Abstract

Objective:

To estimate the serological prevalence of SARS-CoV-2 infection among prison system workers in the state of Espírito Santo, Brazil, between August-September 2020.

Methods:

This was a stratified sample survey, using interviews and serological tests for SARS-CoV-2.

Results:

Among the 986 interviewers, the serological prevalence of SARS-CoV-2 infection was 11.9% (95%CI 8.1%;15.7%) in health professionals, and 22.1% (95%CI 18.8%;25.3%) in prison officers. Positivity was more frequent among health professionals in the north of the state (19.7%) and in male prison officers (24.0%). Among seropositive individuals, fatigue was the most frequent symptom in prison agents (13.4%) and myalgia in health professionals (10.8%); and the most prevalent comorbidities among the seropositive individuals were asthma or bronchitis (16.2%), in health professionals, and hypertension in prison officers (12.8%).

Conclusion:

The serological prevalence of SARS-Cov-2 infection was higher in prison officers, a finding that can support disease control and prevention actions in this scenario.

Keywords:
Prevalence; Coronavirus Infections; Prisons; Occupational Health; Cross-Sectional Studies.

INTRODUCTION

One year after the World Health Organization (WHO) declared the COVID-19 outbreak a pandemic, in March 2020, it could be seen that some population groups, such as black people and individuals with lower income and schooling, have been shown to be more vulnerable to deaths due to SARS-CoV-2.¹1. Baqui P, Bica I, Marra V, Ercole A, van der Schaar M. Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet Glob Health. 2020;8(8):e1018-26. doi: 10.1016/S2214-109X(20)30285-0
https://doi.org/10.1016/S2214-109X(20)30... ^.22. Ribeiro KB, Ribeiro AF, Veras MASM, Castro MC. Social inequalities and COVID-19 mortality in the city of São Paulo, Brazil. Int J Epidemiol. 2021:50(3):732-42. doi: 10.1093/ije/dyab022
https://doi.org/10.1093/ije/dyab022...

In addition, individuals in confined spaces with potential agglomeration of people are more exposed to contagion and the spread of the virus.³3. 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 Heal. 2020;5(4):e188-9. doi: 10.1016/S2468-2667(20)30058-X
https://doi.org/10.1016/S2468-2667(20)30... As such, prison environment provide the ideal conditions that potentially facilitate the spread of COVID-19,³3. 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 Heal. 2020;5(4):e188-9. doi: 10.1016/S2468-2667(20)30058-X
https://doi.org/10.1016/S2468-2667(20)30... given the precarious situation that Brazilian prison system has been facing, described as poorly maintained places, with little or no ventilation, in addition to the problem of chronic overcrowding.⁴4. Ministério da Justiça e Segurança Pública (BR). Departamento Penitenciário Nacional. Levantamento nacional de informações penitenciarias - período de julho à dezembro de 2019. Taxa de aprisionamento e déficit de vagas por ano [Internet]. Brasília: Ministério da Justiça e Segurança Pública [atualizado 2020 jun 24; citado 2021 mar 2]. Disponível em: Disponível em: https://app.powerbi.com/w?r=eyJrIjoiZWI2MmJmMzYtODA2MC00YmZiLWI4M2ItNDU2ZmIyZjFjZGQ0IiwidCI6ImViMDkwNDIwLTQ0NGMtNDNmNy05MWYyLTRiOGRhNmJmZThlMSJ9
https://app.powerbi.com/w?r=eyJrIjoiZWI2...

Data from the Conselho Nacional de Justiça (CNJ), disclosed by the Departmento Penitenciário Nacional (DEPEN), showed that not only persons deprived of liberty (PDL) have been pointed out as the most vulnerable group affected by COVID-19, but also professionals working in these spaces, such as health professionals; and prison and administrative officers.⁵5. Conselho Nacional de Justiça (BR). Departamento Penitenciário Nacional. Boletim CNJ de monitoramento Covid-19: registro de casos e óbitos. Brasília: CNJ; 2021.

