2013 flu cluster inside Canadian facility offers lessons for COVID-19, report says
Collaboration with health officials needed
On Dec. 6, 2013, a 54- yearold man was arrested and brought to the Edmonton Remand Centre. The same day, a 24- year- old inmate was transferred there from another prison. Both later tested positive for H1N1, an influenza virus.
What happened next hints at what may be coming with a more virulent virus now causing the global COVID-19 pandemic.
The 2013 influenza outbreak at Canada’s largest correctional facility offers experience that could help stop COVID- 19 from surging beyond control inside the unique confines of the world’s prisons and is part of an international study on how prisons should be included in a comprehensive response to COVID-19.
Even at the best of times, prisons are epicentres for infectious diseases. These are not the best of times.
Prisons have unique health care problems. They are built for security. They are often overcrowded, poorly ventilated and unsanitary.
It can be difficult to maintain social distance inside, as pandemic control requires.
The potent ial for a COVID-19 surge in prisons was highlighted when Iran released 85,000 inmates to reduce coronavirus transmission.
Inmates already face higher levels of risk for infection, unavoidable close contact and poor access to health care, say the authors of a paper published in the medical journal Lancet Public Health last week, as part of its COVID-19 Resource Centre.
The concern is not only for inmates and staff inside.
“Explosive outbreaks in these settings have the potential to overwhelm prison health- care services and place additional demands on overburdened specialist facilities in the community,” writes Stuart Kinner, a justice and health specialist at Australia’s University of Melbourne, who is lead author of the paper.
Further, through visitations, facility transfers, inmates being released or taken to court, prisons are vectors for community transmission.
One of the first documented influenza outbreaks in prison was at San Quentin State Prison, north of San Francisco, during the 1918 influenza pandemic, known as the Spanish Flu.
A team of researchers studied more recent influenza outbreaks to find relevance in this pandemic, including outbreaks at the Edmonton Remand Centre and in the United States, Australia, Taiwan and Thailand.
In Edmonton, the two inmates arrived on Dec. 6, 2013. Neither showed symptoms when they entered the facility. One, the 24- yearold, sought medical attention four days after arriving with a cough, fever and sore throat. The other, the 54- year- old, came to the infirmary with the same symptoms, six days after arriving.
Both tested positive for H1N1.
The Lancet study includes a dissection of the Edmonton outbreak from a study led by Jonathan Besney of the University of Alberta, published in the Journal of Infection Prevention in 2017. Although that study does not directly identify the Edmonton Remand Centre, it is the only detention facility in Canada matching the description.
The two infected inmates lived in different housing units. In the case of the younger inmate, he is known to have infected one other inmate in his unit; the older inmate is known to have infected three other inmates in his unit.
However, quick reaction stopped the spread inside the facility, the study notes, “given the high turnover in the facility, there was high probability that multiple inmates were exposed and may not have reported symptoms or were released/transferred before the onset of symptoms.”
Of the inmates found infected, their average age was 41. Three were Canadian- born non- Indigenous, two were Canadian- born Indigenous and one was foreign- born. There were no serious complications or deaths.
Of particular concern comparing this experience to the current pandemic is that in 2013, the incubation period for the H1N1 virus was one to four days; COVID-19’S incubation period can be up to 14 days, meaning many inmates could be walking around in prisons not knowing they are infected.
The Edmonton study’s authors warned that outbreak management guidelines are typically focused on conventional health- care settings and “may not address the specific challenges within the non-traditional setting of a correctional facility.”
That is something the Lancet paper amplifies.
It says prison influenza outbreaks often feature earlier onset and greater severity than community cases. Rigid security processes required in prisons have the potential to delay diagnosis and treatment.
The study recommends that prisons and detention centres be included in overall public health planning instead of leaving them to act alone.
Correctional systems should seek to limit transmission from and to the community and other facilities through entry screening, personal protection measures, social distancing, intensive cleaning and disinfecting, restricting movement, ending visitation and limiting transfers.
Suspected cases of COVID-19 should be isolated and contacts traced. Information sharing is also essential, the authors say.
“Close collaboration between health and justice ministries should be established to ensure continuity of information, which is a crucial component of an effective, coordinated, whole- of- government response,” the authors say.
“Governance of prison health by a ministry of health, rather than a ministry of justice or similar, is likely to facilitate timely information sharing.”
The Correctional Service of Canada, responsible for running Canada’s federal prisons, said “unprecedented steps are being taken by CSC to address COVID-19,” in a statement.
“The continued health, safety and well- being of our employees and offenders is critical, as is our ongoing ability to maintain safe and secure environments and public safety.”
Visits from the public and volunteers have been cancelled, all temporary absences and work releases for offenders, unless medically necessary, have been halted.
To help inmates keep in contact with family, CSC is waiving deductions from inmate pay for use of the telephone system in federal institutions.