By James Simons–
Government scientific advisers have warned that coronavirus restrictions may have to be in place for many more months in prisons unless there is faster universal vaccination of staff and inmates.
The Scientific Advisory Group for Emergencies (Sage) said measures behind bars to keep the infections under control and outbreaks to a minimum have ”a highly negative effect on mental health”.
Prison outbreaks are reportedly some of the worst in the UK, and in the second wave of the pandemic, 79% of outbreaks in jails in England and Wales involved 50 people or more, the scientists said.
The scientists say that an increase of prisoners to normal levels will make controlling infections more challenging , and put the wider society at risk.
In the absence of universal vaccination of staff and prisoners it is likely that these measures will need to be continued for many more months.
“Without high levels of immunity or continued intensive control measures, prisons could in future become amplifiers or reservoirs of infection, including variants of concern.
“The flow of prisoners into prison is set to increase markedly as courts reopen and a large backlog of cases are addressed.
“This will lead to increased occupancy levels and difficulty in maintaining current control measures.”
The current “severe restrictions employed have a highly negative effect on mental health of prisoners and their families and rehabilitation”, the paper warned, adding: “In the absence of universal vaccination of staff and prisoners it is likely that these measures will need to be continued for many more months.
“Modelling suggests that universal vaccination of prisoners would have a similar impact to the current highly intensive control measures and that vaccination of staff would also decrease infection levels in residents.
“This suggests that severe restrictions could be lifted much faster if vaccine is rolled out faster than currently planned under the current prioritisation criteria.”
The paper added: “Failure to protect prisons from increased transmission levels will leave a window of opportunity for new variants to amplify, potentially leading to prisons as a reservoir of infection for the community as has been observed with other infectious diseases.”
Crowded
Prisons were described by scientists as “crowded, communal settings” which were “highly prone to outbreaks of Covid-19 and consequent raised risk of hospitalisations and deaths”.
The outbreaks – defined as such when at least two prisoners or staff test positive – are “frequent, large, long lasting (over a period of weeks) and difficult to control”. There is “ongoing evidence” they are continuing and there are “higher levels of infection than in the general population”, the group said.
Incidence of the disease, the number and size of outbreaks, hospital admissions. and mortality rates have “increased markedly” during the second wave compared to the first, “as also observed in the community”, the paper said.
This is despite prison staff now having routine testing, as well as mass testing during outbreaks, prisoners being tested when they arrived and checks carried out on wastewater.
The paper said: “Regular testing of staff helps to minimise risk but is limited by incomplete uptake.”
It also noted that prisoners often come from, and are released to, “poorer communities with higher levels of Covid-19”.
Juliet Lyon, chairman of the independent advisory panel on deaths in custody, urged the Government to “act now on scientific advice to protect the lives of prisoners, staff and the wider community”, adding: “Sage provides clear and pressing reasons to vaccinate people held in closed institutions and the staff who care for them, not piecemeal by age, but all at once and immediately.”
Systematic Review
Last year, researchers at the University of Oxford, Department of Psychiatry, conducted a systematic review on managing outbreaks of highly contagious diseases in prisons, using 28 studies of investigations. All were based in high-income countries with documented outbreaks of tuberculosis, influenza (types A and B), varicella, measles, mumps, adenovirus and COVID-19.
The researchers identified a number of challenges specific to managing infectious disease outbreaks in prisons .
The researchers said contact tracing in prisons is complicated by reluctance to disclose symptoms due to stigma, concerns about confidentiality, and fear of further restrictions, like prolonged periods of medical isolation.
They also found that effective isolation and quarantine measures are difficult due to overcrowding, poor ventilation, sanitation and hygiene, which are common in many prisons. ”Prisons can easily become a reservoir for COVID-19 infection to the community as turnover is high and transmission can occur at multiple points including via staff”’, they added.
Many physical and mental health comorbidities, consistently shown to be more common than in community persons of similar age. Thus, the paper recommends a coordinated approach to managing outbreaks in these settings with prisons and public health authorities working closely.