As of February 22, 2021, 62,459 tests were performed and 15,450 cases of COVID-19 were diagnosed in Brazilian prison system workers, of whom 112 died. Regarding the Federative Units, São Paulo state accounted for the highest number of cases (2,751), while Rio Grande do Sul state had the lowest occurrence.¹³13. Buonafine CP, Paiatto BNM, Leal FB, Matos SF, Morais CO, Guerra GG, et al. High prevalence of SARS-CoV-2 infection among symptomatic healthcare workers in a large university tertiary hospital in São Paulo, Brazil. BMC Infect Dis. 2020;20(1):917. Doi: 10.1186/s12879-020-05662-8
https://doi.org/10.1186/s12879-020-05662... The South region of Brazil had the lowest percentage of deaths related to the disease, 5.4%, and the Southeast region accounted for 46.6% of deaths from COVID-19 in the country. In the state of Espírito Santo, Southeast region, 835 cases in prison system workers and three deaths due to the disease had been reported until then.⁵5. Conselho Nacional de Justiça (BR). Departamento Penitenciário Nacional. Boletim CNJ de monitoramento Covid-19: registro de casos e óbitos. Brasília: CNJ; 2021.

An international study on data from the COVID Prison Project, regarding the period between April 2020 and January 2021, showed that prison staff reported higher rates of COVID-19 compared to the general population, and close to that observed in the PDL from the countries studied.⁶6. Nowotny KM, Seide K, Brinkley-Rubinstein L. Risk of COVID-19 infection among prison staff in the United States. BMC Public Health. 2021;21(1):1036. doi: 10.1186/s12889-021-11077-0
https://doi.org/10.1186/s12889-021-11077...

Thus, it is extremely important to know this reality, in order for the health and/or security institutions to develop strategies aimed at controlling COVID-19 transmission in those places and, consequently, protecting the health of people deprived of liberty, prison staff, health professionals, lawyers or justice professionals, or any individual who enters the prison, in addition to the general community.⁷7. Fundação Oswaldo Cruz. Covid-19 e a população privada de liberdade. Rio de Janeiro: Fiocruz; 2020.

This study aimed to estimate the serological prevalence of SARS-CoV-2 infection among the prison system workers in the state of Espírito Santo, Brazil.

METHODS

This was a cross-sectional study, using data from a population-based survey,⁸8. World Health Organization. Population-based age-stratified seroepidemiological investigation protocol for COVID.19 virus infection, 17 March 2020 [Internet]. Geneva: WHO; 2020[updated 2020 apr 04; cited 2020 july 17]. Available from: Available from: https://apps.who.int/iris/handle/10665/331656
https://apps.who.int/iris/handle/10665/3... with quota sampling, conducted in prisons in the state of Espírito Santo, stratified according to the categories of workers such as ‘health professionals’ and ‘prison officers’.

The study was conducted between August 31^st and September 4^th, 2020, and had as target population professionals working in the 34 prisons in Espírito Santo state, distributed over 13 municipalities in the state. 441 health professionals and 3,101 prison officers worked in those units.

For the calculation of the sample, we took into consideration the population size described, an expected prevalence of COVID-19 of 10%, sampling error of 2 percentage points and 5% confidence level. The minimum sizes defined for the sample were 293 health professionals and 667 prison officers. They were proportionally calculated according to the number of health professionals and prison officers in each prison unit.

One week before the beginning of this study, according to a list of names provided by the Prison System Administration of the state of Espírito Santo, we selected those who would take part in the study at random, considering the two categories of workers. At this stage of the process, there was around a 40% increase in the number of participants included in the study, in order to compensate for any absences or leave, or alternating work shift.

An application was developed on the ArcGIS Online Platform software, in order to be installed on mobile devices and it could be used offline, which allowed data collection in the prisons. At the end of each application day, the devices were connected to the internet and the technical team immediately received the data package collected on that journey.

A research monitoring panel was developed for each of the prisons, in order to monitor which units were close to or had already achieved the goals for each of the profiles addressed in the survey - prison officers and health professionals working in the state prison system.

