A time-series analysis of testing and COVID-19 outbreaks in Canadian federal prisons to inform prevention and surveillance efforts

  1. Alexandra Blair
  2. Abtin Parnia
  3. Arjumand Siddiqi

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Abstract

Background: Approximately 14,000 adults are currently incarcerated in federal prisons in Canada. These facilities are vulnerable to disease outbreaks and an assessment of coronavirus disease 2019 (COVID-19) testing and outcomes is needed. The objective of this study was to examine outcomes of COVID-19 testing, prevalence, case recovery and death within federal prisons and to contrast these data with those of the general population. Methods: Public time-series outcome data for prisoners and the general population were obtained on-line from the Correctional Service of Canada and the Public Health Agency of Canada, respectively, from March 30 to May 27, 2020. Prison, province and sex-specific frequency statistics for each outcome were calculated. A total of 50 facilities were included in this study. Results: Of these 50 facilities, 64% reported fewer individuals tested per 1,000 population than observed in the general population and 12% reported zero tests in the study period. Testing tended to be reactive, increasing only once prisons had recorded positive tests. Six prisons reported viral outbreaks, with three recording over 20% cumulative COVID-19 prevalence among prisoners. Cumulatively, in prisons, 29% of individuals tested received a positive result, compared to 6% in the general population. Two of the 360 cases died (0.6% fatality). Four outbreaks appeared to be under control (more than 80% of cases recovered); however, sizeable susceptible populations remain at risk of infection. Female prisoners (5% of the total prisoner population) were over-represented among cases (17% of cases overall). Conclusion: Findings suggest that prison environments are vulnerable to widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. Gaps in testing merit public health attention. Symptom-based testing alone may not be optimal in prisons, given observations of widespread transmission. Increased sentinel or universal testing may be appropriate. Increased testing, along with rigorous infection prevention practices and the potential release of prisoners, will be needed to curb future outbreaks.

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  1. Version published to 10.14745/ccdr.v47i01a10
  2. ScreenIT

    SciScore for 10.1101/2020.05.02.20086314: (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: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: The primary strength of this study is its use of the best available data on COVID-19 testing and case incidence in Canadian Federal penitentiaries and the general Canadian population to give an early situational report on testing and infection-related outcomes within these facilities. This study is a baseline assessment from which future analyses using updated data can be based. A limitation of this study is our use of the maximum potential capacity of each penitentiary as the population denominator for rate calculations, rather than the ‘true’ population at the time of data collection. We expect that these denominators are likely too large, given that prisons may not be at their full capacity and pressures to release non-violent offenders to reduce the number of susceptible individuals within prisons [17]. This may have led to the under-estimation of testing and infection prevalence estimates. Further, this study was not able to also count the number of tests and cases identified within custodial and health staff within these same penitentiaries, which is an important contributing factor to disease transmission. While other deaths in federal penitentiaries were recorded by CSC during the study period (e.g. [18]), only one case was reported as COVID-19 related. It is unclear whether other deaths occurring within CSC facilities have or will be tested for COVID-19 post-mortem. Lastly, these findings may not be generalizable to provincial, remand, or i...

    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

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  3. Version published to 10.1101/2020.05.02.20086314v1 on medRxiv