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      COVID-19 and Prisons in Spain: is there any good news? Translated title: COVID-19 e instituciones penitenciarias em España: ¿Tenemos buenas noticias?

      editorial
      Revista Española de Sanidad Penitenciaria
      Sociedad Española de Sanidad Penitenciaria

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          Abstract

          The Law on Cohesion and Quality of the National Health System was passed in 2003. Thanks to the efforts of bodies such as the Spanish Society of Prison Health, the sixth additional provision of the law states: “The healthcare services that form part of prison functions shall be transferred to the autonomous communities for full integration into the corresponding regional health services. To this end, the prison health services in the National Health System shall be integrated 18 months after this law takes effect, in accordance with the system of transfers established by regional statutes” 1 . At that time we congratulated each other because we thought that a new and interesting period was about to start, one in which we would almost certainly see improvements in the quality, efficacy and efficiency of prison healthcare, in which the impact of prisons on public health would be reduced and greater cohesion and quality in the healthcare provided to inmates would be guaranteed. In other words, this new approach would lead to greater fairness and efficiency in the National Health System 2 . Now, in 2022, few of the prison healthcare services run by the National Health System have been integrated into the regional services. And that is not good news. However, the COVID-19 pandemic demonstrated the importance of considering the prison population and prisons in general as important places for public health 3 , everyone’s health in fact, as stated in Lancet Public Health: Prison health is public health by definition 4 . The level of coordination and joint commitment of the health and prison authorities was outstanding, while the inmates themselves played an equally important role in the measures for prevention and control of transmission and vaccination. One notable example is the major reduction in the prison population and the releases that took place to avoid transmission of SARS-CoV-2 in the early days of the pandemic and lockdown 5 . Mass screening, the active search for symptomatic cases and close contacts, isolation and quarantine all proved to be effective strategies in preventing the spread of the virus in prisons and in the community 6 , 7 . It is hardly surprising then that COVID-19 mortalities in Spain amongst prison staff and inmates were exceptionally low, even more so when compared to other countries such as the USA 8 . The concern shown by the Ministry of Health for the inmates and staff was constant throughout the pandemic, expressed in documents that specifically addressed such groups, such as: “New normality in prisons at the end of the state of emergency” 9 or the latest publication: “Update of the adaptation of measures for early detection, oversight and control of Covid-19 after the acute phase of the pandemic for prisons managed by the general secretary of prisons” 10 . Most of these measures, which are exceptional according to García-Guerrero y Vera-Remartinez, have respected inmates’ rights and in general terms follow the dictates of non-discrimination and guarantees of treatment equivalent to that received by the general public; coordination with health authorities; interruption or reduction in the circulation of the virus to and from prisons; greater efforts to seek alternatives to prison sentencing; measures to restrict mobility inside prisons and to minimise risks for prison staff 11 . Likewise, inmates and staff were regarded as a high priority group right from the first vaccination programme in December 2020 12 . The update of the COVID-19 vaccination strategy on 30 March 2021 established all prison healthcare staff as group 2 candidates and workers in prison institutions as group 3B. It also stated that the prison population “brings together people of all ages and conditions of risk. To facilitate operations and access to the centres where they are held and, in view of the greater risk of exposure and the principle of necessity and protection against conditions of vulnerability, the recommendation in this case is to merge and simplify the vaccination processes for this population, while bearing in mind the circumstance of each centre. Vaccination for this group shall commence when it is considered most appropriate, but it should coincide at least with group 8 and special attention shall be paid to the characteristics of the population in each centre. The most appropriate vaccine shall be used 13 . The complete vaccination coverage reached in Catalonia in October 2022, was 72.9%. One important feature of this figure is that it includes prisoners in preventive custody, a very mobile and complex group in terms of access * . Such figures are of course very encouraging and we should applaud the response of administrations, prison healthcare staff and the inmates themselves. The hope now is that after such an excellent example of cooperation, demands will increase for the autonomous communities that have not yet taken on their responsibilities for prison health to do so once and for all and comply with the legal requirements in this regard.