The interviewers were trained in the performance of blood test, which was performed with a blood sample collected using digital puncture. Immunochromatographic rapid test for detecting IgM and IgG antibodies, MedLevensohn brand, Agência Nacional de Vigilância Sanitária (Anvisa) registration No. 80560310056, was used. The result was estimated based on the observation of the markers, according to the amount of time specified by the manufacturer. In case of doubts regarding the interpretation, the tests were repeated and forwarded to the medical team responsible for the research. The test was considered positive - IgG or IgM; however, information on which of the two markers had a positive result was not available to the authors.

The interviewers received all personal protective equipment (PPE) recommended by the Anvisa for possible contact with people with COVID-19, in addition to other necessary items, such as cell phones and alcohol, and also other materials used in serological surveys, provided by the Espírito Santo State Department of Health.

In addition to COVID-19 testing, information was collected from the participants using a face-to-face interview with closed-ended questions. As such, the following variables were selected and categorized:

The information was stored in a database, and the statistical analysis was performed using the Statistical Package for the Social Science (SPSS), version 20.0. Prevalence and respective 95% confidence intervals (95%CI) were estimated. The differences between exposure variables and COVID-19 seropositivity, stratified for health professionals and prison officers, was analyzed using Pearson’s chi-square test, or Fisher’s exact test. The level of significance adopted was 5%.

All individuals selected for the sample in the prison units were informed about the objective of this study, risks and benefits involved, along with advice on preventive measures. The material for serology tests and data were collected after the participants signed the Free and Informed Consent Form. All individuals who had been tested, received the result a few minutes after its performance. Positive cases were reported and referred to the Municipal Health Services for clinical evaluation. All biosafety measures were taken in order to ensure the health of field workers. The study was approved by the Human Research Ethics Committee, Center for Health Sciences of the Universidade Federal do Espírito Santo (CEP/CCS/UFES): Opinion No. 4,209,127, issued on August 12, 2020.

RESULTS

986 individuals working in the prison system in the state of Espírito Santo took part in the survey: 311 health professionals and 675 prison officers. There were no refusals to participate in the study.

The majority of the health professionals who took part in the study worked in prisons in the metropolitan region of Vitória, capital city of Espírito Santos (61.7%), closed regime (90.7%), were female (76.8%), aged between 31 and 40 years (41.3%), had complete higher education (43.5%) and self-reported Brown race/skin color (44.8%). Among prison officers, most of them worked in prisons in the metropolitan region of Vitória (59.4%), closed regime (89.5%), were male (76.1%), aged between 31 and 40 years (54.8%), had complete higher education (45.5%) and self-reported Brown race/skin color (49.9%) (Table 1).

The prevalence of positive cases was 11.9% (95%CI 8.1%;15.7%) among health professionals, and 22.1% (95%CI 18.8%;25.3%) among prison officers.

Positive cases for SARS-CoV-2 were more frequent among health professionals in the north region of Espírito Santo (19.7%) and in male prison officers (24.0%). In both groups of workers, the outcome was associated with lower education (complete high school) (Table 1).

Most health professionals and prison officers had no symptoms (67.5% of health professionals and 64.9% of prison officers) and had not sought health care in the last 15 days (77.5% of health professionals and 83.8% of prison officers) did not have comorbidities (73.6% of health professionals and 77.8% of prison officers), reported hand hygiene habits (99.0% of health professionals and 98.2% of prison agents), did not use public transportation to commute to work (61.0% of health professionals and 90.1% of prison officers) and had a weekly workload of 40 hours (48.7% of health professionals and 94.3% of prison officers) (Table 2).

Among prison officers, positive cases for SARS-CoV-2 were more frequent in individuals who presented one symptom (13.4%), although 59.7% of the prison officers who tested positive for SARS-Cov-2 did not present any symptoms. Among health professionals who had positive test results, 64.9% did not report covid-19 symptoms. Regarding prison officers, a higher proportion of positive results was observed among individuals working 20-hour shifts (63.6%), compared to other working time regimes: 31.3% for 30 hours and 20.4% for 40 hours (p=0.001) (Table 2).

