Serial Laboratory Testing for SARS-CoV-2 Infection Among Incarcerated and Detained Persons in a Correctional and Detention Facility — Louisiana, April–May 2020

Abstract

On June 29, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), by asymptomatic and presymptomatic persons poses important challenges to controlling spread of the disease, particularly in congregate settings such as correctional and detention facilities (1). On March 29, 2020, a staff member in a correctional and detention facility in Louisiana developed symptoms † and later had a positive test result for SARS-CoV-2. During April 2-May 7, two additional cases were detected among staff members, and 36 cases were detected among incarcerated and detained persons at the facility; these persons were removed from dormitories and isolated, and the five dormitories that they had resided in before diagnosis were quarantined. On May 7, CDC and the Louisiana Department of Health initiated an investigation to assess the prevalence of SARS-CoV-2 infection among incarcerated and detained persons residing in quarantined dormitories. Goals of this investigation included evaluating COVID-19 symptoms in this setting and assessing the effectiveness of serial testing to identify additional persons with SARS-CoV-2 infection as part of efforts to mitigate transmission. During May 7-21, testing of 98 incarcerated and detained persons residing in the five quarantined dormitories (A-E) identified an additional 71 cases of SARS-CoV-2 infection; 32 (45%) were among persons who reported no symptoms at the time of testing, including three who were presymptomatic. Eighteen cases (25%) were identified in persons who had received negative test results during previous testing rounds. Serial testing of contacts from shared living quarters identified persons with SARS-CoV-2 infection who would not have been detected by symptom screening alone or by testing at a single time point. Prompt identification and isolation of infected persons is important to reduce further transmission in congregate settings such as correctional and detention facilities and the communities to which persons return when released. * These two authors contributed equally. † COVID-19-related signs and symptoms include subjective fever, cough, shortness of breath, chills, muscle aches, headache, sore throat, loss of taste, or loss of smell. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/ symptoms.html. * During the 2 months preceding the date of data collection. † During the 2 months preceding testing and during the 14-day testing period. The person who was asymptomatic and had a positive test result on day 14 had not developed symptoms at follow-up 1 week later. § Persons who reported onset of symptoms after the date of specimen collection, which resulted in a positive test.

Managing outbreaks of highly contagious diseases in prisons: a systematic review

“…78 79 Thus, the most applicable evidence is in relation to screening and contact tracing with appropriate isolation procedures. 70 Part of this strategy will require a particular emphasis on staff health and safety to implement testing, tracing and isolation of suspected and confirmed cases of PIP. In terms of contact tracing, the use of tracking apps needs further consideration, but such an approach is unlikely to be easily implemented as PIP do not typically have access to mobile phones or other personal internetenabled devices.…”

“…Eight studies described outbreaks of tuberculosis (TB), 45-47 54 56 59 62 63 seven of influenza (types A, eg, H1N1 and H3N2, and type B), 43 44 48 49 53 64 68six of varicella, 52 57 58 60 61 65four of measles 50 51 55 66 and one each of mumps, 67 adenovirus type 14p1 69 and COVID-19. 70 The outbreaks occurred in seven different countries: 12 in the US 45-47 54 56 59 62 63 66 70 ; six in Australia 43 50 53 58 64 68 ; four in the UK 51 55 57 69 ; three in Canada 44 60 67 and one each in China (Taiwan), 49 Italy 65 and Switzerland. 52 All described outbreaks occurred in adult custodial facilities, with the exception of one which took place in a youth custody facility.…”

“…Only one study described an outbreak of COVID-19 in prison. 70 The applicability of this evidence base to COVID-19 is not clear as it is highly contagious (less than measles and varicella, but more than others), with moderate morbidity but very rapid spread (typically more than other infections). Importantly, unlike all the other contagious diseases reviewed, there is no known appreciable population immunity to COVID-19, permitting its rapid propagation through susceptible populations due to absence of any herd immunity.…”

“…Persons in affected dormitories were tested on three separate occasions during the investigation period in order to classify cases as asymptomatic, presymptomatic, or symptomatic. 70 This dual strategy increases identification of presymptomatic or asymptomatic persons infected with SARS-CoV-2 who could potentially be missed if symptom screening alone was employed. 73 Moreover, symptom screening can also be ineffective due to related disincentives associated with reporting illness among PIP such as avoidance of medical isolation, and, in some cases, costs incurred by medical care.…”

“…61 62 In the COVID-19 study, test results were used to inform whether PIP should remain in quarantined dormitories or be transferred to another facility for medical isolation. 70 One study reported the exclusion of symptomatic staff, 53 and another reported isolation or exclusion from work (during the incubation period) of PIP and staff who refused vaccination programmes. 50…”