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          Prisons and custodial settings are part of a comprehensive response to COVID-19

          Prisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to health-care services relative to that in community settings. 1 Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19). One of the first documented influenza outbreaks in prison occurred in San Quentin prison in California, USA, during the 1918 influenza pandemic. In three separate instances, infection was introduced by a newly received prisoner, and a single transfer to another prison resulted in an outbreak there. Isolation was central to containment. 2 More recently, prison influenza outbreaks have been described in the USA, Canada, Australia, Taiwan, and Thailand.3, 4 We are unaware of any published reports of influenza outbreaks in youth detention or immigration detention centres, although modelling suggests that outbreaks would progress similarly in these settings. 5 Since early 2020, COVID-19 outbreaks have been documented worldwide, including Iran, where 70 000 prisoners have been released in an effort to reduce in-custody transmission. 6 Prisons concentrate individuals who are susceptible to infection and those with a higher risk of complications. COVID-19 has an increased mortality in older people and in those with chronic diseases or immunosuppression. Notably, multimorbidity is normative among people in prison, often with earlier onset and greater severity than in the general population, and prison populations are ageing in many countries. 7 Furthermore, inadequate investment in prison health, substantial overcrowding in some prison settings, and rigid security processess have the potential to delay diagnosis and treatment. As such, COVID-19 outbreaks in custodial settings are of importance for public health, for at least two reasons: first, that 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; and second, that, with an estimated 30 million people released from custody each year globally, prisons are a vector for community transmission that will disproportionately impact marginalised communities. What must be done to mitigate the impact of large outbreaks of COVID-19 in prisons? The public health importance of prison responses to influenza outbreaks has been recognised in the USA, 8 where the Centers for Disease Control and Prevention have developed a checklist for pandemic influenza preparedness in correctional settings. WHO has also issued prison-specific guidance for responding to COVID-19 (panel ). 9 Panel Prison-specific guidance for responding to COVID-19 Joint planning Include prison health and correctional authorities in the overall public health response, rather than permitting them to plan and operate in isolation. Risk management Design and implement adequate systems for limiting importation and exportation of cases from or to the community, and transmission and spread within prisons. Prevention and control Develop protocols for entry screening, personal protection measures, social distancing, environmental cleaning and disinfection, and restriction of movement, including limitation of transfers and access for non-essential staff and visitors. Treatment Explicitly and transparently align prison health systems with the wider health and emergency planning systems, including transfer protocols for patients requiring specialised care. Isolate cases and contacts if required to control the spread of infection in prisons. However, special consideration of the potentially serious mental health effects of isolation in these settings is essential.10, 11 In high-income countries, maintaining isolation without depriving incarcerated people of human contact might be possible. 12 Information sharing 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. Governance of prison health by a ministry of health, rather than a ministry of justice or similar, is likely to facilitate timely information sharing. 13 Prison health is public health by definition. Despite this and the very porous borders between prisons and communities, prisons are often excluded or treated as separate from public health efforts. The fast spread of COVID-19 will, like most epidemics, disproportionately affect the most disadvantaged people. Therefore, to mitigate the effects of prison outbreaks on tertiary health-care facilities and reduce morbidity and mortality among society's most marginalised, it is crucial that prisons, youth detention centres, and immigration detention centres are embedded within the broader public health response.
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            Ley 16/2003, de 28 de mayo, de cohesión y calidad del Sistema Nacional de Salud

            (2003)
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              Public health response to an outbreak of SARS-CoV2 infection in a Barcelona prison

              An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.
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                Author and article information

                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                Sep-Dec 2022
                21 November 2022
                : 24
                : 3
                : 77-78
                Affiliations
                [1] originalProfessor of Preventive Medicine and Public Health. University of Leon. Leon, Spain normalizedUniversidad de León orgnameUniversity of Leon Leon, Spain
                Author notes
                [Correspondence ] Vicente Martín Sánchez. E-mail: vicente.martin@ 123456unileon.es
                Article
                10.18176/resp.00054
                9768560
                36533784
                478dd15b-493e-4041-81da-657207c8acc4

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

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                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 02
                Categories
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