With regard to workers who had positive test results in the group of health professionals, the most prevalent symptom was myalgia (10.8%), while in the group of prison officers, fatigue (13.4%) and myalgia (12.2%) were the most frequent symptoms. Test positivity was associated with the presence of heart palpitations in the group of health professionals (p=0.024), while among prison officers, it was associated with the symptoms of anosmia (p=0.021), fatigue (p=0.002) and palpitations (p=0.014) (Figure 1).

Figure 2 shows the comorbidities reported by health professionals and prison officers, among those who had positive test results. Regarding health professionals, the distribution of comorbidities ranged from no cases of kidney disease, tuberculosis and cancer to 16.2% of asthma or bronchitis. Among prison officers, this distribution ranged from 0.7% of kidney disease and tuberculosis to 12.8% of hypertension. Finally, among health professionals, the presence of heart disease was associated with test positivity (p=0.006).

DISCUSSION

Among the prison staff who took part in this study, the sorological prevalence of SARS-CoV-2 infection was 11.9% in health professionals, and 22.1% in prison officers. Data from DEPEN revealed that 24.7% of the tests performed on prison staff nationwide showed a positive result,⁵5. Conselho Nacional de Justiça (BR). Departamento Penitenciário Nacional. Boletim CNJ de monitoramento Covid-19: registro de casos e óbitos. Brasília: CNJ; 2021. indicating a small difference regarding national data.

Data disclosed and collected by the CNJ (Conselho Nacional de Justiça) until the end of September 2020 showed that the contamination rate of SARS-CoV-2 among prison staff in the country was three times as high as that found in the general population, given that this group recorded 7,694.5 cases per 100,000 professionals, while in the general population, there were 2,258.2 cases per 100,000 inhabitants. In the same period, the contamination rate among the PDL was 3,774.4 cases per 100,000 prisoners.⁹9. Conselho Nacional de Justiça (BR). Covid-19: contaminação entre servidores de prisões é três vezes maior que a geral [Internet]. Brasília: CNJ; 2020 [atualizado 2020 set 30; citado 2021 mar 17]. Disponível em: Disponível em: https://www.cnj.jus.br/covid-19-contaminacao-entre-servidores-de-prisoes-e-tres-vezes-maior-que-a-geral/
https://www.cnj.jus.br/covid-19-contamin...

A study conducted with 1,163 emergency service workers in Porto Alegre, capital city of Rio Grande do Sul, showed a prevalence of more than 80% exposure to SARS-CoV-2, and an antibody production of 5.5% - 1.6 times as high as the proportion of antibodies developed by the municipal population.¹⁰10. Federação das Santas Casas e Hospitais Beneficentes, Religiosos e Filantrópicos do RS. Estudo realizado entre profissionais de saúde aponta elevada exposição ao coronavírus [Internet]. Porto Alegre: Federação das Santas Casas e Hospitais Beneficentes, Religiosos e Filantrópicos do RS; 2020 [citado 2021 Mar 17]. Disponível em: Disponível em: https://federacaors.org.br/estudo-realizado-entre-profissionais-de-saude-aponta-elevada-exposicao-ao-coronavirus/
https://federacaors.org.br/estudo-realiz...

An ongoing research on data updated on August 30^th, 2021, conducted with health professionals providing care to those with COVID-19, in the metropolitan regions of Porto Alegre, Fortaleza, capital city of Ceará, Belém, capital city of Pará, São Paulo, and Recife, capital city of Pernambuco, showed that 40.5% of these professionals had COVID-19 infection and 35.3% psychiatric symptoms.¹¹11. Instituto de Avaliação de Tecnologia em Saúde. Projeto avalia saúde mental de profissionais em atuação na pandemia [Internet]. Porto Alegre: IATS, 2020 [atualizado 2020 maio 1; citado 2021 ago 30]. Disponível em: Disponível em: https://www.iats.com.br/26-dos-profissionais-de-saude-apresentam-sintomas-indicativos-de-depressao-ou-ansiedade-aponta-estudo/e https://datastudio.google.com/u/0/reporting/66637ba4-e0a3-4b24-ac41-0c9331d07e5b/page/est2B
https://www.iats.com.br/26-dos-profissio...

