COVID-19 Cases in Federal Bureau of Prisons Higher Than in General US Population

By Carolyn Crist

March 15, 2021

NEW YORK (Reuters Health) - The rate of COVID-19 cases in the Federal Bureau of Prisons is about five times higher than in the general U.S. population, which is consistent with the rates seen in prisons nationwide, according to the bureau's health-services division.

Adjusting for age and sex, inmates were about 2.6 times as likely to die from COVID-19, the authors write in the American Journal of Preventive Medicine.

"Inmates are a vulnerable population who don't have an opportunity to quarantine at home in the same way many other populations do," said lead author Dr. Robin Toblin of the U.S. Food and Drug Administration, who has helped with the bureau's COVID-19 response.

"In addition, correctional staff interact closely with inmates as well as the local community, so it is difficult to determine if cases come in from the surrounding community or vice versa," she told Reuters Health by email. "But in both directions, an outbreak in a prison is likely to impact community transmission."

Dr. Toblin and colleague Liesl Hagan analyzed data from the Federal Bureau of Prisons inmate-management system, the bureau's COVID-19 database and the Centers for Disease Control Prevention. They focused on data from February to September 2020 and calculated testing rates and case and infection fatality rates.

Near the end of September, the Bureau of Prisons had tested half of its inmates, and the U.S. has tested about a third of the population. The bureau reported about 11,700 cases per 100,000 people, as compared with about 2,500 cases per 100,000 people in the U.S.

The bureau also reported about 77 deaths per 100,000 people, as compared with 81 per 100,000 people in the overall population. The infection fatality rate for both the Bureau of Prisons and the U.S. was about 0.7%.

Deaths occurred in about a quarter of the prisons. Among the 25 institutions that tested 85% or more of inmates, case rates were about 33,000 per 100,000 people. The infection fatality rate for these institutions was 0.8%.

"High testing rates likely means that a greater proportion of asymptomatic cases were identified than in the U.S. generally," Dr. Toblin said. The bureau "also has standardized and timely death reporting, both of which could lead to a more accurate rate of deaths among people who get COVID-19 compared to the U.S. generally."

The high case rate is also likely related to close contact within congregate living environments and transmission from staff, new inmates from other jurisdictions and inmates with hospital-acquired infections, the authors write.

"Although correctional institutions are generally regarded as isolated from the wider community, there is a great deal of daily travel in and out, and between institutions," said Dr. Andre Montoya-Barthelemy of HealthPartners in St. Paul, Minneapolis, who has written about COVID-19 in prisons.

"As a result, correctional facilities can act as an amplifier and reservoir for infectious disease transmission," he told Reuters Health by email. "Controlling the virus in these settings is essential to protect life, both inside the facility and in the community."

As of March 4, the bureau has reported more than 47,000 COVID-19 cases among inmates and more than 5,000 cases among staff during the pandemic. In addition, 224 inmates and four staff members have died from COVID-19. The bureau has administered more than 69,000 COVID-19 vaccine doses.

"In COVID-19 hotspots, like prisons, we have a lot of people who are more vulnerable to severe illness living in conditions that make it too easy for disease to spread," said Julie Ward of the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, who has researched COVID-19 cases and deaths in federal and states prisons.

"Prison staff get sick, families are kept apart, and an already strained system becomes even less able to keep people safe and healthy," she told Reuters Health by email. "We have to prioritize protecting vulnerable people specifically and changing the conditions that make it easy for the virus to thrive and spread more generally."

SOURCE: American Journal of Preventive Medicine, online February 24, 2021.