![]() ![]() Data on activities are only displayed for residents who were in custody the entire week. Before COVID-19-related closures, population sizes were larger than the column total because COVID-19 led to population reductions. Before closures indicates January, 2020 (before closures due to COVID-19), and with closures indicates November, 2020 (with closures due to COVID-19 implemented). Residents' participation in activities out of their rooms (but still in the prison) in the past week with at least one other resident. Notably, the medical prison simulated here is for male residents only since California has no women's medical prison, medically vulnerable women are housed in two general population women's prisons, one of which is included in this study. Simulated prisons include a low-to-medium security men's prison consisting mostly of dormitories (rooms with at least three occupants), a low-to-medium security men's prison with a mix of dormitories and cells (rooms with no more than two occupants), a high-security men's prison with mostly cells, a women's prison with mixed security levels and mostly cells, and a medical prison that houses older residents and those with medical vulnerabilities mostly in cells ( appendix pp 15–20). We selected five specific prisons from California's 35 state prisons that vary across these characteristics and are comparable to other prison systems in the USA. Correctional staff are characterised by age the staff population size varies by prison. The characteristics also include the number of residents and their age, sex, comorbidities, security level, room assignment and type, and participation in prison labour or other out-of-room activities. ![]() ) and their organisation within buildings and yards. However, we could not find any studies that have evaluated the impact of vaccines, assessed reopening scenarios, or considered the effects of viral variants on populations in correctional settings. Studies have also called for the prioritisation of people who are incarcerated in vaccination efforts. Some studies have analysed the increased risks of dense and overcrowded congregate settings, including prisons, and others have used mathematical models to assess depopulation and non-pharmaceutical interventions. We did not find any studies meeting these criteria. We searched the published literature (using PubMed) and preprints (using medRxiv) using the search terms “covid-19 OR sars-cov-2 OR coronavirus” AND “prison OR prisons OR jail OR correctional OR carceral OR carcel” for studies published between Jan 1, 2020, and April 23, 2021, that assessed the safety of resuming in-person activities in carceral settings given COVID-19 vaccination and the proliferation of viral variants of concern. A common approach was halting in-person activities (eg, group therapy or educational classes) to reduce transmission, with many prisons now considering resumption of such activities. There has been a lack of evidence on how to prevent and mitigate outbreaks in prisons, and prison systems have taken a range of approaches to preventing infections as well as severe outcomes such as hospitalisations and deaths, with mixed results. Prisons in the USA, a country that accounts for almost a quarter of the global incarcerated population, have experienced devastating COVID-19 outbreaks.
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