Implementation of novel and conventional outbreak control measures in managing COVID-19 outbreaks in a large UK prison

  1. Paul C. Coleman
  2. Adam Pailing
  3. Anjana Roy
  4. Éamonn O’Moore
  5. Joht Singh Chandan
  6. Victoria Lumby
  7. Paul Newton
  8. Anna Taylor
  9. Esther Robinson
  10. Jonathon Swindells
  11. Sarah Dowle
  12. Roger Gajraj

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Background

Outbreak control measures during COVID-19 outbreaks in a large UK prison consisted of standard (e.g., self-isolation) and novel measures, including establishment of: (i) reverse cohorting units for accommodating new prison admissions; (ii) protective isolation unit for isolating symptomatic prisoners, and (iii) a shielding unit to protect medically vulnerable prisoners.

Methods

Single-centre prospective longitudinal study (outbreak control study), implementing novel and traditional outbreak control measures to prevent a SARS-COV-2 outbreak. The prison held 977 prisoners and employed 910 staff at that start of the outbreak.

Results

120 probable and 25 confirmed cases among prisoners and staff were recorded between March and June 2020 during the first outbreak. Over 50% of initial cases among prisoners were on the two wings associated with the index case.

During the second outbreak, 182 confirmed cases were recorded after probable reintroduction from a staff member. Widespread testing identified 145 asymptomatic prisoners, 16.9% of the total prisoner cases. The cohorting units prevented re-infection from new prison admissions and the shielding unit had no COVID-19 infections linked to either outbreak.

Conclusions

Identifying and isolating infected prisoners, cohorting new admissions and shielding vulnerable individuals helped prevent uncontrollable spread of SARS-COV-2. These novel and cost-effective approaches can be implemented in correctional facilities globally.

Article activity feed

  1. Version published to 10.1186/s12889-022-12991-7
  2. ScreenIT

    SciScore for 10.1101/2020.12.07.20234641: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Here we focus on two main issues that merit further discussion: (i) use of isolation and cohorting units for symptomatic, vulnerable and newly received admissions and (ii) limitations in SARS-CoV-2 testing capabilities. The WHO have highlighted the importance of increased testing as an essential part of the response to COVID-19. Testing allows effective isolation of true cases and contacts of cases to be identified and quarantined. However, the effectiveness of isolating symptomatic individuals in a COVID-19 outbreak depends on the extent of transmission from pre-symptomatic and asymptomatic infection, and the proportion of cases that are asymptomatic. Data suggests that 20-50% of infections may be asymptomatic16,17 and that 40% of transmission occurs before symptoms develop.18,19 The infectiousness of asymptomatic individuals is similar to or less than those with symptoms.20 Wider testing of individuals with no symptoms therefore allows the identification and isolation of asymptomatic cases who can transmit infection, and identification and quarantining of their contacts. While the original source of infection was likely an asymptomatic staff member moving between wings, as the outbreak progressed it can be assumed that staff continued to be infected from both prisoners and the wider community. For technical reasons, testing of prisoners was unavailable for most of the outbreak, so only 33% of probable cases were tested. This in part explains the low incidence of confirmed c...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.12.07.20234641v1 on medRxiv