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Williams DB, Spinks B, Williams D, Lewis R, Bull F, Edwards A. Effects of the COVID-19 pandemic on people experiencing incarceration: a systematic review. BMJ Open 2024; 14:e076451. [PMID: 38582532 PMCID: PMC11002388 DOI: 10.1136/bmjopen-2023-076451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/01/2024] [Indexed: 04/08/2024] Open
Abstract
OBJECTIVE To assess the effect of the COVID-19 pandemic on people experiencing incarceration (PEI), focusing particularly on clinical outcomes compared with the general population. DESIGN Systematic review with narrative synthesis in accordance with the Centre for Reviews and Dissemination's good practice guidelines. DATA SOURCES Medline, Social Policy and Practice, Criminology Connection, ASSIA, EMBASE, SCOPUS, Web Of Science, CINAHL, Cochrane Library, Cochrane COVID-19 reviews, COVID-19 Evidence Reviews and L*OVE COVID-19 Evidence databases were searched up to 21 October 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included studies presenting data specific to adults ≥18 years experiencing incarceration, with exposure to SARS-CoV-2 infection. All studies with a comparison group, regardless of study design and country were included. Studies with no comparison group data or not measuring clinical outcomes/health inequalities were excluded. Studies focussing on detained migrants, forensic hospitals, prison staff and those not in English were also excluded. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted data and assessed risk of bias. Data underwent narrative synthesis using a framework analysis based on the objectives, for infection rates, testing, hospitalisation, mortality, vaccine uptake rates and mental health outcomes. There was no scope for meta-analysis, due to the heterogeneity of evidence available. RESULTS 4516 references were exported from the databases and grey literature searched, of which 55 met the inclusion criteria. Most were from the USA and were retrospective analyses. Compared with the general population, PEI were usually found to have higher rates of SARS-CoV-2 infection and poorer clinical outcomes. Conflicting data were found regarding vaccine uptake and testing rates compared with the general population. The mental health of PEI declined during the pandemic. Certain subgroups were more adversely affected by the COVID-19 pandemic, such as ethnic minorities and older PEI. CONCLUSION PEI have poorer COVID-19 clinical outcomes than the general public, as shown by largely low-quality heterogenous evidence. Further high-quality research of continuing clinical outcomes and appropriate mitigating interventions is required to assess downstream effects of the pandemic on PEI. However, performing such research in the context of incarceration facilities is highly complex and potentially challenging. Prioritisation of resources for this vulnerable group should be a focus of national policy in the event of future pandemics. PROSPERO REGISTRATION NUMBER CRD42022296968.
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Affiliation(s)
| | - Bethany Spinks
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Denitza Williams
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Francesca Bull
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Adrian Edwards
- Health and Care Research Wales Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Santoriello C, De Rosa C, Rufo C, Romano F, Termoli G, Fiorillo G, Caprio L, Vitolo M, Pagano AM. Suicide Risk Screening and Assessment before and after the COVID-19 Pandemic in New Inmates. Healthcare (Basel) 2024; 12:100. [PMID: 38201006 PMCID: PMC10779268 DOI: 10.3390/healthcare12010100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/26/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Suicide is the main cause of death in Italian prisons. The largest number of inmates who killed themselves was recorded during three years of the COVID-19 pandemic. This study aimed to explore psychosocial risk factors for suicide among inmates incarcerated before and after the onset of COVID-19. (2) Methods: At prison reception, inmates underwent clinical interviews and were assessed using the Blaauw Scale and Suicide Assessment Scale. Psychological distress, measured by the Symptom Checklist-90-R, was compared between inmates admitted before and after COVID-19. Regression analyses were run to examine psychosocial vulnerabilities associated with suicidal intent in newly incarcerated individuals at risk of suicide. (3) Results: Among the 2098 newly admitted inmates (93.7% male) aged 18 to 87 years (M = 39.93; SD = 12.04), 1347 met the criteria for suicide risk, and 98 exhibited high suicidal intent. Inmates who entered prison after the onset of COVID-19 were older and had fewer social relationships. They had a higher prevalence of recidivism and substance abuse, along with elevated levels of psychological distress. An increase in perceived loss of control, anergia, obsessive-compulsive symptoms, phobic anxiety, and paranoid ideation emerged as the factors most strongly associated with high suicidal intent. (4) Conclusions: These findings support the value of psychosocial screening in promptly identifying inmates at risk of suicide, enabling the implementation of targeted, multi-professional interventions. Future research should replicate these results, with a focus on longitudinal studies that monitor the same inmates throughout their incarceration period.
