Crowding in Massachusetts prisons led to increase in COVID-19 cases
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Increased crowding in Massachusetts state prisons led to an increase in COVID-19 cases, researchers reported in JAMA Internal Medicine.
Abigail I. Leibowitz, MPH, an MD candidate at the University of Colorado School of Medicine, and colleagues conducted a longitudinal ecological study of 14 Massachusetts state prisons between April 21, 2020, and Jan. 11, 2021.
According to the authors, all 14 prisons implemented the same COVID-19 measures — masking, hand hygiene, no in-person visitations during periods of high community transmission, quarantining for those who are newly incarcerated, and symptom screening and isolation for those showing symptoms.
The 14 prisons — 12 designated for males, and two for females — were designed to hold a total of 7,287 people. During the study period, they held an average of 6,876 people, Leibowitz and colleagues reported.
The study found that the incidence of COVID-19 was significantly greater among prisons operating at a higher capacity (incidence rate ratio [IRR] per 10 percentage-point difference, 1.14; 95% CI, 1.03-1.27), and was highest among prisons operating above full capacity (IRR, 4.86; 95% CI, 1.37-17.27).
The incidence was significantly lower (IRR, 0.82; 95% CI, 0.73-0.93) in prisons where individuals were housed separately in single-cell units.
Throughout the study, there were 2,497 reported cases of COVID-19 among all incarcerated prisoners. The mean incidence rate was 956 cases per 100,000 individuals compared with 150 cases per 100,000 individuals in the entire state of Massachusetts (IRR, 6.38; 95% CI, 6.14-6.64).
“Our findings indicate that prison crowding may be an important driver of COVID-19 incidence in state prisons,” the authors wrote.
In a related editorial, A. Asa Clemenzi-Allen, MD, MAS, assistant clinical professor of medicine at the University of California, San Francisco, and Lisa A. Pratt, MD, MPH, director of jail health services at the San Francisco Sheriff’s Office, said the results are likely underestimates because of limited testing in prisons and asymptomatic infections.
“The findings by Leibowitz [and colleagues] provide another example of why overcrowding of carceral settings is dangerous to the health of incarcerated individuals,” the authors wrote.
References:
Leibowitz AI, et al. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.4392.
Clemenzi-Allen AA, Pratt LA. JAMA Intern Med. 2021;doi:10.1001/jamainternmed.2021.4389.
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