For nursing professionals, the information collected by the Federal Nursing Council, regarding the time interval between March 20^th and May 28^th, 2020, showed 17,414 suspected and 5,732 confirmed cases, and 134 deaths occurred in that period in Brazil. With regard to other characteristics evaluated, the Southeast region presented the highest number of cases and deaths, the age group with the most reported cases was 31-40, and the highest case fatality ratio among men.¹²12. Duprat IP, Melo GC. Análise de casos e óbitos pela COVID-19 em profissionais de enfermagem no Brasil. Rev. Bras. Saúde Ocup. 2020;45:e30. doi: 10.1590/2317-6369000018220 These findings corroborate data from this study, in which a higher frequency of positive test results among health professionals aged 31 to 40 years working in the prison system was also observed.

A cross-sectional study conducted at a university hospital in São Paulo assessed the prevalence of SARS-Cov-2 infection among symptomatic health professionals using the RT-PCR test. Data showed that 42.4% of the symptomatic professionals presented a positive result.¹³13. Buonafine CP, Paiatto BNM, Leal FB, Matos SF, Morais CO, Guerra GG, et al. High prevalence of SARS-CoV-2 infection among symptomatic healthcare workers in a large university tertiary hospital in São Paulo, Brazil. BMC Infect Dis. 2020;20(1):917. Doi: 10.1186/s12879-020-05662-8
https://doi.org/10.1186/s12879-020-05662... As in the study conducted in São Paulo, the present study did not find a significant difference in the prevalence of comorbidities among professionals with positive or negative test results. Regarding symptoms, the same study conducted in São Paulo showed that anosmia and eye pain were independently associated with infection positivity, while in this study, anosmia, fatigue and palpitation were significant.

In March 2020, WHO published a guidance entitled ‘Preparedness, Prevention and Control of COVID-19 in prisons and other places of detention’, aimed to assist countries in developing specific plans for these detention settings to deal with COVID-19. The document reinforces the importance for each country to be prepared to respond to possible scenarios for the disease. Therefore, countries should adjust and tailor their approach to the local context, in order to identify, manage and treat the disease.¹⁴14. World Health Organization. Regional Office for Europe. Preparedness, prevention and control of COVID-19 in prisons and other places of detention. Interim guidance; 15 March 2020 [Internet]. [updated 2020 mar 25; cited 2021 apr 14]. Available from: Available from: http://www.euro.who.int/__data/assets/pdf_file/0019/434026/Preparedness-prevention-and-control-of-COVID-19-in-prisons.pdf?ua=1
http://www.euro.who.int/__data/assets/pd...

In Brazil, the CNJ published its Recommendation No. 62, 2020, with preventive measures against the spread of coronavirus infection in criminal and socio-educational justice systems. Actions aimed at release and non-imprisonment of individuals in risk groups (the elderly, pregnant women and people with chronic conditions), health actions (restriction of visits, frequent hygiene of cells and common spaces), screening persons deprived of liberty at prison entrance, as well as professionals and visitors, and isolation for suspected or confirmed COVID-19 cases, are among the main recommended measures.¹⁵15. Crispim JA, Ramos ACV, Berra TZ, Santos MS, Santos FL, Alves LS, et al. Impacto e tendência da covid-19 no sistema penitenciário do Brasil: um estudo ecológico. Cienc Saúde Coletiva. 2021;26(1):169-78. doi: 10.1590/1413-81232020261.38442020
https://doi.org/10.1590/1413-81232020261... ^.1616. Conselho Nacional de Justiça (BR). Recomendação nº 62, de 17 de março de 2020. Recomenda aos Tribunais e magistrados a adoção de medidas preventivas à propagação da infecção pelo novo coronavírus - Covid-19 no âmbito dos sistemas de justiça penal e socioeducativo. DJe/CNJ nº 65/2020, 2020 mar 17; p. 2.

