MAb for symptomatic COVID-19 in correctional facilities: an important opportunity
Authors: Justin Berk, Lauren Brinkley-Rubinstein, Matthew Murphy, Phil Chan, Josiah Rich
Journal: The Lancet (2021)

Jails and prisons across the USA are at the epicentre of the COVID-19 pandemic. Most of the largest, single-site cluster outbreaks of COVID-19 in the country have occurred in jails and prisons.1Macmadu A Berk J Kaplowitz E Mercedes M Rich JD Brinkley-Rubinstein L COVID-19 and mass incarceration: a call for urgent action.Lancet Public Health. 2020; 5: e571-e572Summary Full Text Full Text PDF PubMed Scopus (30) Google Scholar Much attention has focused on the need for testing, masks, and robust access to vaccination; however, calls to increase access to treatment are largely absent. In November, 2020, the US Food and Drug Administration (FDA) authorised the use of monoclonal antibodies (mAbs) for the treatment of mild to moderate COVID-19 because these treatments prevent progression to severe disease and considerably reduce hospitalisations and emergency room visits.2US Food and Drug AdministrationCoronavirus (COVID-19) update: FDA authorizes monoclonal antibodies for treatment of COVID-19.https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-monoclonal-antibodies-treatment-covid-19Date: Nov 21, 2020Date accessed: January 27, 2021Google Scholar However, uptake of these treatments has been slow, including in the correctional setting. In response to the COVID-19 pandemic, as well as implementing widespread surveillance testing of residents and staff, universal mask wearing, small group cohorting, and vaccination of detained individuals at high risk, the Rhode Island Department of Corrections (RI, USA) administered an anti-SARS-CoV-2 mAb approved by the FDA and Emergency Use Authorization to a symptomatic, incarcerated person with COVID-19 on Jan 22, 2021, for the first time. The individual met criteria on the basis of timing of symptoms, age, and presence of comorbidities. There were no complications, and the individual did not require hospitalisation. To our knowledge, mAbs have been sparsely used in correctional settings across the USA. This treatment, and any other approved treatment that has the potential to reduce serious disease and death from COVID-19, should be made widely available to individuals who are incarcerated or detained and meet eligibility criteria. Incarcerated individuals are at high risk of infection and death from COVID-193Saloner B Parish K Ward JA Dilaura G Dolovich S COVID-19 cases and deaths in federal and state prisons.JAMA. 2020; 324: 602-603Crossref PubMed Scopus (250) Google Scholar and are often overlooked in this pandemic. However, they can have a major role in statewide outbreaks.4Reinhart E Chen DL Incarceration and its disseminations: COVID-19 pandemic lessons from Chicago's Cook County Jail.Health Aff (Millwood). 2020; 39: 1412-1418Crossref PubMed Scopus (119) Google Scholar MAb treatments not only benefit individuals at high risk of disease but can also decrease the burden on over-run community medical centres and hospitals. In the current environment, where implementation of mAbs has proven challenging and many doses of medication go unused nationally,5McGinley L Monoclonal antibodies: overburdened hospitals are not offering this treatment against COVID-19.https://www.washingtonpost.com/health/2020/12/31/covid-monoclonal-antibodies-unused/Date: Dec 31, 2020Date accessed: January 27, 2021Google Scholar correctional facilities offer the unique opportunity to efficiently identify and administer this evidence-based intervention. Health departments, hospital systems, policy makers, and correctional administrations should collaborate to ensure access to evidence-based treatments, such as mAb therapy, as quickly as possible. In this way, society can not only treat a marginalised population at high risk but also efficiently decrease community burden on the local health-care infrastructure. JB reports being the Medical Director for the Rhode Island Department of Corrections. All other authors declare no competing interests.