Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 151 No. 0506 (2021)

COVID-19 Inmate Risk Appraisal (CIRA): development and validation of a screening tool to assess COVID-19 vulnerability in prisons

DOI
https://doi.org/10.57187/smw.2021.20471
Cite this as:
Swiss Med Wkly. 2021;151:w20471
Published
08.02.2021

Summary

OBJECTIVES

To develop and validate a screening tool designed to identify detained people at increased risk for COVID-19 mortality, the COVID-19 Inmate Risk Appraisal (CIRA).

DESIGN

Cross-sectional study with a representative sample (development) and a case-control sample (validation).

SETTING

The two largest Swiss prisons.

PARTICIPANTS

(1) Development sample: all male persons detained in Pöschwies, Zurich (n = 365); (2) Validation sample: case-control sample of male persons detained in Champ-Dollon, Geneva (n = 192, matching 1:3 for participants at risk for severe course of COVID-19 and participants without risk factors).

MAIN OUTCOME MEASURES

The CIRA combined seven risk factors identified by the World Health Organization and the Swiss Federal Office of Public Health as predictive of severe COVID-19 to derive an absolute risk increase in mortality rate: Age ≥60 years, cardiovascular disease, diabetes, hypertension, chronic respiratory disease, immunodeficiency and cancer.

RESULTS

Based on the development sample, we proposed a three-level classification: average (<3.7), elevated (3.7-5.7) and high (>5.7) risk. In the validation sample, the CIRA identified all individuals identified as vulnerable by national recommendations (having at least one risk factor). The category “elevated risk” maximised sensitivity (1) and specificity (0.97). The CIRA had even higher capacity in discriminating individuals vulnerable according to clinical evaluation (a four-level risk categorisation based on a consensus of medical staff). The category “elevated risk” maximised sensitivity and specificity (both 1). When considering the individuals classified as extremely high risk by medical staff, the category “high risk” had a high discriminatory capacity (sensitivity =0.89, specificity =0.97).

CONCLUSIONS

The CIRA scores have a high discriminative ability and will be important in custodial settings to support decisions and prioritise actions using a standardised valid assessment method. However, as knowledge on risk factors for COVID-19 mortality is still limited, the CIRA may be considered preliminary. Underlying data will be updated regularly on the website (http://www.prison-research.com), where the CIRA algorithm is freely available.

