Two new studies on COVID-19 outbreaks in California prisons recommend decarceration as outbreak mitigation strategy

Two new studies from UC Berkeley School of Public Health researchers detail lessons learned from a June 2020 COVID-19 outbreak at San Quentin California State Prison and offer recommendations for containment and mitigation in future outbreaks of respiratory disease.

Ada Kwan, postdoctoral scholar at UCSF and lead author of a paper published in the International Journal of Prisoner Health, said, “what we observed at San Quentin was an extreme superspreading environment characterized by biological, social, and built dynamics. The outbreak spread to at least 2,241 (62.3%) incarcerated people and 445 (27%) of staff. We felt the scientific need and moral obligation to document how the community’s access to non-pharmaceutical interventions simply weren’t going to prevent COVID-19 spread in such settings.

“Through site observations and environmental risk assessments … our research focused on critical aspects that have been insufficiently covered in the literature and policy for mitigating outbreaks in congregate settings, such as prisons,” Dr. Kwan said.

Her team’s analysis showed that masking and social distancing are not enough to prevent respiratory disease spread in such environments and that  “additional levels of preparedness—ventilation, air filtration, decarceration, and emergency evacuation planning are needed in such congregate settings that incarcerate medically at-risk populations.”

A second paper published in BMC Public Health by lead authors Catherine Duarte and Drew B. Cameron, former PhD students at Berkeley Public Health now at Stanford and Yale, respectively, offers “a case study on the implementation of key public health recommendations for containment and prevention” of COVID-19.

“Using a multi-level determinants framework adapted to systematically assess infectious disease risk in carceral settings, this work examined factors that may have contributed to the containment of one of the early COVID-19 outbreaks in a California prison and identified remaining vulnerabilities with likely implications for future outbreaks, including documenting where barriers to the implementation of effective interventions arose and recommendations to address them,” said Dr. Duarte.

The new framework the researchers developed for evaluating COVID-19 risk in prisons included eight risk factors that included policy, built environment, ideology, and more.

Using the framework, researchers determined that “the single most effective strategy to prevent and limit COVID-19 spread is to dramatically decrease population density at each prison through decarceration. … Decarceration must be explicitly defined as large-scale releases of people from confinement with support for optimal community reentry through investments in and collaborations with non-carceral, community-led reentry services.”

“Our observations shed more light on the unique and dynamic susceptibility of carceral settings to respiratory pathogens—susceptibilities which will only be further tested with vaccine-resistant variants or in the next respiratory pandemic,” said Dr. Cameron. “Our hope is that the recommendations laid out in this manuscript—principally decarceration—will be taken up in full and implemented with urgency so that their protective effects precede, and therefore prevent, future outbreaks.”

The work of Kwan, Duarte, Cameron, and their co-authors, including Berkeley Public Health professors Stefano M. Bertozzi and Sandra McCoy, also resulted in CalPROTECT (California Prison Roadmap for Targeting Efforts to Address the Ecosystem of COVID Transmission).

“The CAL-PROTECT initiative, from which Dr. Duarte and Dr. Kwan’s papers are derived, is a multidisciplinary initiative of public health experts, clinicians, and scientists in behavior, environmental engineering, and economics at UCSF and UC Berkeley,” said Dr. McCoy. “The project aims to collect information on how COVID-19 is transmitted in California State Prisons and integrate that knowledge with the experiences and perspectives of correctional and facility staff, medical staff, and residents to give correctional leaders and policymakers the scientific evidence they need to optimize the health and dignity of those who live and work in prison facilities during the COVID-19 pandemic.

“Both papers document important lessons learned for pandemic preparedness, including persistent vulnerabilities at prisons such as housing density and poor ventilation, and the central importance of decarceration to prevent and mitigate disease.”

CAL-PROTECT issued a recent report that showed that overcrowding, sometimes in antiquated buildings, compounded by rapidly changing conditions and the need for complex coordination, helped to drive a dramatic surge in COVID-19 in California’s prisons.

Read the full papers:

International Journal of Prisoner Health

Co-authors include Ada Kwan of UCSF, who was a PhD candidate at UC Berkeley School of Public Health when this research began; Rachel Sklar of UCSF; Drew B. Cameron of Yale University, who was a PhD candidate at UC Berkeley School of Public Health when this research began; Robert C. Schell, Stefano M. Bertozzi, Sandra McCoy, and David A. Sears of UC Berkeley School of Public Health; and Brie Williams of UCSF.

BMC Public Health

Co-authors include Catherine Duarte, postdoctoral fellow at Stanford, who was a PhD candidate at UC Berkeley School of Public Health when this research began; Drew B. Cameron of Yale University, who was a PhD candidate at UC Berkeley School of Public Health when this research began; Ada Kwan of UCSF, who was a PhD candidate at UC Berkeley School of Public Health when this research began; Stefano M. Bertozzi and Sandra McCoy of UC Berkeley; and Brie A. Williams of UCSF.