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Affiliation(s)
- Carmen Santoriello
- Unità Operativa Semplice Dipartimentale U.O.S.D. Department of Adults and Minors Healthcare, Criminal Area, Local Health Authority of Salerno, 84132 Salerno, Italy
| | | | | | | | | | | | | | | | - Antonio Maria Pagano
- Unità Operativa Semplice Dipartimentale U.O.S.D. Department of Adults and Minors Healthcare, Criminal Area, Local Health Authority of Salerno, 84132 Salerno, Italy
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Yan Y, Hou J, Li Q, Yu NX. Suicide before and during the COVID-19 Pandemic: A Systematic Review with Meta-Analysis. Int J Environ Res Public Health 2023; 20:3346. [PMID: 36834037 PMCID: PMC9960664 DOI: 10.3390/ijerph20043346] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/09/2023] [Accepted: 02/11/2023] [Indexed: 06/01/2023]
Abstract
Synthesizing evidence to examine changes in suicide-related outcomes before and during the pandemic can inform suicide management during the COVID-19 crisis. We searched 13 databases as of December 2022 for studies reporting both the pre- and peri-pandemic prevalence of suicidal ideation, suicide attempts, or rate of death by suicide. A random-effects model was used to pool the ratio of peri- and pre-pandemic prevalence of suicidal ideation and attempt (Prevalence Ratio-PR) and rate of death by suicide (Rate Ratio; RR). We identified 51, 55, and 25 samples for suicidal ideation, attempt, and death by suicide. The prevalence of suicidal ideation increased significantly among non-clinical (PR = 1.142; 95% CI: 1.018-1.282; p = 0.024; k = 28) and clinical (PR = 1.134; 95% CI: 1.048-1.227; p = 0.002; k = 23) samples, and pooled estimates differed by population and study design. Suicide attempts were more prevalent during the pandemic among non-clinical (PR = 1.14; 95% CI: 1.053-1.233; p = 0.001; k = 30) and clinical (PR = 1.32; 95% CI: 1.17-1.489; p = 0.000; k = 25) participants. The pooled RR for death by suicide was 0.923 (95% CI: 0.84-1.01; p = 0.092; k = 25), indicating a nonsignificant downward trend. An upward trend of suicidal ideation and suicide attempts was observed during the COVID-19 pandemic, despite suicide rate remaining stable. Our findings suggest that timely prevention and intervention programs are highly needed for non-clinical adult population and clinical patients. Monitoring the real-time and long-run suicide risk as the pandemic evolves is warranted.
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Affiliation(s)
- Yifei Yan
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
| | - Jianhua Hou
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
| | - Qing Li
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China
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Park H, Linthwaite B, Dussault C, Halavrezos A, Chalifoux S, Sherman J, Del Balso L, Buxton JA, Cox J, Kronfli N. Factors associated with changes in illicit opioid use during the COVID-19 pandemic among incarcerated people who use drugs in Quebec, Canada. Int J Prison Health 2022; 19:464-473. [PMID: 36519779 PMCID: PMC10598516 DOI: 10.1108/ijph-06-2022-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE People who use drugs (PWUD) have been disproportionately affected by the COVID-19 pandemic. This study aims to examine changes in illicit opioid use and related factors among incarcerated PWUD in Quebec, Canada, during the pandemic. DESIGN/METHODOLOGY/APPROACH The authors conducted an observational, cross-sectional study in three Quebec provincial prisons. Participants completed self-administered questionnaires. The primary outcome, "changes in illicit opioid consumption," was measured using the question "Has your consumption of opioid drugs that were not prescribed to you by a medical professional changed since March 2020?" The association of independent variables and recent changes (past six months) in opioid consumption were examined using mixed-effects Poisson regression models with robust standard errors. Crude and adjusted risk ratios with 95% confidence intervals (95% CIs) were calculated. FINDINGS A total of 123 participants (median age 37, 76% White) were included from January 19 to September 15, 2021. The majority (72; 59%) reported decreased illicit opioid consumption since March 2020. Individuals over 40 were 11% less likely (95% CI 14-8 vs 18-39) to report a decrease, while those living with others and with a history of opioid overdose were 30% (95% CI 9-55 vs living alone) and 9% (95% CI 0-18 vs not) more likely to report decreased illicit opioid consumption since March 2020, respectively. ORIGINALITY/VALUE The authors identified possible factors associated with changes in illicit opioid consumption among incarcerated PWUD in Quebec. Irrespective of opioid consumption patterns, increased access to opioid agonist therapy and enhanced discharge planning for incarcerated PWUD are recommended to mitigate the harms from opioids and other drugs.
