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      Clinical and epidemiological characteristics of prisoners infected and deceased by COVID-19, National Penitentiary Institute of Peru, 2020 Translated title: Características clínico-epidemiológicas de los reclusos infectados y fallecidos por COVID-19, según datos del Instituto Nacional Penitenciario del Perú de 2020

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          Abstract

          Objectives

          To describe the clinical and epidemiological characteristics of inmates who were infected and died from COVID-19 in Peruvian prisons from April to October 2020.

          Material and method

          Descriptive, cross-sectional, retrospective study with a secondary data source. All the inmates who were infected and died from COVID-19 in Peruvian prisons during the study period were considered. The information was collected through the validated data collection sheet and was analyzed with descriptive statistics applying the SPSS v26 software.

          Results

          37,103 (42.3%) inmates were analyzed out of a prison population of 87,754. All of them reactive to the rapid test, with a mean age of 39.9 ± 12.6 years; 95.5% were male. 60.1% were IgG reactive; 36.1% were IgM/IgG reactive and 3.8% were IgM reactive. 20.1% of reactive inmates had COVID-19 symptoms at the time of testing. The most frequent symptoms were headache (55.6%), general malaise (49.7%), fever (49.0%) and cough (48.0%). Among the risk factors for COVID-19 were: age over 60 years (8.4%), high blood pressure (2.8%) and diabetes mellitus (2.4%). 445 deaths were registered. Total fatality reached 1.2% of the number of infected. The highest number of deaths was recorded in April and May (89 and 162, respectively).

          Discussion

          The study findings imply different approaches to managing epidemics in the prison context compared to the general population. The short and long term scenarios are uncertain, but the need to reorganize the prison health system, and to prioritise and modernise it are evident. The long-delayed reform of the prison system and the measures that set out to contain the spread of the COVID-19 disease in prisons are related processes in this regard.

          RESUMEN

          Objetivos

          Describir las características clínicas y epidemiológicas de reclusos infectados y fallecidos por enfermedad por coronavirus de 2019 (COVID-19) en el Perú en el Instituto Nacional Penitenciario (INPE), en el periodo de abril a octubre del 2020.

          Material y método

          Estudio descriptivo, transversal retrospectivo, de fuente de datos secundaria. Se consideró la totalidad de los internos infectados y fallecidos por COVID-19 en el INPE durante el periodo del estudio. La información se recopiló mediante la ficha de recolección de datos validada y fue analizada con la estadística descriptiva aplicando el software Statistical Package for Social Science en su versión 26 (SPSS v26).

          Resultados

          De una población penitenciaria de 87.754 reclusos, se analizaron 37.103 internos (el 42,3%), siendo todos ellos reactivos a la prueba rápida, con edad media de 39,9 ± 12,6 años; el 95,5% eran varones. El 60,1% eran reactivos a inmunoglobulina (Ig) G; el 36,1%, IgM/IgG reactivos; y el 3,8%, IgM reactivos. El 20,1% de los reclusos reactivos tenían síntomas de COVID-19 en el momento de realizar la prueba. Los síntomas de mayor frecuencia eran cefalea (55,6%), malestar general (49,7%), fiebre (49,0%) y tos (48,0%). Entre los factores del riesgo para la COVID-19, predominaron la edad mayor de 60 años (8,4%), hipertensión arterial (2,8%) y diabetes mellitus (2,4%). Asimismo, se registraron 445 fallecidos. La letalidad total alcanzó el 1,2% del número de infectados. En los meses de abril y mayo, se registró el mayor número de fallecidos (89 y 162, respectivamente).

          Discusión

          Los hallazgos del estudio implican diferentes enfoques en el manejo de epidemias en el contexto penitenciario en comparación con la población en general. Es incierto el escenario que se espera a corto y a largo plazo, pero es evidente la necesidad de reorganizar el sistema de salud penitenciaria, priorizándolo y modernizándolo. Indudablemente, la reforma postergada del sistema penitenciario y las medidas que pretenden afrontar la expansión de la enfermedad por COVID-19 en los penales está ligado a esta necesidad.

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          Most cited references34

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          A new coronavirus associated with human respiratory disease in China

          Emerging infectious diseases, such as severe acute respiratory syndrome (SARS) and Zika virus disease, present a major threat to public health 1–3 . Despite intense research efforts, how, when and where new diseases appear are still a source of considerable uncertainty. A severe respiratory disease was recently reported in Wuhan, Hubei province, China. As of 25 January 2020, at least 1,975 cases had been reported since the first patient was hospitalized on 12 December 2019. Epidemiological investigations have suggested that the outbreak was associated with a seafood market in Wuhan. Here we study a single patient who was a worker at the market and who was admitted to the Central Hospital of Wuhan on 26 December 2019 while experiencing a severe respiratory syndrome that included fever, dizziness and a cough. Metagenomic RNA sequencing 4 of a sample of bronchoalveolar lavage fluid from the patient identified a new RNA virus strain from the family Coronaviridae, which is designated here ‘WH-Human 1’ coronavirus (and has also been referred to as ‘2019-nCoV’). Phylogenetic analysis of the complete viral genome (29,903 nucleotides) revealed that the virus was most closely related (89.1% nucleotide similarity) to a group of SARS-like coronaviruses (genus Betacoronavirus, subgenus Sarbecovirus) that had previously been found in bats in China 5 . This outbreak highlights the ongoing ability of viral spill-over from animals to cause severe disease in humans.
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            COVID-19 Cases and Deaths in Federal and State Prisons

            This study describes coronavirus disease 2019 (COVID-19) case rates and deaths among federal and state prisoners and compares them with corresponding rates for the US population.
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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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                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
                Jan-Apr 2022
                31 March 2022
                : 24
                : 1
                : 15-22
                Affiliations
                [1 ] originalNorbert Wiener Private University. Lima. Perú. normalizedUniversidad Privada Norbert Wiener orgnameNorbert Wiener Private University Lima, Peru
                [2 ] originalNational Prison Institute of Peru Peru. orgnameNational Prison Institute of Peru Peru
                Author notes
                [* ] Correspondence: Andrey Sindeev. Escuela de Postgrado, Universidad Privada Norbert Wiener, Jr. Larrabure y Unanue 110, Santa Beatriz, Lima, Perú. E-mail: asindeev@ 123456samgmu.org

                Conflict of interest: None declared by the authors.

                Article
                10.18176/resp.00045
                9017609
                35411908
                fa4436d3-63ea-4f22-8ecc-b72f8f14a493

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

                History
                : 14 February 2021
                : 31 March 2021
                Page count
                Figures: 4, Tables: 2, Equations: 0, References: 26, Pages: 8
                Funding
                Funded by: Norbert Wiener Private University
                Award ID: 067-2020-R-UPNW
                Grant Fund 2020 of the Norbert Wiener Private University (Lima, Peru), ruling no. 067-2020-R-UPNW
                Categories
                Original

                coronavirus infections,prisoners,prisons,health services,pandemics,infecciones por coronavirus,prisioneros,prisiones,servicios de salud,pandemias

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