New research and guidance focus on critical health aspects during COVID-19 epidemic

Reviewed by James Ives, M.Psych. (Editor)May 14 2020

New research and guidance in the American Journal of Preventive Medicine, published by Elsevier, focus on critical topics pertaining to community and individual health during the COVID-19 epidemic.

Researchers outline guidelines to help address the unique and often overlooked risks posed by COVID-19 to both prison inmates and correctional officers

The correctional environment is often considered distinct or isolated from the wider society and health system, but the wellbeing of correctional workers and prisoners is inexorably linked to the health of the country as a whole. Almost 3 million people are incarcerated, or work in, state and federal prisons, local jails, and other detention facilities.

Their safety is inherently a matter of public health. Researchers highlight some of the inherent risks within correctional systems that may increase COVID-19 transmission among and between inmates and staff.

They outline recommendations from the Centers for Disease Control and Prevention, WHO, and other organizations to help correctional professionals mitigate these risks and protect and treat anyone who lives and works in their institution.

This includes collaboration between correctional systems and their local public health authorities, adherence to the principles of infectious disease control, and early release or furlough of prisoners whose release would pose fewer public safety risks than their continued incarceration.

"Both correctional employees and inmates have long been overlooked by our society, community leaders, and legislators," said lead author Andre Montoya-Barthelemy, MD, MPH, HealthPartners Occupational and Environmental Medicine, St. Paul, MN; and American College of Occupational and Environmental Medicine, Elk Grove Village, IL.

"As we researched this article, we were immediately struck by how abruptly COVID-19 has exposed our neglect of those who live and work within the prison system, and how the health of our neighbors in the correctional environment is so tightly bound to our own."

Vulnerable populations may pay the highest price in the COVID-19 epidemic, researchers warn

Marginalized in the best of times, people who are homeless, incarcerated, or using drugs are likely to experience a higher risk of exposure to SARS-CoV-2 because of their social circumstances. A response to these forgotten populations must be central to the COVID-19 response.

Planning should incorporate dedicated efforts, funding, and guidelines specific to these populations, both because they deserve care and services and not doing so poses greater risk to the broader community.

Researchers note that homeless shelters are ideal for viral transmission. They caution that healthcare resources may be prioritized for those at least risk of death, and vulnerable populations may be further marginalized.

People who are homeless, incarcerated or living with opioid use disorder already experience significant stigma and health inequities. It is critical that public health responses to SARS-CoV-2 account for these populations so as not to exacerbate existing disparities and to hamper community transmission."

Elizabeth M. Salisbury Afshar, MD., MPH., Study Lead Author, American Institutes for Research

Researchers find clear racial and income disparities in risk factors for severe COVID-19, which should be considered in physical distancing and other protective measures

Identifying those at heightened risk of several illness from COVID-19 is essential for modeling disease, designing return to work criteria, allocating economic assistance, advancing health equity, and limiting morbidity and mortality.

To date there has been limited analysis of the population at risk based on income, and racial and ethnic factors, but preliminary national data suggest that disparities in hospitalization are already developing.

Using data from the 2018 Behavioral Risk Factor Surveillance System, a nationally representative study of more than 400,000 adults, Matthew Raifman MPP, of the Department of Environmental Health, and Julia Raifman, ScD, of the Department of Health Law, Policy and Management, both at the Boston University School of Public Health, Boston, MA, found clear disparities in the prevalence of risk factors for severe COVID-19.

In particular, Non-Hispanic Black Americans and American Indians are disproportionately at higher risk of severe illness relative to non-Hispanic White Americans. People with lower incomes are more likely to be at risk; 25 million Americans living in households receiving less than $25,000 a year have at least one risk factor for severe COVID-19 illness.

"COVID-19 is the most recent example in the long history of structural inequalities shaping the burden of disease in America," the authors note.

"Decades of inequitable policies have created conditions in which there are disparities by race and income in access to healthcare, wealth, education, and employment, each of which are associated with chronic diseases that elevate the risk of severe illness due to COVID-19."

"By focusing testing, case detection and treatment programs in communities most at risk of severe illness due to COVID-19, we may be able to reduce the overall toll of the disease."

Mandatory social distancing measures in Clarke County, GA slowed the spread of COVID-19, compared to surrounding counties and the rest of the state

In the state of Georgia, Clarke County was among the first to adopt a mandatory policy of sheltering in place (SIP) in response to the COVID-19 epidemic, effective March 20, 2020. Except for one neighboring county, the counties surrounding Clarke County did not implement similar measures, and statewide measures were not put into effect until April 3, 2020.

Mark H. Ebell, MD and Grace Bagwell-Adams, PhD, MPA, of the College of Public Health, University of Georgia, Athens, GA, explain that this variation in policies at a "hyperlocal" level created a natural experiment prior to the statewide policy change and allowed them to examine the relationship between SIP policy implementation and the doubling rates of COVID-19 cases for Clarke County versus surrounding counties.

Doubling time is a key metric used to evaluate whether progress is being made in containing a virus: the faster it takes the number of cases to double in an area, the faster the disease is spreading.

Dr. Ebell and Dr. Bagwell-Adams observed that doubling time in Clarke County was 11.3 days longer compared to surrounding counties and increased by an average of eight days compared with the entire state. Looking at percentage daily increases, they found a 30 percent decrease in percent increases in Clarke County compared with other counties.

"Our report reinforces the fact that mandatory implementation of distancing measures is the most important way to slow the spread of the COVID-19 pandemic," say Dr. Ebell and Dr. Bagwell-Adams.

"Our mayor and commission were two weeks ahead of the rest of Georgia in mandating isolation measures, and we think the community has benefited as a result."