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Affiliation(s)
- Hyejin Park
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Sylvie Chalifoux
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Jessica Sherman
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Lina Del Balso
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | | | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Canada; McGill University, Montreal, Canada and McGill University Health Centre, Montreal, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Montreal, Canada; McGill University, Montreal, Canada and McGill University Health Centre, Montreal, Canada
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Munkholm MC. Prisoners' experiences and coping strategies during the COVID-19 pandemic response - an ethnographic study conducted mid-pandemic. Int J Prison Health 2022; 19:452-463. [PMID: 36512415 DOI: 10.1108/ijph-03-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE This paper aims to report findings about how prisoners experience and cope with COVID-19 restrictions, which can contribute to an understanding of how pandemic responses, and specifically the COVID-19 response, affect prisoners. DESIGN/METHODOLOGY/APPROACH Data was collected through ethnographic fieldwork involving days of observations (N = 24) and the conduction of semi-structured interviews with prisoners (N = 30) in closed prisons and detentions in Denmark between May and December 2021. The transcribed interviews and field notes were processed and coded by using the software programme NVivo. FINDINGS The data analysis reveals that the pains of imprisonment have been exacerbated to people incarcerated during the COVID-19 pandemic. To relieve pains of imprisonment, prisoners turn to censoriousness as an informal coping strategy, where they complain about inconsistency and injustice in the prison's COVID-19 prevention strategy to reveal the prison system itself as a rule-breaking institution. The prisoners criticise the prison management for using COVID-19 as an excuse, treating prisoners unjustly or not upholding the COVID-19 rules and human rights. Furthermore, principles of justice and equality are also alleged by some prisoners who contemplate the difficulty in treating all prisoners the same. RESEARCH LIMITATIONS/IMPLICATIONS More research will be needed to create a full picture of how prisoners cope with pandemic responses. Further research could include interviews with people working inside prisons. ORIGINALITY/VALUE In a Scandinavian context, to the best of the author's knowledge, this study is the first of its kind to apply an ethnographic approach in exploring prison life during the COVID-19 pandemic.
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Gétaz L, Wolff H, Gonçalves L, Togni G, Stringhini S, Chacowry Pala K, Iten A, Guessous I, Kaiser L, Chappuis F, Baggio S. SARS-CoV-2 seroprevalence study after the first wave among persons living and working in an overcrowded Swiss prison. Int J Prison Health 2022; 19:392-399. [PMID: 36269138 DOI: 10.1108/ijph-01-2022-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Prisons can be epicentres of infectious diseases. However, empirical evidence on the impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in prison is still scarce. This study aims to estimate the seroprevalence rates of anti-SARS-CoV-2 in the largest and most crowded Swiss prison and compare them with the seroprevalence rate in the general population. DESIGN/METHODOLOGY/APPROACH A cross-sectional study was conducted in June 2020, one month after the first wave of SARS-CoV-2 in Switzerland. Groups included: people living in detention (PLDs) detained before the beginning of the pandemic (n = 116), PLDs incarcerated after the beginning of the pandemic (n = 61), prison staff and prison healthcare workers (n = 227) and a sample from the general population in the same time period (n = 3,404). The authors assessed anti-SARS-CoV-2 IgG antibodies. FINDINGS PLDs who were incarcerated before the beginning of the pandemic had a significantly lower seroprevalence rate [0.9%, confidence interval (CI)95%: 0.1%-5.9%] compared to the general population (6.3%, CI 95%: 5.6-7.3%) (p = 0.041). The differences between PLDs who were incarcerated before and other groups were marginally significant (PLDs incarcerated after the beginning of the pandemic: 6.6%, CI 95%: 2.5%-16.6%, p = 0.063; prison staff CI 95%: 4.8%, 2.7%-8.6%, p = 0.093). The seroprevalence of prison staff was only slightly and non-significantly lower than that of the general population. ORIGINALITY/VALUE During the first wave, despite overcrowding and interaction with the community, the prison was not a hotspot of SARS-CoV-2 infection. Preventive measures probably helped avoiding clusters of infection. The authors suggest that preventive measures that impact social welfare could be relaxed when overall circulation in the community is low to prevent the negative impact of isolation.
