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Figure.  Trends in Cumulative Coronavirus Disease 2019 (COVID-19) Confirmed Case Rate per 100 000 People for Prison and US Populations
Trends in Cumulative Coronavirus Disease 2019 (COVID-19) Confirmed Case Rate per 100 000 People for Prison and US Populations

Data are from the UCLA Law COVID-19 Behind Bars Data Project and the US Centers for Disease Control and Prevention.3,4 The US population is 327 167 439 and the US prison population is 1 295 285.

Table.  Mortality Attributable to Coronavirus Disease 2019 (COVID-19) Among Prison and US Populations
Mortality Attributable to Coronavirus Disease 2019 (COVID-19) Among Prison and US Populations
1.
Hawks  L, Woolhandler  S, McCormick  D.  COVID-19 in prisons and jails in the United States.   JAMA Intern Med. Published online April 28, 2020. doi:10.1001/jamainternmed.2020.1856 PubMedGoogle Scholar
2.
Aspinwall  C, Neff  J. These prisons are doing mass testing for COVID-19—and finding mass infections. Accessed June 15, 2020. https://www.themarshallproject.org/2020/04/24/these-prisons-are-doing-mass-testing-for-covid-19-and-finding-mass-infections
3.
UCLA Law. UCLA COVID-19 Behind Bars Data Project. Accessed May 21, 2020. https://law.ucla.edu/academics/centers/criminal-justice-program/ucla-covid-19-behind-bars-data-project
4.
US Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in the US. Accessed June 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
5.
Schneider  EC.  Failing the test—the tragic data gap undermining the US pandemic response.   N Engl J Med. Published online May 15, 2020. doi:10.1056/NEJMp2014836 PubMedGoogle Scholar
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    2 Comments for this article
    EXPAND ALL
    The Point Is?
    Peter Westerman, BS | None applicable.
    The “IMR” (Infection to Mortality Ratio) reported in this article is only 1.21% - a fraction of the 10-12% experienced in/around Detroit and the double-digit numbers in/around New York City and many East Coast locations.

    Comparing prison numbers with long term care facilities (which are also prisons of a sort) makes much more sense than comparing with the general population.
    CONFLICT OF INTEREST: None Reported
    Data Problem is Understated
    Bruce Reilly, J.D. | Voice of the Experienced
    The authors acknowledge the limitations of "official data" yet the prison and jail data problem during COVID is more severe than it seems.

    1. The federal government does not require any data from jails and prisons;

    2. Jails and prisons have a historic pattern of not testing, thus not knowing, about any diseases (which alleviates the need to treat any ailment);

    3. Because there is no simple manner of providing treatment, and no funding at the ready to do so (Medicaid only reimburses for overnight hospitalizations), there is less incentive to "know";

    4. Correctional security
    officials will not cede decision-making power to public health officials, attributing to some prevention programs with no basis in science;

    5. With already poor medical treatment being further stretched due to COVID, staff absences, and lock down procedures, many people are getting even worse treatment for their non-COVID medical needs. This conflates the "cause of death" in some situations, yet if COVID is preventing prior treatment, then one could argue the cause of death is indeed COVID.

    6. Prison, jail, and Governor staffs are facing massive pressure to decarcerate until social distancing can be achieved. Thus, these officials have a deep set of interests in underselling the prison pandemic, including transmission and death.

    To whatever degree the authors wanted to make these points, the overall point should have been a top line caveat... and the toll is certainly worse than advertised.
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    July 8, 2020

    COVID-19 Cases and Deaths in Federal and State Prisons

    Author Affiliations
    • 1Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
    • 2UCLA Law COVID-19 Behind Bars Data Project, Los Angeles, California
    • 3University of California Los Angeles School of Law, UCLA Law COVID-19 Behind Bars Data Project, Los Angeles
    JAMA. Published online July 8, 2020. doi:10.1001/jama.2020.12528

    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.1 Although news reports document prison outbreaks of COVID-19, systematic data are lacking.2 Relying on officially reported data, we examined COVID-19 case rates and deaths among federal and state prisoners.