References

  1. Yang H, Thompson JR. Fighting covid-19 outbreaks in prisons. BMJ. 2020;369:m1362. doi:.https://doi.org/10.1136/bmj.m1362 DOI: https://doi.org/10.1136/bmj.m1362
  2. Kinner SA, Young JT, Snow K, Southalan L, Lopez-Acuña D, Ferreira-Borges C, et al. Prisons and custodial settings are part of a comprehensive response to COVID-19. Lancet Public Health. 2020;5(4):e188–9. doi:.https://doi.org/10.1016/S2468-2667(20)30058-X DOI: https://doi.org/10.1016/S2468-2667(20)30058-X
  3. Penal Reform International. Coronavirus: Healthcare and human rights of people in prison - Penal Reform International. London, UK: Penal Reform International; 2020 Mar. Available from: https://www.penalreform.org/resource/coronavirus-healthcare-and-human-rights-of-people-in/ [accessed 2020 Apr 11]
  4. World Health Organization. Preparedness, prevention and control of COVID-19 in prisons and other places of detention. Interim guidance 15 March 2020. Copenhagen: WHO Regional Office for Europe; 2020 Mar. Available from: http://www.euro.who.int/__data/assets/pdf_file/0019/434026/Preparedness-prevention-and-control-of-COVID-19-in-prisons.pdf [accessed 2020 Apr 13]
  5. Condon L, Gill H, Harris F. A review of prison health and its implications for primary care nursing in England and Wales: the research evidence. J Clin Nurs. 2007;16(7):1201–9. doi:.https://doi.org/10.1111/j.1365-2702.2007.01799.x DOI: https://doi.org/10.1111/j.1365-2702.2007.01799.x
  6. Watson R, Stimpson A, Hostick T. Prison health care: a review of the literature. Int J Nurs Stud. 2004;41(2):119–28. doi:.https://doi.org/10.1016/S0020-7489(03)00128-7 DOI: https://doi.org/10.1016/S0020-7489(03)00128-7
  7. Wilper AP, Woolhandler S, Boyd JW, Lasser KE, McCormick D, Bor DH, et al. The health and health care of US prisoners: results of a nationwide survey. Am J Public Health. 2009;99(4):666–72. doi:.https://doi.org/10.2105/AJPH.2008.144279 DOI: https://doi.org/10.2105/AJPH.2008.144279
  8. World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 2020 Feb. Available from: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf [accessed 2020 Apr 11]
  9. Federal Office of Public Health. People at especially high risk. 2020. Available from: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/besonders-gefaehrdete-menschen.html [accessed 2020 Apr 11]
  10. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al.; Latin American Network of Coronavirus Disease 2019-COVID-19 Research (LANCOVID-19). Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623. doi:.https://doi.org/10.1016/j.tmaid.2020.101623 DOI: https://doi.org/10.1016/j.tmaid.2020.101623
  11. Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: evidence from meta-analysis. Aging (Albany NY). 2020;12(7):6049–57. doi:.https://doi.org/10.18632/aging.103000 DOI: https://doi.org/10.18632/aging.103000
  12. Xu L, Mao Y, Chen G. Risk factors for severe corona virus disease 2019 (COVID-19) patients: A systematic review and meta analysis. medRxiv. 2020. doi:https://doi.org/10.1101/2020.03.30.20047415 DOI: https://doi.org/10.1101/2020.03.30.20047415
  13. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: A systematic review and meta-analysis. Int J Infect Dis. 2020;94:91–5.. doi:.https://doi.org/10.1016/j.ijid.2020.03.017 DOI: https://doi.org/10.1016/j.ijid.2020.03.017
  14. Zhao X, Zhang B, Li P, et al. Incidence, clinical characteristics and prognostic factor of patients with COVID-19: A systematic review and meta-analysis. medRxiv. 2020. Available from: https://www.medrxiv.org/content/10.1101/2020.03.17.20037572v1.full.pdf [accessed 2020 Apr 14]. doi:htps://doi.org/10.1101/2020.03.17.20037572
  15. Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China] Article in Chinese. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145–51. doi:.https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003
  16. Chow N, Fleming-Dutra K, Gierke R, Hall A, Hughes M, Pilishvili T, et al.; CDC COVID-19 Response Team. COVID-19 Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus disease 2019 — United States, February 12–March 28, 2020 MMWR Morb Mortal Wkly Rep. 2020;69(13):382–6. doi:.https://doi.org/10.15585/mmwr.mm6913e2 DOI: https://doi.org/10.15585/mmwr.mm6913e2
  17. COVID-19 Surveillance Group. Characteristics of COVID-19 patients dying in Italy. Rome, Italy: Istituto Superiore di Sanità; 2020 Mar. Available from: https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_20_marzo_eng.pdf [accessed 2020 Apr 14]
