Congregate living in the time of COVID-19

Ohio recently emerged as having, at least for a moment in time, the largest outbreak of COVID-19 in the country. The outbreak occurred in the Marion Correctional Institution in which 80 percent of inmates have tested positive. Many of them are asymptomatic. Marion is not the only correctional facility with an outbreak, at the time of this writing, Pickaway Correctional Institution reported eight deaths due to COVID-19. Along with tracking cases and deaths among the general public, the Ohio Department of Health COVID-19 Dashboard includes reports from multiple types of congregate living facilities including juvenile correctional facilities, rehabilitation and correctional facilities, psychiatric hospitals, state development centers and long-term care facilities. While the numbers can feel overwhelming, it is not altogether surprising to see outbreaks in these types of facilities. Congregate living facilities, including prisons, are particularly susceptible to the way the virus spreads.

As described in the Centers for Disease Control and Prevention (CDC) COVID-19 FAQ, the virus spreads when people are in close contact:

The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).

COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in many affected geographic areas. Community spread means people have been infected with the virus in an area, including some who are not sure how or where they became infected.”

When living in close quarters with many other people and with staff who travel between individual rooms to provide services, medication or nutrition, opportunities for the virus to be carried from person to person abound. Fortunately, governing bodies have provided guidance and checklists for multiple types of congregate living quarters including nursing homes, assisted-living facilities, correctional facilities, institutions of higher education, military barracks, homeless shelters and group homes. It is believed that following these guidelines can reduce or delay the spread of the virus and should be rigorously followed and enforced by facility administrators. Still, due the nature of the virus and the realities of congregate living, we should expect to see high rates of infection within all types of congregate facilities and be prepared to respond through high rates of testing and quick access to medical treatment.

In a recent press briefing, Governor Mike Dewine and Dr. Amy Acton, the health director for the Ohio Department of Health, explained that the state is following the CDC protocol for testing. When a case is identified in congregate living facility, additional testing is done within the facility to determine the extent of the spread of the virus. Director Acton shared ODH’s prioritization of testing. The top priority group includes individuals with symptoms who are hospitalized or those who are health care workers. The second priority group includes those with and without symptoms who work or live in a congregate living facility. Dewine has also indicated that such facilities are being asked to develop relationships with local hospitals to have partnerships in place when cases surge within a facility.

The first step to prepare for large outbreaks in congregate living facilities is to identify how many people could be impacted.

The first step to prepare for large outbreaks in congregate living facilities is to identify how many people could be impacted. To get a sense for how many Ohioans live within congregate living facilities, we can look at data from the U.S. Census Bureau provided by the American Community Survey (ACS) on group quarters. The ACS distinguishes between institutionalized and non-institutionalized group quarters. The Census’ website describes institutional group quarters as correctional facilities, nursing homes or mental hospitals and non-Institutional group quarters as college dormitories, military barracks, group homes, missions or shelters. The tables below include estimates of the those living in group settings by age group. In addition to these groups of individuals, staff at each of these facilities would also be at risk of contracting the virus during an outbreak.

Cornell University has an expanded explanation of the ACS definitions which are included above each table.

Non-institutional group quarters
Includes facilities that are not classified as institutional group quarters; such as college/university housing, group homes intended for adults, residential treatment facilities for adults, workers’ group living quarters and Job Corps centers and religious group quarters.

Ohio Noninstitutionalized Group Quarters Population:
Age Group College/University
Student Housing
Other Total
Under 15 years601601
15 to 17 years6805351,215
18 to 24 years112,8614,431117,292
25 to 34 years1,2905,3126,602
35 to 44 years1045,3135,417
45 to 54 years36,0086,011
55 to 64 years36,6046,607
65 to 74 years02,7592,759
75 to 84 years1,6141,614
85 years and older1,3421,342
Source: 2018 ACS 5-Year Estimates

Institutionalized group quarters

Includes facilities for people under formally authorized, supervised care or custody at the time of enumeration. Generally, restricted to the institution, under the care or supervision of trained staff, and classified as “patients” or “inmates.” Includes: correctional, nursing, and in-patient hospice facilities, psychiatric hospitals, juvenile group homes and residential treatment centers.

Ohio Institutionalized Group Quarters Population:
Age GroupAdult Correctional FacilitiesSkilled Nursing FacilitiesOtherTotal
Under 15 yearts993993
15 to 17 years672,5612,628
18 to 24 years10,8761891,03412,099
25 to 34 years26,39670026727,363
35 to 44 years19,2591,35524420,858
45 to 54 years12,0123,99239916,403
55 to 64 years5,4409,83023115,501
65 to 74 years1,25014,4255715,732
75 to 84 years33621,736022,072
85 years and over5030,936030,986
Source: 2018 ACS 5-Year Estimates