Taking into consideration both aforementioned documents, the Fundação Instituto Oswaldo Cruz (Fiocruz) has developed a booklet addressed to health professionals and managers working in the prison system, adding information about the COVID-19 pandemic in the context of Brazilian prison system.¹⁷17. Sánchez A, Simas L, Diuana V, Larouze B. COVID-19 nas prisões: um desafio impossível para a saúde pública?. Cad Saude Publica. 2020;36(5):e00083520. doi: 10.1590/0102-311x00083520
https://doi.org/10.1590/0102-311x0008352... Among the main contributions of Fiocruz’s document, the following measures stand out: (i) the adoption of changes in daily routine, such as suspension of visits and separation of elderly prisoners and people with chronic diseases; (ii) early COVID-19 testing in individuals with compatible symptoms; (iii) the notification of suspected COVID-19 cases with flu-like symptoms within 24 hours, and the inclusion of PDL and prison staff in the epidemiological surveillance system; and, finally, (iv) keeping health professionals and prison officers informed about the regulations for the monitoring and treatment of cases of the disease.¹⁷17. Sánchez A, Simas L, Diuana V, Larouze B. COVID-19 nas prisões: um desafio impossível para a saúde pública?. Cad Saude Publica. 2020;36(5):e00083520. doi: 10.1590/0102-311x00083520
https://doi.org/10.1590/0102-311x0008352... ^.1818. Governo do Estado (Espírito Santo). Secretaria de Estado da Justiça do Estado do Espírito Santo. Nota técnica para padronização das medidas de prevenção, controle e manejo do novo coronavírus no sistema prisional do espirito santo. Vitória: Secretaria de Estado da Justiça; [2020]. [citado 2021 mar 02]. Disponível em: Disponível em: https://sejus.es.gov.br/Media/sejus/Arquivos%20PDF/NOTA%20T%C3%89CNICA%20SOBRE%20O%20NOVO%20CORONAV%C3%8DRUS%20-%20VERS%C3%83O%20FINAL.pdf
https://sejus.es.gov.br/Media/sejus/Arqu... The booklet also advises that for comprehensive health care and psychosocial support, a COVID-19 contingency plan should be developed at local levels, including both intervention strategies and the guarantee of specialized health care within the scope of the Brazilian National Health System.¹⁷17. Sánchez A, Simas L, Diuana V, Larouze B. COVID-19 nas prisões: um desafio impossível para a saúde pública?. Cad Saude Publica. 2020;36(5):e00083520. doi: 10.1590/0102-311x00083520
https://doi.org/10.1590/0102-311x0008352...

The State Secretariat of Justice of Espírito Santos has developed a COVID-19 Contingency Plan to be adopted by the prison units in the state, with recommendations for identifying, preventing and coping with COVID-19 in the prison system, establishing general guidelines for the prevention and management of suspected and/or confirmed cases. The Plan recommends, among other measures, the screening of suspected COVID-19 cases using a questionnaire and temperature measurement of people at prison entrance such as PDL, prison staff and visitors.¹⁹19. Governo do Estado (Espírito Santo). Secretaria de Estado da Justiça do Estado do Espírito Santo. Plano de contingência para o novo coronavírus (COVID-19). Vitória: Secretaria de Estado da Justiça ; 2020[citado 2021 mar 02]. Disponível em: Disponível em: https://sejus.es.gov.br/Media/sejus/Arquivos%20PDF/PLANO_DE_CONTINGENCIA_COVID_-_SEJUS.pdf
https://sejus.es.gov.br/Media/sejus/Arqu... ^.2020. Ministério da Justiça e Segurança Pública (BR). Departamento Penitenciário Nacional. Levantamento nacional de informações penitenciarias - período de janeiro à junho de 2020 [Internet]. Brasília: Ministério da Justiça e Segurança Pública [atualizado 2020 set 30; citado 2021 mar 02]. Disponível em: Disponível em: https://app.powerbi.com/w?r=eyJrIjoiMjU3Y2RjNjctODQzMi00YTE4LWEwMDAtZDIzNWQ5YmIzMzk1IiwidCI6ImViMDkwNDIwLTQ0NGMtNDNmNy05MWYyLTRiOGRhNmJmZThlMSJ9
https://app.powerbi.com/w?r=eyJrIjoiMjU3...

