COVID-19 in Correctional Facilities: Screening, Testing, Race and Ethnicity
By Brent Gibson, MD, MPH, CAE, FACPM, CCHP-P
In March 2020, NCCHC partnered with researchers from the Harvard Kennedy School and Harvard Law School to develop and deploy a weekly survey to correctional facilities around the nation measuring the spread of COVID-19 in staff and incarcerated people. The response includes 510 unique facilities ever reporting data, 117 this past week. Our most recent survey as of this article closed May 25, 2020. Data on 295,148 incarcerated persons, 54,801 correctional staff, and 12,052 health staff are represented in the report ending May 25.
Participation is voluntary, so the sample is not a random sampling of jails and prisons. The responding facilities cover the United States and are primarily jails (70%), followed by prisons (20%), juvenile detention centers (5%) and other.
Our effort is a real-time emergency public health initiative, designed to gather as much immediately available data as possible.
To date, among the reporting facilities, there have been 1,739 reported cases among the incarcerated, 836 reported cases among correctional officers, and 143 reported cases among health staff. The data has revealed shortfalls in testing as well as racial and ethnic disparities.
Screening and Testing
At the time the surveys began in March, 93% of reporting facilities said they screened inmates at intake; that has risen to 97%. Screening for those already incarcerated increased over the course of the study from 46% to 56%. Staff screening also increased, from 79% to 89%.
In terms of positive tests, our data for the incarcerated reveal 1,382 positive tests among 8,127 total tests, for a positivity rate of 17%. Among officers, the data reveals 531 positive tests among 4,794 total tests, or 11%. Finally, among health staff, there are 64 positive tests among 804 total tests, or 8%. By comparison, the CDC reports that for May 25, 2020, 13% of all tests conducted are positive.
Access to adequate testing was reported initially by only 64% of facilities and has increased to 92%.
While many facilities are adept at infection control, widespread access to testing is critically important to drive down COVID-19 rates for this vulnerable population.
Racial and Ethnic Disparities
Looking at the data reported for the period ended May 25 for cases and suspected cases where information on race was provided, the NCCHC sample data reveal an overall prevalence of 8,745 per 100,000 inmates and a disaggregated breakdown of:
- A rate of 16,642 per 100,000 black inmates.
- A rate of 4,927 per 100,000 white inmates.
These compare to a rate of 497 cases per 100,000 people in the United States as a whole as of May 25, 2020. As another point of comparison, the Marshall Project, which tracks prison data provided by state and federal agencies, reports prevalence of 2,179 confirmed cases per 100,000 for the week of May 20.
The stark differences in racial and ethnic groups are critically important, although there is an important caveat of sample size as racial and ethnic breakdowns were only provided by a subset of reporting facilities. As shown below in data gathered on two surveys (weeks ending May 18 and May 25), there is a staggering 3.2x prevalence among black inmates when compared to white inmates. In terms of ethnic distinctions, there is an even more striking 5.9x prevalence in Hispanic versus non-Hispanic individuals.
While the racial disparities for COVID-19 have been documented in the community, it’s clearly appearing in corrections as well. More study of these striking facts is recommended.
As our study underscores, data and transparency are essential to public health and health policy. The more programs share data, the clearer the picture of national correctional health care response becomes. Armed with knowledge, leaders and line staff alike are informed and can help tailor preparedness and relief efforts.
Next, it’s important to remain vigilant while we continue to contain the pandemic. This applies even more so in a correctional environment where the risks of transmission may be greater than in other settings. Just as we see high rates of transmission in urban vs. rural areas, we might predict a similar dynamic in any congregate setting, including corrections. To combat this, correctional facilities must implement and maintain protective measures such as personal hygiene, social distancing, masks, and other policies/items standard in the community.
Facilities with high rates of incidence should learn from the current surge and make plans now for handling additional waves of the virus that may appear in the future. NCCHC accreditation is a process that can help facilities implement and document data-driven, integrated approaches to health care and can be invaluable in keeping staff and incarcerated individuals safe and healthy.
As a final note, thank you to all those who have participated in our COVID-19 study, and to all correctional and health staff who are working day and night to limit the effects of COVID-19 for their populations. Please reach us at NCCHC-COVID@ncchc.org for additional assistance.