Recovery, Renewal, Resilience

Prisons are high risk environments as places of close physical proximity[1]. Persistent overcrowding[2], close living spaces, and staff moving in and out, make social distancing and the isolation and management of any contagion difficult to arrange[3]. National strategies to suppress COVID-19 should focus on reducing outbreaks within prisons, recognising that prison health is public health[4]. Coordinating evidence-based approaches to managing outbreaks of COVID-19 in prison settings can address the spread of the virus in potentially vulnerable people inside prisons and to communities where staff live[5].

In March 2020, WHO published interim guidance on how to deal with COVID-19 in prisons through a whole-of-society approach, with comprehensive guidance in the following key areas[6]:

• Preparation - through collaborative working with health and justice sectors, local and national public health authorities, and civil protection agencies; risk assessment and continuous evaluation; action planning to mitigate risks; assessment of essential infectious control supplies such as PPE, environmental sanitation, hand hygiene and disinfection
• Prevention - through implementation of public health guidelines, such as hand hygiene, social distancing and facemasks; monitoring of staff travelling into prisons from affected communities or who have a history of exposure; reviewing continuity and contingency plans to ensure critical functions can be delivered with reduced numbers of personnel
• Training and Education - planned and targeted at healthcare and custodial staff, including basic disease knowledge, hand hygiene practice, respiratory etiquette, the effective use of PPE and environmental prevention measures such as cleaning and disinfection. WHO have developed several online resources and training that can support this[7]
• Control - through robust prevention strategies; diagnostic strategies, including contact tracing, and interventions, including the environmental cleaning of health-care rooms or cells, where the management of a suspected case has taken place

A recent study identified some core challenges in managing infectious disease in prisons[8], such as:

• Overcrowding and a lack of best practice on managing the early release of prisoners
• Prisoners withholding symptoms for fear of stigma, leading to outbreaks
• Limited capacity of staff and resources to facilitate isolation, quarantine, and contact tracing

Addressing overcrowding, including communicating complex policies, such as an amnesty

Governments and judiciaries globally are considering strategies to tackle overcrowding and reduce prison populations through early release and alternative incarceration for vulnerable detainees and low-risk offenders[9]. Although strongly supported by human rights groups[10] and recommended by the UN[11], COVID-19 amnesties in the Ukraine were however rejected by legislators, media, and the public. This highlights that the explanation and communication of complex policies are just as vital as their design[12]. When communicating amnesties, consider:

• Work closely with civil society, particularly NGOs directly engaged with the public, to assess views and perceptions of amnesties, using this information to inform policy design and implementation
• Establish a clear communication strategy to accompany all elements of the process of transitioning incarcerated persons back into society, with a tailored approach to different social and regional groups
• Communicate informed and factual information through government and trusted civil society organisations, explaining the different elements of amnesties and their place in the larger reintegration framework to help the public feel more informed, secure and resilient

Inmate Volunteers

Irish Red Cross inmate volunteers are trained annually in Infection Control as part of the Community Based Health and First Aid Programme[13]. The activities of the inmate volunteers helped to contribute to zero positive cases amongst prisoners across the country for more than six months. Consider supporting a targeted inmate volunteer training programme to aid the management of infectious disease in prisons:

• As part of preparation and contingency planning, train inmate volunteers and staff on infectious disease and contact tracing to support the education of prisoners and custodial staff, and efforts to control transmission
• Train volunteers to support inmates who face mental health challenges/fears of stigma, e.g., distributing information and education packs, and supplementing support from psychologists, teachers, chaplains, and family visitation services, where these lack capacity
• Inmate volunteers can support the establishment of prison communication strategies on COVID-19, e.g. volunteers can write newsletters that can be distributed throughout prisons each week to provide updated information and educational material regarding COVID-19. Newsletters can include services that are available for inmates, and instructions for exercises and other activities that inmates can do while isolating and in quarantine

References:

[1] Redondo, S. et al. (2020) Corrections and Crime in Spain and Portugal during the Covid-19 Pandemic: Impact, Prevention and Lessons for the Future, Victims & Offenders, 15:7-8, 1156 – 1185, doi: 10.1080/15564886.2020. 1827108

[2] https://www.amnesty.org/en/latest/news/2020/12/pakistan-overcrowding-in-pakistans-prisons-is-a-ticking-time-bomb/

[3] Pagano, M. (2020). COVID-19 Risk Management and Screening in the Penitentiary Facilities of the Salerno Province in Southern Italy. International journal of environmental research and public health, 17(21), p.8033.

[4] https://www.unodc.org/documents/middleeastandnorthafrica//2020/COVID19/COVID_19_Egypt_Final.pdf

[5] https://www.psych.ox.ac.uk/news/people-in-prison-must-be-part-of-public-health-response-to-covid-19

[6] https://apps.who.int/iris/bitstream/handle/10665/336525/WHO-EURO-2020-1405-41155-55954-eng.pdf?sequence=1&isAllowed=y

[7] Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control [OpenWHO online course]. Geneva: World Health Organization; 2020 (https://openwho.org/courses/introduction-to-ncov)

[8] Beaudry, G., Zhong, S., Whiting, D., Javid, B., Frater, J. and Fazel, S., 2020. Managing outbreaks of highly contagious diseases in prisons: a systematic review. BMJ global health, 5(11), p.e003201 https://gh.bmj.com/content/5/11/e003201

[9] Amnesty International (2020) https://www.amnesty.org/en/latest/news/2020/12/pakistan-overcrowding-in-pakistans-prisons-is-a-ticking-time-bomb/

[10] https://uacrisis.org/uk/amnistiya-ye-realnym-sposobom-borotby-z-poshyrennyam-koronavirusu-u-mistsyah-nesvobody-pravozahysnyky

[11] https://www.unian.info/society/human-rights-un-recommends-ukraine-grant-amnesty-to-certain-convicts-amid-covid-19-pandemic-11155589.html

[12] https://www.chathamhouse.org/2020/11/covid-19-holds-lessons-ukraines-amnesty-policy

[13] https://www.redcross.ie/national-news/irish-red-cross-responds-to-covid19/

Recently, European Union countries have begun enforced lockdowns in smaller regions in response to new outbreaks of COVID-19, rather than bringing the entire country to a halt. 'Smart lockdowns' have been undertaken in Germany, Portugal, Italy, and the UK where local governments have declared local lockdown where cases of COVID-19 could not be contained.

