UK: Covid-19 Transmission in Prison Settings

23rd April 2021

Despite stringent infection prevention and control measures in prisons in the England and Wales for over a year, there is ongoing evidence of frequent large-scale COVID-19 outbreaks across the prison sector, higher levels of infection in prison than in the general population, higher rates of hospitalisations and higher associated mortality in prisoners and prison officers.

In response, the Ministry of Justice commissioned the Scientific Advisory Group for Emergencies (SAGE) EMG Transmission Group to produce research on transmission of COVID-19 in prison settings, to inform longer-term policy responses.

The research by SAGE presents evidence relating to: COVID-19 related-health outcomes of prisoners and prison staff, information on current control measures employed in prisons and their perceived effectiveness, the potential effectiveness of wider/additional control measures such as increased vaccination, considerations and concerns relating to the onward risk of infections and outbreaks in prisons, and the potential for prisons to become infection amplifiers/reservoirs.
 

Vaccination

The research explores the findings of two recent prison vaccination models. One model from London School of Hygiene & Tropical Medicine (LSHTM) has evidenced that vaccinating all prisoners and staff is the only vaccination strategy that prevents a further large wave of cases within two years. This strategy was predicted to reduce cases by 89%. The LSHTM model found that restricting vaccination to all prisoners and staff over the age of 50 was considerably less effective at preventing outbreaks. Vaccinating all staff would reduce rates in prisoners by 24%.

New modelling from the University of Manchester shows that universal vaccination of prisoners would be broadly as effective as non-pharmaceutical interventions (NPIs) (e.g. mask-wearing, social distancing etc) employed in prison settings. This suggests that widespread vaccination of staff and prisoners would offer an equivalent level of protection as the highly restrictive NPIs currently in place, offering the possibility to withdraw restrictive measures if vaccination was rolled out. However, currently, neither prisoners nor staff are prioritised for vaccination unless they fall into existing JCVI prioritisation categories.
 

Control measures

The research notes that while vaccination would allow for faster lifting of severe restrictions, no one strategy will be sufficient to support lifting of the prison lockdown regime, proposing a host of interventions to support a return to the normal regime. Importantly, the research notes that “new or existing control measures need to take into account the welfare of prisoners and their families and security in prisons”. These measures include: PCR testing to support the re-introduction of family visits, regular staff testing, dedicated mess testing resources to allow control of prison outbreaks and measures to understand transmission dynamics, including modelling.
 

Mental health

Although the restrictions have saved lives, qualitative surveys have indicated that spending up to 23 hours a day in a cell, suspension of visits, and cancellation of rehabilitative activities have had a substantial negative impact on mental health. Whilst this parallels mental health problems associated with pandemic restrictions in the wider community, the extent of the restrictions has been greater in prison and the prison population is also already highly vulnerable to mental health problems.

The research notes that while restrictions remain in prisons, prisoner mental health and wellbeing will suffer from the psychological effect of watching the country unlock whilst their regime stays persistently severely restricted. This will become harder to explain to people in prison, and to maintain over time.
 

Other key messages emerging from the research:

• Without high levels of immunity or continued intensive control measures, prisons could become reservoirs and amplifiers of infection, including variants of concern. This presents a risk to the wider community as well as to those in the prison.
• Prisoners often come from, and are released to, poorer communities with higher levels of COVID-19. Prisoners may be released to communal settings such as approved premises or end up in homeless hostels, where risk of outbreaks may continue.
• Often infections introduced into a prison will not spread, and this is reduced further by control measures. However, experience has shown that even with control measures in place, there remains a significant risk that a single strain can rapidly amplify to a large outbreak, which can be difficult to control.
• Prison outbreaks occur despite highly intensive control measures including; substantial restrictions on prisoner mixing, reverse cohorting of new arrivals, confining prisoners to their cells for up to 23 hours a day, reduced socialisation, training and exercise opportunities and stopping of visitors.
• Control of infection coming into the prison will become increasingly challenging as numbers of prisoners increase to normal levels.
   

Read ‘COVID-19 Transmission in Prison Settings’ in full here.