Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey and Enhanced Outbreak Study

Emma Plugge*, Danielle Burke, MacIej Czachorowski, Kerry Gutridge, Fiona Maxwell, Nuala McGrath, Oscar O'Mara, Eamonn O'Moore, Julie Parkes

*Corresponding author for this work

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    Abstract

    Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases. 

    Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors. 

    Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: As soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons. 

    Results: The UK Government s Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants. 

    Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons.

    Original languageEnglish
    Article numbere30749
    JournalJMIR Research Protocols
    Volume11
    Issue number1
    DOIs
    Publication statusPublished - 12 Jan 2022

    Bibliographical note

    Funding Information: NMcG is a recipient of a National Institute for Health Research Professorship award (RP-2017-08-ST2-008). The main funder for this study is the Department of Health and Social Care (DHSC), UK Government. The Ministry of Justice, the Office for National Statistics, Public Health England, and the University of Southampton provided in-kind support for the study. The DHSC had no role in the development of the design of the study or in the collection, analysis, and interpretation of data and in writing the manuscript.

    Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

    Publisher Copyright: ©Emma Plugge, Danielle Burke, Maciej Czachorowski, Kerry Gutridge, Fiona Maxwell, Nuala McGrath, Oscar O'Mara, Eamonn O'Moore, Julie Parkes. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 12.01.2022.

    Citation: Plugge E, Burke D, Czachorowski M, Gutridge K, Maxwell F, McGrath N, O'Mara O, O'Moore E, Parkes J. Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey
    and Enhanced Outbreak Study. JMIR Res Protoc 2022;11(1):e30749
    URL: https://www.researchprotocols.org/2022/1/e30749
    doi: 10.2196/30749
    PMID: 34751157

    DOI: 10.2196/30749

    Keywords

    • COVID-19
    • SARS-CoV-2
    • epidemiology
    • health inequalities
    • outbreak
    • prison
    • testing

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