Special consideration should be given to the identified causes of spikes in transmission. Localised COVID-19 outbreaks in Europe and the USA share a number of similarities. In most cases, overcrowded living conditions, poor working conditions, cultural practices, and/or limited socio-economic capital point to increased risk of infection and transmission. In Warendorf (Germany) and Cleckheaton (England), outbreaks were attributed to abattoirs and meat factories , which often employ migrant workers in poor working conditions on low-paid contracts. While the outbreak in Cleckheaton does not seem to have spread into the community, the fallout from the abattoir in Germany resulted in the lockdown of the city of Warendorf. Similar patterns are being witnessed in the USA, where workers from meat processing plants in Georgia, Arkansas and Mississippi, who are predominantly migrant workers or people of colour, have died from the virus or have become infected.

Conversely, in Marche (Italy) and Lisbon (Portugal) outbreaks originated in migrant communities that were living in overcrowded quarters or experiencing unsafe working conditions. Similarly, this week in Leicester (England), a local lockdown has been enforced. Possible reasons for the spike in cases shares stark similarities to the local lockdowns that have gone on elsewhere.

Reportedly, in Leicester some garment factories continued to operate throughout the crisis and forced their workers to work despite high levels of infection. Wage exploitation of the largely immigrant workforce, failure to protect workers' rights in Leicester's garment factories (a subject of concern for years), and poor communication of lockdown rules with Leicester's large ethnic minority community have all contributed to a resurgence in the disease.

Secondly, the East of the city, suspected to be the epicenter of the outbreak, has extreme levels of poverty, is densely packed with terraced housing, and has a high proportion of ethnic minority families where multi-generational living is common.

These patterns barely differ from the spike in cases in Singapore in May 2020 in which Singapore's progress on tackling COVID-19 was halted as tens of thousands of migrant workers contracted the disease due to poor living conditions and being neglected by testing schemes as their migrant status and relative poverty meant they were overlooked by the government.

Implementing smart lockdowns requires:

• Outbreak control plans for the COVID-19 partnership to be developed, written, and communicated to wider partners, specifying their role in the outbreak response
• Collaborate closely across the public sector to understand possible at-risk communities e.g. minority groups, migrant workers, those in poor or insecure housing, those in particular occupations
• Identify new cases early through rapid testing and contact tracing and sharing timely data across agencies
• Decide the threshold at which a cluster of new cases become an outbreak
• Decide the threshold at which an outbreak triggers the lockdown of an area, and how the size of that area is determined
• Collaborate closely with the public sector to communicate and enforce local lockdowns e.g. the police, the health and social sector, local leaders
• Ensure there is capacity in local-health care systems to respond to the outbreak
• Collaborate with citizens to ensure good behavioural practices are understood and adhered to e.g. hand washing, social distancing at work and in public areas
• Ensure the parameters of the local lockdown are clear. For example, in a UK "local authority boundaries can run down the middle of a street" which makes it different to differentiate what is appropriate for a city or region, and to understand how a local community identifies with the place and boundaries in which they live

Local outbreaks, whether in migrant worker accommodation, meat factories or impoverished areas of a city, clearly underscore the disproportionate impact of COVID-19 on minority, migrant, and poor communities. Increased engagement with, and attention to ethnic minority groups, marginalised people and impoverished communities is key to staving off local and national resurgences of COVID-19. Strong multi-organisational partnerships are required to account for varying needs and concerns with certain communities including addressing their living and working conditions and the risks this poses to public health.

To read this case study in its original format (including source links and references, follow the source link below.

Such issues include loneliness and anxiety about returning to the outside world and recovering from the physical impacts of the disease. Consider:

• Maintain coordinating arrangements with the charity and non-profit sector to support those suffering with physical and mental health impacts of COVID-19
• Share information about vulnerable populations with non-profit and the charity sector where they have permission so that they are able to offer appropriate support
• Retain communication channels such as hotlines to facilitate community engagement
• The needs of those who have survived COVID-19, thinking of the mental health impacts such as fear of going outside, and physical impacts such as organ scarring, impaired vision and mobility, which may require ongoing support

This lesson was contributed by a representative of the Social Welfare Department in Portugal and UNDRR City Resilience Stories Australia during project data collection.

This could include:

• Retrofitting programmes to make buildings more energy-efficient
• Mass tree planting
• Investment in solar and wind power
• Building infrastructure required for increased consumption and use of electric cars such as improved electricity networks, and public and personal capacity for charging stations

Additionally, due to lockdown these measures may not be as disruptive to people's daily lives compared to, for example, offices being retrofitted while in constant use.

This lesson was conributed to by Chief Resilience Officers in Italy and Australia during project data collection, along with the source link below.

As a way to keep people connected with the environment and land during recovery. This will help embed the importance of the environment in the public mind long term.

Reference: Civil Protection expert, Portugal