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Epidemiology of COVID-19 Among Incarcerated Individuals and Staff in Massachusetts Jails and Prisons

Our take —

This study of the incarcerated population in 16 Massachusetts Department of Corrections (DOC) facilities and 13 county-level systems from April 5 to July 8, 2020 found substantially higher rates of SARS-COV-2 infection among incarcerated persons compared to the general population. Specifically, the rate of SARS-COV-2 infection was 44.3 cases/1000 persons (about 2.9 times that of the Massachusetts general population & 4.8 times that of the US general population). Mitigation measures such as increased testing, contract tracing and avoiding overcrowding are urgently needed to prevent high rates of SARS-COV-2 transmission within this population, and the larger community.

Study design

Prospective Cohort

Study population and setting

This study examined infection with SARS-COV-2 among incarcerated individuals and staff in Massachusetts jails and prisons. Researchers analyzed publicly available data reported by 16 Massachusetts Department of Corrections (DOC) facilities and 13 county-level systems from April 5 to July 8, 2020. The denominator for the rates of SARS-CoV-2 infection was the baseline population at the facilities.

Summary of Main Findings

664 out of 14,987 incarcerated individuals tested positive for SARS-COV-2 by July 8, 2020. This translated to a rate of 44.3 cases/1000 persons (about 2.9 times that of the Massachusetts general population & 4.8 times that of the US general population). County facilities had lower rates of SARS-COV-2 among incarcerated persons compared to DOC facilities (35.7 vs. 52.4 cases/1000 persons). However, the proportion positive (positivity rate) was higher in county facilities than in DOC facilities (14% vs. 5%). A total of 368 confirmed cases were observed among staff across facilities, but the authors were unable to calculate case and testing rates in this group, and no reason was specified why. Incidence of SARS-COV-2 was lower among facilities that released a higher percentage of the baseline population (county jails released ~ 21% of their overall population compared to ~9% in DOC).

Study Strengths

Laboratory confirmation of SARS-COV-2, and inclusion of data from several facilities were strengths of the study.

Limitations

Authors noted high variability in reporting of SARS-COV-2 data across facilities. Little information was provided about how testing was administered, including if testing was performed at random or amongst symptomatic persons and close contacts. Differences in testing rates between county and DOC facilities (254/1000 persons vs 1093/1000 persons) likely contributed to lower rates of SARS-COV-2 cases identified in county facilities and the higher positivity rates. Thus, the actual rate of SARS-CoV-2 infection may be under or overestimated, based on who was and was not tested within this population of incarcerated individuals, especially in county jails.

Value added

This paper presents important data on the burden of SARS-COV-2 among incarcerated persons, a group at high risk for infectious disease acquisition.

This review was posted on: 10 September 2020