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Discussions on Health for Correctional Facilities and COVID-19

Interrupting SARS-CoV-2 transmission in confined, exceptional prevention challenges are created by congregate settings. Louisiana has the second highest incarceration rate in the United States, with 144 correctional and detention facilities and an estimated daily correctional census of 45,400.  

In Louisiana, staff members responding to interviews directed by the CMAR tool showed overall and awareness comprehension of CDC guidance.  But security constraints, and physical, logistical inherent to these settings make it difficult to fully implement the recommendations.  Some facilities’ reported inability to individually quarantine contacts of detained or incarcerated persons with COVID-19 could result among persons inside the units in spread.CDC guidance recommends a quarantine for close contacts of a COVID-19 patient.  Movement restrictions can be lifted if symptoms do not develop within those 14 days.  However some centers decided, in addition, to test persons back to the general facility population. 

Although it isn’t known if the virus was present, some of these asymptomatic persons had test results at the end of quarantine.  Persons that were asymptomatic and presymptomatic have been shown to contribute to transmission in long term maintenance facilities.   Facilities should be aware when using the test-based plan for release from isolation that positive test results have been reported for longer than 14 days (up to 36 times ) after symptom onset, even though it is unknown if the persons with these test results are still infectious. The findings in this report are subject to at least five limitations.  

So the total number of cases reported among staff members is an underestimate first, the amount of COVID-19 cases among staff members was not available for all facilities.  Second, case finding is dependent upon the testing and surveillance practices, which might differ among facilities of the facility.  Third, CMAR participation was voluntary and therefore may not be representative of all facilities in Louisiana.  Fourth, the CMAR tool revised and was being tested throughout the investigation; thus, available information might differ slightly by facility.  

Since CMAR is telephone based, observation could not directly evaluate the interventions that were described.Challenges are faced by correctional and detention facilities to the control of diseases like COVID-19. Incarcerated and detained persons largely rely on the correctional or detention system for infection prevention and control within the facility.  Correctional and detention facilities vary in size, population, facility layout, and operations, and no uniform strategy will address the needs of all facilities.  

CMAR provides an accessible method to facilitate assistance by public health officials regarding CDC’s interim advice on management of COVID-19 in correctional and detention facilities and to build capacity to serve the needs of facilities. LDH staff members continue to run CMARs with centers in the state.  CMAR may be used by local, state, and national public health agencies to help correctional and detention facilities to better handle COVID-19 cases and guide control activities to prevent or mitigate SARS CoV-2 transmission.  Preventing and mitigating transmission in these facilities not only protects staff members’ health and incarcerated and detained persons, it also protects the health of members of communities.

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