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Affiliation(s)
- Laurent Gétaz
- Division of Prison Health, Geneva University Hospitals, University of Geneva, Geneva, Switzerland and Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Thônex, Switzerland
| | - Hans Wolff
- Division of Prison Health, Geneva University Hospitals, Thônex, Switzerland
| | - Leonel Gonçalves
- Division of Prison Health, Geneva University Hospitals, Thônex, Switzerland
| | - Giuseppe Togni
- Microbiology Lab, Unilabs Coppet Core Lab Ouest, Coppet, Switzerland
| | - Silvia Stringhini
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland; Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland and University Center for General Medicine and Public Health, University of Lausanne, Lausanne, Switzerland
| | | | - Anne Iten
- Infection Control Program, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland and Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Kaiser
- Geneva Center for Emerging Viral. Diseases and Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland and Department of Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Francois Chappuis
- Division and Tropical and Humanitarian Medicine, Geneva University Hospitals, Geneva, Switzerland and Department of Health and Community Medicine, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals, Thônex, Switzerland and Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Kim H, Hughes E, Cavanagh A, Norris E, Gao A, Bondy SJ, McLeod KE, Kanagalingam T, Kouyoumdjian FG. The health impacts of the COVID-19 pandemic on adults who experience imprisonment globally: A mixed methods systematic review. PLoS One 2022; 17:e0268866. [PMID: 35594288 PMCID: PMC9122186 DOI: 10.1371/journal.pone.0268866] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 12/18/2022] Open
Abstract
Background The prison setting and health status of people who experience imprisonment increase the risks of COVID-19 infection and sequelae, and other health impacts of the COVID-19 pandemic. Objectives To conduct a mixed methods systematic review on the impacts of the COVID-19 pandemic on the health of people who experience imprisonment. Data sources We searched Medline, PsycINFO, Embase, the Cochrane Library, Social Sciences Abstracts, CINAHL, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Sociology Database, Coronavirus Research Database, ERIC, Proquest Dissertations and Theses, Web of Science, and Scopus in October 2021. We reviewed reference lists for included studies. Study eligibility criteria Original research conducted in or after December 2019 on health impacts of the COVID-19 pandemic on adults in prisons or within three months of release. Study appraisal and synthesis methods We used the Joanna Briggs Institute’s Critical Appraisal Checklist for Qualitative Research for qualitative studies and the Joanna Briggs Institute’s Critical Appraisal Checklist for Studies Reporting Prevalence Data for quantitative studies. We qualitized quantitative data and extracted qualitative data, coded data, and collated similar data into categories. Results We identified 62 studies. People in prisons had disproportionately high rates of COVID-19 infection and COVID-19 mortality. During the pandemic, all-cause mortality worsened, access to health care and other services worsened, and there were major impacts on mental wellbeing and on relationships with family and staff. There was limited evidence regarding key primary and secondary prevention strategies. Limitations Our search was limited to databases. As the COVID-19 pandemic is ongoing, more evidence will emerge. Conclusions Prisons and people who experience imprisonment should be prioritized for COVID-19 response and recovery efforts, and an explicit focus on prisons is needed for ongoing public health work including emergency preparedness. Prospero registration number 239324.