    Methods

    Counts of COVID-19 cases and presumed or confirmed deaths among prisoners were collected daily by the UCLA Law COVID-19 Behind Bars Data Project from March 31, 2020, to June 6, 2020.3 Counts were extracted daily from departments of corrections websites and, as needed, supplemented with news reports and press releases. Data included all states, the District of Columbia, and the Federal Bureau of Prisons. Cases were reported cumulatively (including active confirmed cases, recoveries, and decedents). Deaths attributable to COVID-19 were defined by each department of corrections based on the determination of the departments of corrections or external medical examiners. COVID-19 case rates and deaths for the states were obtained for the same period from the US Centers for Disease Control and Prevention.4

    Separately, prison population data were obtained from current departments of corrections reports in early May 2020, representing the best available census of all state and federal prisons. US population data were obtained from the US Census Bureau’s American Community Survey. We calculated crude COVID-19 case and death rates separately for prisoners and the overall population. To account for demographic differences between prisons and the overall population, we also calculated mortality rates adjusted for age and sex with indirect standardization. This calculation relied on mortality rates specific to age and sex in the overall population (mortality breakdowns by age and sex were not reported for prisons by departments of corrections). Because this study used aggregated public data, it was determined not to constitute human subject research by the Johns Hopkins University institutional review board. Data were analyzed using RStudio version 1.2.5042.

    Results

    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.

    The Figure displays the daily trends in cumulative, confirmed cases of COVID-19 in state and federal prisons and the US population from March 31, 2020, to June 6, 2020. The COVID-19 case rate was initially lower in prisons but surpassed the US population on April 14, 2020. The mean daily case growth rate was 8.3% per day in prisons and 3.4% per day in the US population.

    Discussion

    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.2,5 Mass testing in select prisons revealed wide COVID-19 outbreaks, with infection rates exceeding 65% in several facilities.2 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.

    Section Editor: Jody W. Zylke, MD, Deputy Editor.
    Back to top
    Article Information

    Corresponding Author: Brendan Saloner, PhD, Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, 624 N Broadway, Room 344, Baltimore, MD 21205 (bsaloner@jhu.edu).

    Conflict of Interest Disclosures: Dr Saloner reported receiving personal fees from the University of Wisconsin and the Cambridge Health Alliance. Ms DiLaura reported receiving personal fees from Bloomberg Law. No other disclosures were reported.

    Published Online: July 8, 2020. doi:10.1001/jama.2020.12528

    Author Contributions: Mr Parish and Ms Ward had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Saloner, Parish, Ward.

    Acquisition, analysis, or interpretation of data: All authors.

    Drafting of the manuscript: Saloner, Parish, Ward, DiLaura.

    Critical revision of the manuscript for important intellectual content: All authors.

    Statistical analysis: Saloner, Parish, Ward.

    Obtained funding: Dolovich.

    Administrative, technical, or material support: Parish, Ward, Dolovich.

    Supervision: Saloner, Parish, Dolovich.

    Additonal Contributions: We acknowledge assistance from Nicholas Bell, MA (University of Pennsylvania), who provided uncompensated technical assistance.

    References
    1.
    Hawks  L, Woolhandler  S, McCormick  D.  COVID-19 in prisons and jails in the United States.   JAMA Intern Med. Published online April 28, 2020. doi:10.1001/jamainternmed.2020.1856 PubMedGoogle Scholar
    2.
    Aspinwall  C, Neff  J. These prisons are doing mass testing for COVID-19—and finding mass infections. Accessed June 15, 2020. https://www.themarshallproject.org/2020/04/24/these-prisons-are-doing-mass-testing-for-covid-19-and-finding-mass-infections
    3.
    UCLA Law. UCLA COVID-19 Behind Bars Data Project. Accessed May 21, 2020. https://law.ucla.edu/academics/centers/criminal-justice-program/ucla-covid-19-behind-bars-data-project
    4.
    US Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): cases in the US. Accessed June 13, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
    5.
    Schneider  EC.  Failing the test—the tragic data gap undermining the US pandemic response.   N Engl J Med. Published online May 15, 2020. doi:10.1056/NEJMp2014836 PubMedGoogle Scholar
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