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Public Health Response to COVID-19 Cases in Correctional and Detention Facilities – Louisiana, March-April 2020

Our take —

Correctional/detention facilities are at greater risk of COVID-19 outbreaks due to the confined physical spaces, high contacts between inmates, and logistical and security issues that make it difficult to implement recommended distancing measures. This study does not report details of testing and screening policies; cases may be severely undercounted. The CMAR tool helps public health officials systematically assess risks and provide tailored strategies for infection control within correctional and detention facilities.

Study design

Cross-Sectional

Study population and setting

This paper describes: 1) the prevalence of COVID-19 in correctional and detention facilities across 144 facilities in Louisiana, USA, with an incarcerated or detained population of 45,400, based on active daily surveillance between March 22 to April 22, 2020; and 2) the benefits of using the COVID-19 Management Assessment and Response (CMAR) tool to help public health officials provide tailored and specific guidance to 24 correctional and detention facilities. The Centers for Disease Control and the Louisiana Department of Health collaborated to develop the CMAR, a phone-based assessment tool. CMAR systematically records the characteristics of correctional facilities so that technical advisors can recommend strategies to address identified weaknesses, evaluate management protocols, and guide conversations between public health practitioners and correctional facilities staff.

Summary of Main Findings

There were 489 laboratory-confirmed cases of COVID-19 in the incarcerated or detained population and 253 cases among staff across 46 facilities. The CMAR tool was used in 24 facilities, 13 of which had confirmed cases. All facilities implemented hand-washing recommendations, screened new inmates for symptoms, and stopped visitation to facilities. However, there was variation in uptake of interventions such as wearing masks, quarantine of close contacts, and allocating specific staff to each unit. The CMAR tool highlighted how structural, physical, and logistical facility-specific barriers such as limited space, close contact between inmates, low staffing numbers, and deterrents to reporting cases probably contributed to the spread of COVID-19 in correctional and detention facilities.

Study Strengths

Surveillance data were collected from 144 correctional and detention facilities across Louisiana.

Limitations

No information is presented on either statewide or facility-specific testing and screening protocols, making it difficult to interpret case counts and prevalence estimates. There were no data available on the overall number of staff members. The number of COVID-19 cases among staff is underreported, as not all facilities provided case numbers. Case numbers were detected through surveillance systems specific to each facility, and these systems may have varied in quality and coverage. Facilities that chose to use the CMAR tool (24/144) may be different from other facilities. Implementation and uptake of interventions could not be directly observed, as this was a phone-based tool.

Value added

As one of the first studies to focus on COVID-19 in correctional/detention facilities in the US, the study highlights the challenges in controlling an outbreak in these settings. The CMAR tool provides a way for public health officials to communicate with facility administration and provide recommendations for infection control.