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Affiliation(s)
- Hannah Kim
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Hughes
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Alice Cavanagh
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emily Norris
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Angela Gao
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Susan J. Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Katherine E. McLeod
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Tharsan Kanagalingam
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Fiona G. Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
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Mazzilli S, Tavoschi L, Soria A, Fornili M, Cocca G, Sebastiani T, Scardina G, Cairone C, Arzilli G, Lapadula G, Ceccarelli L, Cocco N, Bartolotti R, De Vecchi S, Placidi G, Rezzonico L, Baglietto L, Giuliani R, Ranieri R. COVID-19 Infection Among Incarcerated Individuals and Prison Staff in Lombardy, Italy, March 2020 to February 2021. JAMA Netw Open 2022; 5:e224862. [PMID: 35353164 PMCID: PMC8968466 DOI: 10.1001/jamanetworkopen.2022.4862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Owing to infrastructural and population characteristics, the prison setting is at increased risk for transmission of SARS-CoV-2 and for severe clinical outcomes. Because of structural and operational reasons, research in prison settings is challenging and available studies are often monocentric and have limited temporal coverage; broader-based research is necessary. OBJECTIVES To assess the extent and dynamics of the COVID-19 pandemic within the prison system of a large Italian region, Lombardy, and report the infection prevention and control measures implemented. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study was carried out from March 1, 2020, through February 28, 2021 (first wave, March-June 2020; second wave, October 2020-February 2021) in the prison system of Lombardy, which includes 18 detention facilities for adults. All incarcerated persons and the prison staff of the penitentiary system of the Lombardy region participated in the study. EXPOSURES The main exposures of interest were the weekly average number of incarcerated individuals placed in quarantine in single or shared isolation rooms, the rate of sick leave by symptomatic and asymptomatic prison staff reported to the prison occupational medicine department on a weekly basis, and the level of overcrowding. MAIN OUTCOMES AND MEASURES The primary outcome measures were weekly COVID-19 crude case rates, weekly test positivity rate, and the relative risk of acquiring the infection for prison staff, incarcerated persons, and the general population. RESULTS The study population comprised a mean of 7599 incarcerated individuals and 4591 prison staff. Approximately 5.1% of the prison population were women; demographic characteristics of the prison staff were not available. During the study, COVID-19 occurred in 1564 incarcerated individuals and 661 prison staff. Most of these cases were reported during the second wave (1474 in incarcerated individuals, 529 in prison staff), when stringent measures previously enforced were relaxed. During both epidemic waves, incarcerated individuals and prison staff had a higher relative risk for COVID-19 infection than the general population during both the first wave (incarcerated individuals: 1.30; 95% CI, 1.06-1.58; prison staff: 3.23; 95% CI, 2.74-3.84) and the second wave (incarcerated individuals: 3.91; 95% CI, 3.73-4.09; prison staff: 2.61; 95% CI, 2.41-2.82). CONCLUSIONS AND RELEVANCE The findings of this study suggest that the prison setting was an element of fragility during COVID-19 pandemic, with a high burden of COVID-19 cases among both the incarcerated individuals and prison staff. The prison setting and prison population need to be included and possibly prioritized in the response during epidemic events.
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Affiliation(s)
- Sara Mazzilli
- Scuola Normale Superiore, Pisa, Italy
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Lara Tavoschi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Alessandro Soria
- Clinic of Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy
| | - Marco Fornili
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgia Cocca
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Teresa Sebastiani
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Giuditta Scardina
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Cristina Cairone
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giuseppe Lapadula
- Clinic of Infectious Diseases, San Gerardo Hospital, ASST Monza, Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Luca Ceccarelli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Nicola Cocco
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Raffaella Bartolotti
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Stefano De Vecchi
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Giacomo Placidi
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Leonardo Rezzonico
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Laura Baglietto
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ruggero Giuliani
- Infectious Diseases Service, Penitentiary Health System, San Vittore Prison Health Unit, Azienda Socio-Sanitaria Territoriale Santi Paolo e Carlo, Milan, Italy
| | - Roberto Ranieri
- Welfare General Directorate, Lombardy Regional Health Authority, Milan, Italy
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