It is worth highlighting that, the prison environment is unhealthy and favors the spread of the virus,⁴4. Ministério da Justiça e Segurança Pública (BR). Departamento Penitenciário Nacional. Levantamento nacional de informações penitenciarias - período de julho à dezembro de 2019. Taxa de aprisionamento e déficit de vagas por ano [Internet]. Brasília: Ministério da Justiça e Segurança Pública [atualizado 2020 jun 24; citado 2021 mar 2]. Disponível em: Disponível em: https://app.powerbi.com/w?r=eyJrIjoiZWI2MmJmMzYtODA2MC00YmZiLWI4M2ItNDU2ZmIyZjFjZGQ0IiwidCI6ImViMDkwNDIwLTQ0NGMtNDNmNy05MWYyLTRiOGRhNmJmZThlMSJ9
https://app.powerbi.com/w?r=eyJrIjoiZWI2... as well as the inadequate working conditions of prison staff contribute to aggravate this scenario. In 2019, the Tribunal de Contas do Estado de São Paulo inspected the São Paulo prison system, responsible for the largest number of prisoners in the country,²¹21. Moraes RN, Santos AM, Mattos Filho HFM, Braz JPG. Sistema Prisional brasileiro e os direitos fundamentais em tempos de pandemia de covid-19. Etic. 2020;16(16):[não paginado]. and found: the inmate-to-prison officer ratio was 9.8 to 1, in prisons in São Paulo, twice as high as the maximum recommended by the Conselho Nacional de Política Criminal e Penitenciária, which is an inmate-to-prison officer ratio of 5 to 1.²²22. Brasil. Ministério da Saúde. Ministério da Justiça. Portaria Interministerial nº 1777 de 9 de setembro de 2003. Aprova o Plano Nacional de Saúde no Sistema Penitenciário, constante do Anexo 1, destinado a prover a atenção integral a saúde da população prisional confinada em unidades masculinas e femininas, bem como nas psiquiátricas. Diário Oficial da União, Brasília (DF), 2003 set 11; Seção 1:39. In the same period, it could be seen that many prisons did not have a team with a minimum number of health professionals (18), according to the recommendations of the Interministerial Ordinance of the Ministry of Health and Ministry of Justice, No. 1,777/2003,²³23. Brasil. Ministério da Saúde. Ministério da Justiça. Portaria Interministerial nº 1, de 2 de janeiro de 2014. Institui a Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade no Sistema Prisional (PNAISP) no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da União, Brasília (DF), 2014 jan 3; Seção 1:2. and the National Policy for Comprehensive Health Care of People Deprived of Liberty in the Prison System.

This study presents limitations regarding the design, and it is not possible to determine the causality between the variables studied and the positive test result to ensure that the confounding factors are equally distributed among the groups, or even to portray the reality of the moment when the research was conducted. Another limitation of this study lies in the impossibility of distinguishing whether SARS-CoV-2 was active or past infection, due to a single test result for IgG and IgM antibodies. During data collection, no worker was hospitalized due to severe manifestations of COVID-19.

Given this scenario, it is worth highlighting the challenge experienced by managers and professionals from different areas in coping with the COVID-19 pandemic, showing the weaknesses of the country’s penal system. All these aspects have been aggravated by the precarious situation that Brazilian prison system has been facing, in addition to overcrowding, devaluation and insufficient number of professionals, among other aspects. It is worth mentioning that the Brazilian state has a constitutional duty to guarantee the protection of individuals in its custody, as well as to provide adequate working conditions for its employees, with the objective of ensuring the maintenance of the health and well-being of these citizens.

References

Publication Dates

History