COVID-19 prevention and outbreak control in a large Spanish prison: an intersectoral approach

Abstract

IssueThe COVID-19 pandemic poses a challenge for prison settings, given their population vulnerability and the complexity of their internal functioning. We summarize the actions and outcomes concerning outbreak prevention and control in the Antoni Asunción Hernández (AAH) Prison (Valencian Region, Spain), one of the largest in Europe.DescriptionAn intersectoral commission was established in March 2020 at the Valencia General Hosp Health Dept to coordinate the COVID-19 response in penitentiary centres. A contingency plan was developed, with successive contention layers: general measures, restriction of interaction with the community (including suspension of visits), 14 days quarantine on admission and return, reduction of activities, modular confinement, voluntary confinement in cells, occupational risks prevention, vaccination, epi surveillance, outbreak management (incl sectorisation), isolation of cases (PCR at discharge), contact tracing and 14d quarantine (PCR at 0,7&14d), expanded testing and healthcare services.ResultsOn 8 Jan 2021, with a regional 14d cum incidence of 394/100,000 pop, an outbreak was declared. The index case initiated symptoms the 14th day after return from leave, after quarantine discharge. In 57 days 281 confirmed cases were diagnosed: 274 inmates (out of 1,823) and 7 workers (of 890). Mean age 40,7 years (SD 12,0), 9 cases + 65 year-olds, 99,3% men. 7 out of 32 modules and the nursing unit were affected, with an overall attack rate of 38,5% (range 6,1-77,4%). 5 inmates were hospitalised, of which 2 in ICU. All patients had an uneventful recovery. Case fatality rate 0. No new variant was detected.LessonsIntersectoral coordination mechanisms, involving prison officials, public health authorities and healthcare services, are crucial to unfold an appropriate COVID-19 response. Tailored, rigorous, dynamic and proportionate measures are essential to reduce COVID-19 impact on the health and well-being of prisons' population and their communities.Key messages Prisons are at risk of large COVID-19 outbreaks, with potentially severe consequences, given their population vulnerability and organisational complexity. We recommend a 14d quarantine duration.Intersectoral coordination mechanisms are crucial to unfold an appropriate COVID-19 response, wich should include tailored, rigorous, dynamic and proportionate prevention and control measures.