Jails pose a threat of unleashing Covid variants of concern into the wider community, government scientific advisers have warned, with “universal” vaccination of inmates and prison staff recommended as the best way to mitigate the risk.
A report from the Scientific Advisory Group for Emergencies (Sage) on Covid-19 transmission in prisons says that even as prevalence of the virus decreases in the community, prisons will remain at high risk of outbreaks and may act as “a potential reservoir and amplifier of infection for the community”.
The advisers say prisons have had the largest single outbreaks in the country and infections rates among prisoners are more than twice that of the general population, as are mortality and hospitalisation rates.
They say that control of infection coming into the prison will become increasingly challenging as numbers of prisoners increase to normal levels. While the severe restrictions in place have gone some way to reducing infections, they are not 100% effective, and modelling shows vaccination of all prisoners and staff is the best way to reduce the risk.
The report says: “Whilst community prevalence decreases, prisons will continue to remain at high risk of outbreaks, and may also act as a potential reservoir and amplifier of infection for the community, unless there are high levels or immunity and/or extensive restrictions and infection prevention and control (IPC) measures in place.
“There is a risk that variants of concern could amplify rapidly within a prison environment, compromising not only the health of those in prison, but also wider community health security.”
Variants of concern are considered one of the greatest threats to the impact of the vaccine rollout in the UK, with more than 33 million adults having received a first dose and more than 11m receiving full protection with a second dose.
The report says: “The risk of amplification is larger than that for other groups. If prisoners remain at higher risk of infection, then they will potentially select for variants that are able to escape pre-existing immunity and/or able to transmit more effectively.
“The high prevalence and frequent exposure also creates a possibility for generation of [new] variants including recombination events, which have been observed in non-prison settings.”
It adds: “Despite stringent infection prevention and control measures in prisons for the last year there is ongoing evidence of frequent large-scale Covid-19 outbreaks across the prison sector, higher levels of infection in prison than in the general population, higher rates of hospitalisations and higher associated mortality in prisoners and prison officers.”
The report said 79% of UK prison outbreaks in the second wave of the pandemic involved 50 or more people.
Inmates have endured a highly restrictive regime during the pandemic, with many spending more than 23 hours a day in their cells, social visits from family cancelled and extracurricular training and in some cases paid employment postponed.
The Sage advisers say the current severe restrictions have a “highly negative effect on mental health”, but in the absence of universal vaccination of staff and prisoners, it is likely that the measures will need to be continued for many more months.
“Increasing early vaccination of all prisoners and staff would allow faster lifting of severe restrictions, reduce outbreaks and decrease mortality, and benefit the wider control of Covid-19,” the report says.
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