"COVID-19 Cases and Deaths in Federal and State Prisons"

The title of this post is the title of this new Research Letter just published in JAMA authored by Brendan Saloner, Kalind Parish, Julie A. Ward, Grace DiLaura and Sharon Dolovich.  Here are some excerpts:

Novel coronavirus disease 2019 (COVID-19) represents a challenge to prisons because of close confinement, limited access to personal protective equipment, and elevated burden of cardiac and respiratory conditions that exacerbate COVID-19 risk among prisoners.  Although news reports document prison outbreaks of COVID-19, systematic data are lacking. Relying on officially reported data, we examined COVID-19 case rates and deaths among federal and state prisoners....

By June 6, 2020, there had been 42 107 cases of COVID-19 and 510 deaths among 1 295 285 prisoners with a case rate of 3251 per 100 000 prisoners.  The COVID-19 case rate for prisoners was 5.5 times higher than the US population case rate of 587 per 100 000.  The crude COVID-19 death rate in prisons was 39 deaths per 100 000 prisoners, which was higher than the US population rate of 29 deaths per 100 000 (Table).  However, individuals aged 65 years or older comprised a smaller share of the prison population than of the US population (3% vs 16%, respectively) and accounted for 81% of COVID-19 deaths in the US population.  The Table provides a standardized calculation showing that the adjusted death rate in the prison population was 3.0 times higher than would be expected if the age and sex distributions of the US and prison populations were equal....

COVID-19 case rates have been substantially higher and escalating much more rapidly in prisons than in the US population.  One limitation of the study is that it relied on officially reported data, which may be subject to inaccuracies and reporting delays, but are the only data available.  Comprehensive data on testing rates were not available, and testing rates in both prisons and the overall population were uneven, with many facilities testing no prisoners or only symptomatic persons.  Mass testing in select prisons revealed wide COVID-19 outbreaks, with infection rates exceeding 65% in several facilities.  Reported case rates for prisoners therefore likely understated the true prevalence of COVID-19 in prisons.

A second limitation is that departments of corrections generally did not report demographic data on decedents, and therefore we could not adjust death rates to account for race/ethnicity and comorbidity.  This study focused on prisons but did not include jails or other detention facilities where there have been notable COVID-19 outbreaks.  Although some facilities did engage in efforts to control outbreaks, the findings suggest that overall, COVID-19 in US prisons is unlikely to be contained without implementation of more effective infection control.