Abstract and Introduction
To assess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a detention facility experiencing a coronavirus disease outbreak and evaluate testing strategies, we conducted a prospective cohort investigation in a facility in Louisiana, USA. We conducted SARS-CoV-2 testing for detained persons in 6 quarantined dormitories at various time points. Of 143 persons, 53 were positive at the initial test, and an additional 58 persons were positive at later time points (cumulative incidence 78%). In 1 dormitory, all 45 detained persons initially were negative; 18 days later, 40 (89%) were positive. Among persons who were SARS-CoV-2 positive, 47% (52/111) were asymptomatic at the time of specimen collection; 14 had replication-competent virus isolated. Serial SARS-CoV-2 testing might help interrupt transmission through medical isolation and quarantine. Testing in correctional and detention facilities will be most effective when initiated early in an outbreak, inclusive of all exposed persons, and paired with infection prevention and control.
Correctional and detention facilities face unique challenges for controlling severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19). These challenges include an inability for incarcerated or detained persons to socially distance and an ongoing risk for virus introduction caused by staff movement outside and within the facilities.[1,2] These inherent difficulties underpin increased rates of SARS-CoV-2 infections and deaths among incarcerated and detained persons compared with the general population; 146,472 cases and 1,122 deaths in this population were reported in the United States as of October 20, 2020.[3,4] The Centers for Disease Control and Prevention (CDC) released interim guidance for management of COVID-19 in correctional and detention facilities; however, some facilities reported limitations to fully implementing the guidance.[5–7] In addition, the potential for asymptomatic and presymptomatic transmission limits the effectiveness of symptom screening to identify cases and halt transmission.[8–10] In other congregate settings, serial testing and physically separating persons based on their SARS-CoV-2 test results have been used to interrupt transmission.[11,12]
We investigated a COVID-19 outbreak in a detention center in Louisiana, USA (facility X) and used a serial testing strategy to identify infections and interrupt transmission in affected dormitories. All residents of affected dormitories underwent SARS-CoV-2 testing to assess the extent of transmission within the dormitory, to cohort detained persons based on their test result to prevent transmission, and to evaluate the utility of serial testing in this setting. We report the findings of this investigation; initial results were previously reported.
By March 17, 2020, in response to emergence of COVID-19 in Louisiana, facility X ceased travel of detained persons outside the facility, halted visitors and transfers between facilities, and prohibited movement of detained persons within the facility. On March 29, a staff member showed symptoms consistent with COVID-19; this staff member later tested positive for SARS-CoV-2. On April 7, facility X medical staff identified the first COVID-19 case in a detained person residing in dormitory A. After this diagnosis, staff began active daily monitoring for fever (temperature >100.4°F) and blood oxygen saturation levels (pulse oximeter reading <90%) to detect suspected cases among persons in affected dormitories. On April 9, additional cases were identified in dormitories B and C; the first cases were identified in dormitory D on April 17 and in dormitory E on April 23.
The Louisiana Department of Health requested CDC assistance; a team arrived and began an investigation on May 7. By that date, 3 staff members and 35 detained persons showed development of symptoms and later tested positive for SARS-CoV-2; 5 of 18 dormitories were affected.
Emerging Infectious Diseases. 2021;27(2):421-429. © 2021 Centers for Disease Control and Prevention (CDC)