which allows cumulative trends to be examined across the study period and shows infection rate regardless of population fluctuations in the correctional system. Finally, by standardizing the mortality ratio, the study properly accounts for major population differences of which data is available.

Limitations

The study is limited by reporting issues, both reporting of the prison population and reporting of cases are subject to lags and lack of testing, and the administrative data did not include race/ethnicity of people incarcerated or other factors (such as disability or underlying comorbidities) that could be adjusted for in the standardized mortality rate. Testing has also been limited in many correctional settings, and individuals are only tested if they report symptoms to correctional staff. Therefore, this does not include asymptomatic cases and likely does not include mild symptom cases either, which will result in an underestimation of cases in correctional settings.

Value added

This is one of the most robust datasets of COVID-19 cases in prison facilities.

This review was posted on: 21 July 2020