Determining the prevalence and incidence of SARS-CoV-2 infection in prisons in England: the Rationale, Conceptualization and Design of the COVID in Prisons Study (CiPS) (Preprint)

BACKGROUND There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where the confined, crowded and poorly ventilated conditions facilitate the rapid spread of infectious diseases. The consequences for imprisoned people are likely to be serious given the high proportion of individuals with risk factors for serious disease and death. OBJECTIVE The COVID-19 in Prison Study (CiPS) aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and the recovery period. METHODS CiPS Phase 1 comprises a repeated panel survey of prison residents and staff in a sample of 28 prisons across England, selected to be as representative of the closed prison estate as possible. All residents and all staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 antigens using nasopharyngeal swab twice, six weeks apart. Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognised COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In three outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at three timepoints: as soon as possible after the outbreak is declared (day 0), seven days later (day 7) and at day 28. They will be swabbed twice: a nasal swab for lateral flow device testing and a nasopharyngeal swab for PCR testing. Data will also be collected on individual, prison level and community factors. RESULTS Data collection started on 20th July 2020 and will end on 31st May 2021. As of May 2021, we had enrolled 4,192 staff members and 6,496 imprisoned people in the study. Data analysis has started and we expect to publish initial findings in summer/autumn 2021 CONCLUSIONS CiPS presents an important opportunity to gather data in a unique high-risk setting from the whole population - residents and staff alike. It will provide important epidemiological data to develop our understanding of the transmission dynamics of SARS-CoV-2 in prisons and provide preliminary data on the mental wellbeing of staff and residents. However, there are huge logistical challenges compounded by the fact researchers are currently not allowed into prisons and therefore testing teams, trained in antigen testing for SARS-CoV-2 and the use of PPE must be deployed. CLINICALTRIAL Not applicable