Pandemics in New South Wales prisons: the more things change...

Background: The current COVID-19 pandemic is not the first time New South Wales prisons have faced contagion. This paper examines the current responses in New South Wales prisons to the threat of COVID-19 to prisoner health, by contrasting contemporary activities with actions and policy devel-oped during two historical epidemics: the influenza epidemic of 1860 and pandemic of 1919. Method: Epidemiological information relating to cases of disease in NSW prisons during the 1860 and 1919 influenza epidemics was obtained from the Comptroller-General's reports for the specific outbreak years and for the preceding and succeeding five-year periods. Additional archival sources such as digitised newspaper reports and articles available through the National Library of Australia were analysed for closer detail. The management of these outbreaks was compared to current strate-gies to mitigate against risk from the COVID-19 pandemic in the NSW prison system. Results: Interesting similarities were discovered in relation to the management of the historic influ-enza outbreaks in NSW prisons and in the management of the current COVID-19 pandemic. An outbreak of influenza in mid-1860 impacted seven penal institutions in Sydney and Parramatta. Infection rates at these institutions were between 3.1% and 100%; the mean rate was 41.8%. The public health measures employed at the time included allowing 'air circulation freely night and day', and treatments that were 'tonical and stimulatory'. In 1919, the attack rate of influenza infection for Sydney was 358 per 1,000 population, whereas for the two large penitentiaries in Sydney, it was only 26 per 1,000 population. Similarly, the reported death rates were much reduced for prisoners compared to the general community. The recorded measures in 1919 included: disinfecting of the gaol buildings; inoculation (experimen-tal but of no value); the compulsory wearing of masks; the closure of the border between NSW and Victoria; fumigation and inhalation disinfection; daily examination with isolation for symptomatic staff; and quarantine of new arrivals. These are remarkably similar to current strategies. Discussion: While the past 100 or more years have brought huge progress in scientific knowledge, public health approaches remain the mainstay of outbreak management in prisons; and, as in 1919, the opportunity for Australia to observe the rest of the world and plan for action has not been wasted. Prisons pose a potential risk for pandemic spread but they also present a unique opportunity for reducing disease risk by ironic virtue of the 'separate system' that was recognised even 100 years ago as characteristic of these institutions.