key: cord-1023121-27byibef authors: Zawitz, C.; Welbel, S.; Ghinai, I.; Mennella, C.; Levin, R.; Samala, U.; Bryant Smith, M.; Gubser, J.; Jones, B.; Varela, K.; Kirbiyik, U.; Rafinski, J.; Fitzgerald, A.; Orris, P.; Bahls, A.; Black, S. R.; Binder, A. M.; Armstrong, P. A. title: Outbreak of COVID-19 and Interventions in One of the Largest Jails in the United States: Cook County, IL, 2020 date: 2020-07-14 journal: nan DOI: 10.1101/2020.07.12.20148494 sha: 0aed5fd4cefd2f1cd61665c2198ed1292e9e510b doc_id: 1023121 cord_uid: 27byibef Background: Correctional and detention facilities are disproportionately affected by COVID-19 due to shared space, contact between staff and detained persons, and movement within facilities of detained persons, many with pre-existing medical conditions. On March 18, 2020, Cook County Jail, one of the United States' largest, identified its first suspected case of COVID-19 in a detained person. Methods: This analysis includes SARS-CoV-2 cases confirmed by molecular detection among detained persons and Cook County Sheriff's Office staff. We examined occurrence of symptomatic cases in each building and proportions of asymptomatic detained persons testing positive. We describe timing of interventions including social distancing, mask use, and expanded testing and show outbreak trajectory in the jail versus contemporaneous case counts in Chicago. Results: During March 1-April 30, 907 symptomatic and asymptomatic cases of SARS-CoV-2 infection were detected among detained persons (n = 628) and staff (n = 279), with nine deaths. Symptomatic cases occurred in all housing divisions; in 9/13 buildings, staff cases occurred first. Among asymptomatic detained persons in quarantine, 23.6% tested positive. Programmatic activity and visitation stopped March 9, cells were converted into single occupancy beginning March 26, and universal masking was implemented for staff (April 2) and detained persons (April 13). Cases at the jail declined while cases in Chicago increased. Conclusion: Aggressive intervention strategies coupled with widespread diagnostic testing of detained and staff populations can limit introduction and mitigate transmission of SARS-CoV-2 infection in correctional and detention facilities. In correctional and detention facilities, shared physical space and interaction of detained persons and 45 staff facilitate introduction and spread of viruses like SARS-CoV-2. 1 The attack rate (AR) among detained persons at CCJ was calculated using bed assignments by day. All nine housing divisions experienced cases despite variation in housing type, capacity, security, and 157 characteristics (Table 1) . Epidemic curves for certain divisions demonstrated a traditional bell-shape; 158 others experienced sporadic cases (Figure 3 ). In 9/13 buildings, staff cases arose first, with a median 3 159 days between the first case in a staff member and a detained person. The unit with the highest percent positive was a dormitory with 37 individuals in the RTU, which housed 172 individuals with comorbidities, including some who used CPAP until use in common areas was stopped. Of A high proportion (23.6%) of exposed but asymptomatic detained persons were found to be positive, 221 similar to other congregate settings such as homeless shelters. 15 The role of these individuals in SARS- CoV-2 transmission is not well understood. 16 Widespread testing facilitates rapid identification, early 223 medical isolation, and reduction in potential for spread, though optimal timing for widespread testing is not 224 known. Newly detained persons are exposed to the community prior to entering the jail, making expanded 225 testing and cohorting at intake essential to limiting transmission. When constructing the epidemiologic curve, the date of medical isolation as a proxy for the date of symptom onset was used for detained persons, and self-reported symptom onset date was used for staff. Screening for influenza-like illness among incoming detained persons began October 1, 2019 and was expanded on January 21, 2020 to include symptoms of COVID-19 consistent with CDC guidelines. Screening of asymptomatic detained persons (not displayed in epidemic curve) began on March 3, 2020 among high-risk individuals in the Residential Treatment Unit; testing of all incoming detained persons upon intake began on April 20, 2020. Prisons and custodial settings are part of a 248 comprehensive response to COVID-19 Epidemiology of Covid-19 in a Long-Term Care 250 Facility in King County, Washington Initial Investigation of 252 Transmission of COVID-19 Among Crew Members During Quarantine of a Cruise COVID-19 in Correctional and Detention Facilities -255 United States COVID-19) in Correctional and Detention Facilities Preventing major outbreaks of COVID-19 in jails Global burden of HIV, viral hepatitis, and tuberculosis in 263 prisoners and detainees Pandemic Influenza and Jail 265 Facilities and Populations An analysis of influenza outbreaks in institutions 267 and enclosed societies COVID-19 and the Correctional 269 Environment: The American Prison as a Focal Point for Public Health Influenza outbreak in a correctional facility Influenza at San Quentin Prison Control of an H1N1 outbreak in a correctional facility in central 276 Flattening the Curve for Incarcerated Populations -278 Covid-19 in Jails and Prisons Prevalence of SARS-CoV-2 Infection in 280 Residents of a Large Homeless Shelter in Boston Presymptomatic SARS-CoV-2 Infections and 282 Transmission in a Skilled Nursing Facility Figure 3 : Number of symptomatic cases of COVID-19 by date of symptom onset among detained persons and staff by housing division in one of the largest jails in the United States-Cook County, IL, March 1-April 30, 2020Epidemic curves for seven buildings representing six housing divisions (Division 6, Division 11, Division 8 [Residential Treatment Unit], Division 2 Dorm 2, Division 9, Division 5, and Division 2 Dorm 4) with COVID-19 cases among symptomatic staff and detainees are shown. Building names are labelled on the righthand side of each respective curve. Buildings are those with high case counts compared to remaining buildings not shown (Divisions 10 and 4, Division 2 Dorms 1 and 3, Cermak, and intake/release). Each node represents 1 week of the study period; the highest number of total cases were identified in the jail the week of April 5 th and fell thereafter. The initial doubling times for Chicago, staff, and detained persons were 2.22, 2.15, and 2.1 days, respectively, represented by the increasing slope prior to peak for each population. (13) Light blue bars represent total number of asymptomatic detained persons tested for SARS-CoV-2 infection (a) on a given day or (b) while housed in a given building during the study period. Dark blue bars represent the total number positive, with data labels included to provide percent testing positive.*Data displayed in Figure 1A do not include asymptomatic detained persons housed in the Residential Treatment Unit (RTU) tested on March 25, 2020 (42 tested, 41 [97.6%] positive). Testing of asymptomatic detained persons began in earnest on April 16, 2020 and was expanded as capacity increased. RCDC denotes site of intake/release of detained persons.