THE IRISH PRISON Service had submitted a paper to the World Health Organization on its approach to the Covid-19 outbreak, with no confirmed cases in any of the prisons across the country since testing began.
Although a number of prison staff have tested positive, the prison service said its early action and the cooperation of both its staff and inmates has prevented transmission to and between inmates.
“Early on we were aware of the likely impact in this setting as you have a population living very close to one another, similar to the likes of nursing homes,” Enda Kelly, national nurse manager at the IPS said.
“If you had an active case there is a likelihood that it would spread and could have absolutely devastating consequences for the people we have in custody.”
He said many inmates in Irish prisons are in vulnerable groups, some with high incidences of addictive behaviour or who have been homeless as well as those with mental health issues or chronic illnesses.
We would have a good number who would be in the cocooning group. The fear was that the impact of that would be significant for the prison population and also for the staff – everyone who comes into work has to go home at the end of the day and they could have elderly parents or children with chronic conditions.
The IPS already had some experience in this area after dealing with Tuberculosis outbreaks and a dedicated infection control team was established three years ago. The approach involved not only the training of staff but also a volunteer programme for inmates to be peer teachers, passing on their learnings about health and life in prison.
Kelly said at the start of the crisis, the IPS maintained significant stocks of personal protective equipment and put in place stringent infection control measures.
“Behind any prison wall is basically a community, how people act and behave impacts on everyone they share that environment with. We were quickly able to spread that message that this is very serious and people needed to be careful to protect themselves and other people.”
He said prisoners understood from media coverage and from conversations with their loved ones that the pandemic was significantly impacting on communities outside of the prisons and that they were not the only group being disadvantaged.
“Very practical measures were implemented, mirroring what was happening in the community, so the big thing was social distancing, asking prisoners not to congregate when they queued for meals or to see the governor or the doctor, also hand hygiene and cough etiquette,” he explained.
“There was a huge level of compliance because of the peer to peer training, it gave people an understanding that it was not just an instruction to do it, they understood we were doing it for the greater good.
Even with the suspension of visits there was understanding because they didn’t want their families mixing with people and putting themselves at risk. Video calls were introduced as soon as we could and there were some glitches with it, but it allowed people to maintain contact with their families.
“It was truly a whole of prison approach. All it would take was one person not to play their part and the deck of cards would come tumbling down.”
Those involved with the management of the situation in prisons have also credited a strong contact tracing system. 158 staff were trained up by public health workers in contact tracing and in the use of surveillance and staff log technology.
Fergal Black, director of care and rehabilitation, said there was concern about the impact of delays with testing in the early days of the outbreak in Ireland.
“We were worried that if a test took nine days, contact tracing would be delayed so we started doing contact tracing as soon as there was a suspected cases,” he said.
As part of this, staff would look back at CCTV footage from the previous 48 hours to see who the person had been in contact with. If another staff member was identified as a close contact, they would be asked to stay home until the index case was cleared and any inmates who were considered close contacts were asked to isolate until the result came back.
“The reality is that of the 203 index (suspected) cases of staff, the number of prisoners who were close contacts is extremely low. Prisoners realise that one of the main transmission routes is staff so they have been keeping their distance,” he said.
Black said that new committals were also a potential risk as they were coming in from the community where the virus was actively spreading.
Between 1 April and 26 May there were 699 new committals to prisons across the country. These new inmates had a routine health check on arrival and were then placed in isolation.
“It was a multi-pronged approach, with the infection control team at the core, but there was luck involved as well. I think it’s phenomenal that with 700 people committed over a two month period, nobody was incubating when they came in, none of them were confirmed as having it – there’s a bit of luck in that.”
Black said the IPS, which has been collaborating with colleagues both in UK prison services and the WHO throughout the crisis, wanted to share the experience and learning with other jurisdictions.
He said as society begins to open back up outside of the prisons, the IPS is now examining how it can begin to do the same inside the walls of the prisons.
“We’re finalising risk assessments on the reintroduction of visits, looking at how that can be done and when it is safe to do it. We want to do that as soon as possible and obviously the key objective with all of this is that the populations continues to be protected.”
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