Wayne Cole, BS, State of Connecticut Department of Correction; Alicia G. Dugan, PhD, University of Connecticut School of Medicine; Bryan Viger, BS, State of Connecticut Department of Correction
Purpose/Objectives
In early 2020, COVID-19, a highly-communicable novel coronavirus spread via respiratory droplets, evolved into a global pandemic.1 On March 28, 2020, confirmed positive COVID-19 cases developed in staff and incarcerated populations within one correctional facility in a Northeast state. In spite of mitigation efforts taking place to contain the virus, confirmed cases still soared within that facility. We examined the efficacy of the facility’s mitigation efforts to understand how to better prepare for and respond to future outbreaks of COVID-19 or similar viruses within incarcerated environments.
Background
COVID-19 caused challenges and widespread illness among employees and inmates in incarcerated environments. Department of Correction (DOC) facilities in a Northeast state employed several response strategies to the pandemic.2 Facility pandemic policies and procedures were established according to laws/policies set forth by three entities: the state governor, DOC, and each correctional facility. Engineering controls included installing plexiglas and upgrading air filters. Administrative controls included mandates for safety behaviors (i.e., handwashing, not touching one’s face, and separation/isolation to ensure physical distancing). Personal protective equipment (PPE), including facemasks, was utilized and made available. Movement in and out of facilities was restricted to facility staff and essential contractors; inmates court appearances ceased and new inmates were limited. In early 2020, it was unclear whether mitigation efforts would be effective and whether the little information available about the novel virus was accurate or would change with emerging scientific findings. A literature review of COVID-19 in incarcerated environments yielded few studies, none of which evaluated the efficacy of correctional responses to COVID-19. Studies identified overcrowding, lack of testing, and inadequate infection control as contributing factors to virus spread, and described “decarceration” strategies implemented to reduce incarcerated populations and enable physical distancing.3 In early 2021, positive cases surged among staff and inmates at a particular DOC facility, indicating that mitigation efforts were not wholly effective. An investigation of that facility’s response to the pandemic, guided by an occupational safety framework, was needed.
Methods
Administrative (quantitative) data was gathered for one DOC facility, including positive cases and mortality rates for staff and inmates. To examine facility pandemic-related responses, qualitative data was gathered via focus groups of facility staff covering several topics: staff concerns/fears and how they changed over time, adherence to safety practices (i.e., handwashing, physical distancing and wearing PPE), attitudes toward adherence, reporting to work while sick, perceived effectiveness of mitigation efforts at work and PPE availability, the role of DOC leadership, effectiveness of communication to employees and inmates, and suggestions for improvement in the event of a future outbreak. Focus groups took place during work hours and participants were convenience samples of facility staff including one group of correction officers, one group of correctional counselors, and one group of shift commanders and unit heads. We examined quantitative data using descriptive statistics. Qualitative data from focus groups was content analyzed to identify common themes.
Findings
An examination of the administrative data showed that no cases within the facility resulted in mortality. Comparisons of positive cases within the facility to the general population of the state showed striking similarities in case escalation in April/May 2020 and again in December 2020/January 2021. Main focus group themes were: poor staff and inmate compliance with safety protocols, effective communication of policies or procedures, the important role of facility administrators in responding to the pandemic (compared to senior DOC administrators), and the problem of having a work culture of staff who commonly report to work while ill.
Discussion
Focus group themes can be used to drive future interventions related to COVID-19 or similar communicable viruses. Reliance on PPE or administrative controls requires employee adherence to be successful. Interventions for improving staff compliance or intervening higher within the hierarchy of controls4 would be beneficial (i.e., eliminate/substitute the hazard, improve engineering controls). Given poor inmate adherence to safety guidelines and ineffective improvement strategies (via discipline, accentuating health benefits), we need to identify inmate motivations for compliance. Effective communication of accurate information is key to compliance and easing concerns/fears, and roll call (how administrators communicate to facility staff) should continue to take place regularly without fail. Similarly, communication to inmates must be frequent and timely to ensure the receipt of accurate information prior to them hearing from other sources. A future study is needed evaluating the behavior of reporting to work while sick, including drivers (i.e., organizational culture, individual motivations). The high value that line staff place on the actions of facility administrators suggests that they should be the primary source of communicating essential information. Interventions to increase the visibility of senior DOC administrators are needed to increase the perceived value of their contributions.
Conclusions
We identified several areas for improvement to protect workers and inmates from the transmission of COVID-19. Study findings will help shape facility policy and protocols for future outbreaks of communicable illnesses.