COVID-19 in the California State Prison System: an Observational Study of Decarceration, Ongoing Risks, and Risk Factors

Abstract

BACKGROUND: Correctional institutions nationwide are seeking to mitigate COVID-19-related risks. OBJECTIVE: To quantify changes to California's prison population since the pandemic began and identify risk factors for COVID-19 infection. DESIGN: For California state prisons (March 1-October 10, 2020), we described residents' demographic characteristics, health status, COVID-19 risk scores, room occupancy, and labor participation. We used Cox proportional hazard models to estimate the association between rates of COVID-19 infection and room occupancy and out-of-room labor, respectively. PARTICIPANTS: Residents of California state prisons. MAIN MEASURES: Changes in the incarcerated population's size, composition, housing, and activities. For the risk factor analysis, the exposure variables were room type (cells vs. dormitories) and labor participation (any room occupant participating in the prior 2 weeks) and the outcome variable was incident COVID-19 case rates. KEY RESULTS: The incarcerated population decreased 19.1% (119,401 to 96,623) during the study period. On October 10, 2020, 11.5% of residents were aged ≥60, 18.3% had high COVID-19 risk scores, 31.0% participated in out-of-room labor, and 14.8% lived in rooms with ≥10 occupants. Nearly 40% of residents with high COVID-19 risk scores lived in dormitories. In 9 prisons with major outbreaks (6,928 rooms; 21,750 residents), dormitory residents had higher infection rates than cell residents (adjusted hazard ratio [AHR], 2.51 95% CI, 2.25-2.80) and residents of rooms with labor participation had higher rates than residents of other rooms (AHR, 1.56; 95% CI, 1.39-1.74). CONCLUSION: Despite reductions in room occupancy and mixing, California prisons still house many medically vulnerable residents in risky settings. Reducing risks further requires a combination of strategies, including rehousing, decarceration, and vaccination.

Prevalence and correlates of SARS-CoV-2 seropositivity among people who inject drugs in the San Diego-Tijuana border region

“…Our finding that recent incarceration was independently associated with SARS-CoV-2 seropositivity could reflect institutional exposures. Over-crowding was implicated in COVID-19 outbreaks in California correctional institutions [ 29 ], including those in the U.S.-Mexico border region. Mitigation included early release, halting intakes, and eliminating bail, but a recent analysis suggests that considerable potential for SARS-CoV-2 exposures persists, at least in the California prison system [ 29 ].…”

“…Over-crowding was implicated in COVID-19 outbreaks in California correctional institutions [ 29 ], including those in the U.S.-Mexico border region. Mitigation included early release, halting intakes, and eliminating bail, but a recent analysis suggests that considerable potential for SARS-CoV-2 exposures persists, at least in the California prison system [ 29 ]. Similar measures have not been undertaken in Baja California.…”

Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies

“…We simulated different prisons by instantiating the model with prison-specific characteristics. These include the prison's residential layout: composition of rooms (ie, cells or dormitories) and room occupancy (which has been identified as an important risk factor for prison outbreaks 5,6 ) and their organisation within buildings and yards. The characteristics also include the number of residents and their age, sex, comorbidities, security level, room assignment and type, and participation in prison labour or other out-of-room activities.…”

“…See Online for appendix reflects differences in residents' housing and activity participation, it captures variation in individuals' exposures and thus replicates previous study findings on the increased risks associated with higher-occupancy housing and activity participation. 5 Correctional staff are assumed to mix homogenously with each other and with residents. We explored lower levels of activity and staff transmission in sensitivity analysis.…”

“…Individuals who are incarcerated and living in large dormitories are at especially high risk for infection. 5,6 Whether prisons already have sufficient natural immunity from previous outbreaks to safely resume preepidemic activities without first achieving high vaccination levels is an open question. 7 Two epidemiological features suggest otherwise.…”