Control of a COVID-19 Outbreak in a Spanish Prison: Lessons Learned in Outbreak Control

Abstract

The rapid spread of highly transmissible respiratory infections in carceral settings occurs due to their conglomerate nature. The COVID-19 pandemic has resulted in large outbreaks in jails and prisons in many settings. Herein, we describe an outbreak of SARS-CoV2 infection in a prison in Alicante, Spain. Prior to January 2021, testing for coronavirus infection was not widely available in jails and prisons nationwide. Offering of testing services in Spanish carceral facilities, coincided with the deployment of COVID-19 vaccination in the larger community. However, COVID-19 vaccine role out of incarcerated individuals occurred later during the deployment plan. With the identification of the initial cases of this outbreak, two units of the facility were assigned for population management: one for inmates with confirmed infection by positive PCR detection of SARS-COV-2 infection in nasopharyngeal swabs. Inmates with confirmed exposure and thus considered close contacts were place in a second isolation unit. Functional quarantine was employed in some instances. A reactive testing strategy was instituted at baseline, and at 7 and 14 days of nasopharyngeal specimens by PCR. A total of 1,097 nasopharyngeal specimens were obtained for PCR testing during the outbreak, which lasted a total of 80 days between the index case the end of medical isolation of the last case. A total of 103 COVID-19 cases were identified during the outbreak. Of these, three inmates developed severe manifestations requiring hospitalization, and one died. Were identified, among which there were three hospitalized and one deceased. Among cases and confirmed contacts, we conducted close clinical monitoring, symptom screening, and daily temperature checks. The implementation of these interventions along with early medical isolation of cases, quarantining of contacts, and interval testing to detect presymptomatic or asymptomatic cases were instrumental in containing this outbreak.

Testing for COVID-19 during an outbreak within a large UK prison: an evaluation of mass testing to inform outbreak control

“…It is not surprising that this outbreak occurred at a time when the prevalence of COVID was highest in the north-west of England (Statistics, 2020), and also covers the period where the alpha variant became the dominant variant throughout England which may have exacerbated the outbreak further, though cases in the prison do not mirror the regional trend in North West England at this time (see Figure 4 ). This may suggest that establishments such as prisons may amplify spread of viruses even before marked peaks in community transmission are observed, as has been described in other prison outbreaks ( Duarte et al, 2022 , Henry, 2021 , Vicente-Alcalde et al, 2022 ), with prisons being described as “epicentres of transmission to the community” in some circumstances( Henry, 2021 ).

Figure 4 Positive tests performed by residents and staff in prison, and positive tests in North West England during the same period.

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Acceptance of the COVID-19 Vaccine by Prisoners and Staff in Spanish Prisons

“…According to studies conducted in carceral settings in the U.S. the incidence of COVID-19 infections in prisons was identified in some jails and prisons to be 5.5 times higher than in the community [4,25,26]. Prior to the start of the COVID-19 vaccination campaign in prisons, the pandemic forced the adoption of a series of restrictive measures to prevent infections in prisons [27]. However, there is evidence to suggest that, in the prison settings, with the implementation of COVID-19 vaccinations, the number of cases and fatalities due to COVID-19 were reduced substantially, demonstrating the effectiveness of COVID-19 vaccination in incarcerated individuals and prison staff [22,27].…”

Vaccination against emerging and reemerging infectious diseases in places of detention: a global multistage scoping review

“…Moreover, since the outset of the COVID-19 pandemic, various stakeholders, including international organizations, prison healthcare professionals, scientists, and activists, had cautioned prison systems about the looming COVID-19 crisis on a global scale ( 7 , 8 ). Nonetheless, the alarmingly elevated number of COVID-19 cases in prisons ( 9 ) serves as a glaring indicator of the inadequate response to the disease in numerous countries.…”