  18. Federal Office of Public Health. Maladie à coronavirus 2019 (COVID-19): Rapport sur la situation épidémiologique en Suisse et dans la Principauté de Liechtenstein. Berne, Switzerland: Federal Office of Public Health; 2020 Apr. French. Available from: https://www.bag.admin.ch/dam/bag/fr/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/covid-19-lagebericht.pdf.download.pdf/COVID-19_Situation_epidemiologique_en_Suisse.pdf&usg=AOvVaw096L-UcknWjmD7MoDXXDVg [accessed 2020 Apr 11]
  19. The Federal Council. Federal Act on Research involving Human Beings. Swiss Confederation 2020. Available from: https://www.admin.ch/opc/en/classified-compilation/20061313/index.html [accessed 2020 Nov 12]
  20. Centers for Disease Control and Prevention. Groups at higher risk for severe illness. Atlanta, GA: U.S. Department of Health & Human Services; 2020 Apr. Available from: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html [accessed 2020 Apr 11]
  21. Bretschneider W. Ageing prisoners and ethics behind bars: Law, human rights and health care - old (age) problems and new challenges [dissertation]. Basel, Switzerland: University of Basel; 2015. Available from: https://edoc.unibas.ch/38577/ [accessed 2020 Apr 13]. doi:https://doi.org/10.5451/unibas-006433969
  22. Hajian-Tilaki K. Sample size estimation in diagnostic test studies of biomedical informatics. J Biomed Inform. 2014;48:193–204. doi:.https://doi.org/10.1016/j.jbi.2014.02.013 DOI: https://doi.org/10.1016/j.jbi.2014.02.013
  23. World Health Organization. Cardiovascular diseases (CVDs). 2017. Available from: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) [accessed 2020 Apr 14]
  24. Guan WJ, Liang WH, Zhao Y, Liang HR, Chen ZS, Li YM, et al.; China Medical Treatment Expert Group for COVID-19. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):2000547. doi:.https://doi.org/10.1183/13993003.00547-2020 DOI: https://doi.org/10.1183/13993003.00547-2020
  25. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63. doi:.https://doi.org/10.1370/afm.983 DOI: https://doi.org/10.1370/afm.983
  26. Chatterjee R, Bajwa S, Dwivedi D, Kanji R, Ahammed M, Shaw R. COVID-19 Risk Assessment Tool: Dual application of risk communication and risk governance. Progress in Disaster Science. 2020;7:100109. doi:.https://doi.org/10.1016/j.pdisas.2020.100109 DOI: https://doi.org/10.1016/j.pdisas.2020.100109
  27. English P, Friedman E, McKeown H, Rao M, Sethi S, Strain, WD. Risk Stratification tool for Healthcare workers during the CoViD-19 Pandemic; using published data on demographics, co-morbid disease and clinical domain in order to assign biological risk. MedRxiv. 2020. doi:https://doi.org/10.1101/2020.05.05.20091967 DOI: https://doi.org/10.1101/2020.05.05.20091967
  28. Ali K, Rao S, Berdine G, Test V, Nugent K. A retrospective analysis and comparison of prisoners and community-based patients with COVID-19 requiring intensive care during the first phase of the pandemic in West Texas. J Prim Care Community Health. 2020;11:2150132720954687. doi:.https://doi.org/10.1177/2150132720954687 DOI: https://doi.org/10.1177/2150132720954687
  29. Altibi A, et al. Comparative clinical outcomes and mortality in prisoner and non-prisoner populations hospitalized with COVID-19: A cohort from Michigan. MedRxiv. 2020. doi:https://doi.org/10.1101/2020.08.08.20170787 DOI: https://doi.org/10.1101/2020.08.08.20170787
  30. Subjack J, Aguilar G, Titterington VB. Aging prison population: Factors to consider. In: Bruinsma G, Weisburd D (eds) Encyclopedia of Criminology and Criminal Justice. New York, NY: Springer; 2020. doi:https://doi.org/10.1007/978-1-4614-5690-2_522 DOI: https://doi.org/10.1007/978-1-4614-5690-2_522
  31. Greene M, Ahalt C, Stijacic-Cenzer I, Metzger L, Williams B. Older adults in jail: high rates and early onset of geriatric conditions. Health Justice. 2018;6(1):3. doi:.https://doi.org/10.1186/s40352-018-0062-9 DOI: https://doi.org/10.1186/s40352-018-0062-9
  32. Wormith JS. Automated offender risk assessment. Criminol Public Policy. 2017;16(1):281–303. doi:.https://doi.org/10.1111/1745-9133.12277 DOI: https://doi.org/10.1111/1745-9133.12277
  33. Wynants L, Van Calster B, Collins GS, Riley RD, Heinze G, Schuit E, et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ. 2020;369:m1328. doi:.https://doi.org/10.1136/bmj.m1328 DOI: https://doi.org/10.1136/bmj.m1328
  34. Canton of Zurich. COVID-19 Inmate Risk Appraisal (CIRA). 2020. Available from: www.prison-research.com [accessed 2020 Apr 14]