"Prisons can be incubators for COVID-19"

Nepali Times spoke to Barun Mathema, professor of epidemiology at the Mailman School of Public Health at Columbia University in New York about how the COVID-19 pandemic will affect prisons. He was recently on the Michael Smercornish show on CNN to warn that jails can incubate infections. 

Nepali Times: How serious is the danger of coronavirus or other infections spreading out of prisons into the general population?  

Barun Mathema: For detainees under trail for longer term sentencing I would say we need to guided by two principles: 1) as a society we are obligated to protect detainees (in jails or prisons); 2) likewise, we should take actions to reduce risk to the surrounding communities. Given that COVID-19 thrives on social contact, having crowded jails with people coming in and out is likely to promote transmission into jails, transmission within jails and 'spillover' of infections out of the jails into the community. There are many bridge populations, i.e. jail staff, detainees and visiting members of the community, for example family, that can transport the virus into or out of the jails. Also a very important consideration is that there is likely a sizable population that have a variety of co-morbid conditions that predispose poor/bad COVID-19 clinical outcomes.

So, in my opinion, we need to figure out way to lessen the load of inmates in jails (and prisons) that would require us to restrict or lessen numbers going into jails and prisons and release those in jails responsibly and safely. The criminal justice system should at least consider: i) dropping charges on low-level crimes, ii) relax charging low level offenses in the first place, and 3) release detainees who are the most vulnerable (aging or those with serious co-morbidity). All of this must of course be done safely, ethically and responsibly.

The result will likely help lift some pressure within the jails, reducing the risk of outbreaks and potential spillover into the community ... in addition this will likely help in our general mitigation goal of flattening the curve.

Read also:

Unsafe in prison, Himal Khabarpatrika

Nepal trapped Down Under, Upasana Khadka

Lockdown and the surge in domestic violence, Suvexa Pradhan Tuladha

Your research is mainly on the spread of tuberculosis in Brazil’s jails. But what is your view on the probable immune-enhancing property of the BCG vaccine?

I work primarily on tuberculosis, anti-microbial resistance in tuberculosis and in other bacterial pathogens. 

BCG vaccination is one of the most widely used vaccines in the world. Although role of BCG in preventing TB has been heavily debated over the decades, BCG vaccination is thought to prevent against severe forms of childhood TB. BCG induces a potent immune response (in fact reasons why it is also used for Bladder Cancer therapy). Previous studies have shown that BCG vaccination of infants reduces all-cause mortality, and a considerable amount of infant mortality is due to respiratory and enteric viral infections. Therefore, it is plausible that BCG may induce protective immune response against viral respiratory pathogens such as SARS-CoV2. If this is the case, we do not know the extent or how long this protective immune response would last. My guess is that it will be short term - which would be great at, for example, protecting health care workers. We would need a properly controlled clinical trials for example randomised clinical trials, to demonstrate benefit of BCG vaccination in protecting against SARS-CoV2 - such a trial is underway.

How did you develop an interest in epidemiology and especially on anti-microbial resistance?

I have always been interested in how things work in the real world. Of course, I quickly learned that the real world is quite complex to understand and certainly too simplistic using just one type of lens. Epidemiology, as a discipline, offered a framework to integrate both macro and micro level processes at play and thus was very attractive.

My interest in TB stems from the history of the disease in society, arts, and science. It is one of the oldest diseases that is really part of our social and historical DNA - virtually everywhere in the world. This is the number one killer (due to an infectious agent) in the world with nearly 4,000 deaths a day. Controlling TB, including in places like Nepal, has been challenging and very humbling. Studying TB is really a study of biology, history and society. This disease has really eluded scientists since its discovery in 1882. There is so much we should know about this disease, but just do not.

In my own research, I consider myself a student of evolution. Evolution, of course, is continual a process that cannot be stopped but is rarely so visible in our day to day. AMR is a case and point for evolution. Its emergence is fascinating from a biologic perspective and the consequences quite devastating from a human health perspective. This interface has drawn me to study AMR in TB as well as other bacterial pathogens.

Any comments on the way Nepal has been handling the pandemic so far?

I do not think I know enough to answer this question fairly. It is surprising that there are such few confirmed cases ... likely a consequence of testing.