New research spotlights public health aspects of COVID-19

New research and guidance published in the American Journal of Preventative Medicine looks at critical topics pertaining to community and individual health during the novel coronavirus (COVID-19) pandemic, including the correctional environment, vulnerable populations, and racial and income disparities.

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, the researchers said. 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, according to the study.

 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 U.S. Centers for Disease Control and Prevention, the World Health Organization, 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 Andre Montoya-Barthelemy, MD, MPH, lead author of the study, in a statement. “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."

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, the researchers said.

Additionally, the 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,” said Elizabeth M. Salisbury-Afshar, MD, MPH, lead author of the study, in a statement. “It is critical that public health responses to [COVID-19] account for these populations so as not to exacerbate existing disparities and to hamper community transmission.”

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, researchers said. 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 in Massachusetts, found clear disparities in the prevalence of risk factors for severe COVID-19. Non-Hispanic Black Americans and American Indians are disproportionately at higher risk of severe illness relative to non-Hispanic White Americans, they said.

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," they said in the study. “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.”