Specific admission nursing consultation for SARS-CoV-2 in prison units: prevalence and associated factorsABSTRACT:
Objective: To estimate the prevalence and factors associated with the performance of specific admission nursing consultations for SARS-CoV-2 in individuals deprived of liberty with COVID-19 in prison units in Central Brazil.
Method: Analytical cross-sectional study conducted between May and September 2020 through individual interviews and lateral flow immunochromatography tests to detect IgM/IgG antibodies for SARS-CoV-2. The analysis was performed using the Chi-square or Fischer’s exact tests, with the outcome being the specific admission nursing consultation for SARS-CoV-2.
Results: Among the 1,272 individuals investigated, 21.3% (95% CI: 19.1-23.6) tested positive for antibodies against SARS-CoV-2. Of these, 10.3% (95% CI: 7.0-14.6) underwent a specific nursing consultation for SARS-CoV-2. The most prevalent signs and symptoms were loss of taste (33.2%) and smell (32.8%), body aches (28.8%), and fever (28.4%). The analysis indicated associations between contact with symptomatic COVID-19 case (p=0.039), contact in the yard with a prisoner with COVID-19 (p=0.012), and sore throat (p=0.010), with the outcome.
Conclusions: The low prevalence of specific nursing consultations for SARS-CoV-2 and the high prevalence of COVID-19 reinforce the need for mandatory implementation of this strategy in groups living in closed environments. Furthermore, nursing consultations based on the nursing process must be adopted as a public health measure.
Descriptors:
Nursing; Office Nursing; SARS-CoV-2; Prisoners
RESUMO:
Objetivo: Estimar a prevalência e fatores associados à realização da consulta de enfermagem admissional específica para o SARS-CoV-2 em indivíduos privados de liberdade com COVID-19 em unidades prisionais do Brasil Central.
Método: Estudo transversal analítico conduzido entre maio a setembro de 2020 por meio de entrevistas individuais e testes de imunocromatografia de fluxo lateral para detecção de anticorpos IgM/IgG para SARS-CoV-2. A análise foi realizada por meio dos testes Qui-quadrado ou Exato de Fischer, sendo considerado desfecho a consulta de enfermagem admissional específica para oSARS-CoV-2.
Resultados: Entre os 1.272 investigados, 21,3%; (IC 95%: 19,1-23,6) testaram reagentes para anticorpos contra o SARS-CoV-2. Destes, 10,3% (IC 95%: 7,0-14,6) realizaram a consulta de enfermagem específica para SARS-CoV-2. Os sinais e sintomas mais prevalentes foram diminuição do paladar (33,2%) e do olfato (32,8%), dores no corpo (28,8%) e febre (28,4%).A análise apontou associações entre contato com caso sintomático para COVID-19 (p=0,039), contato no pátio com preso com COVID-19 (p=0,012) e dor de garganta (p=0,010), com o desfecho.
Conclusões: A baixa prevalência de consulta de enfermagem específica para o SARS-CoV-2 e a alta prevalência de COVID-19 reforçam a necessidade de implementação obrigatória dessa estratégia em grupos que vivem em ambientes fechados. Ademais, a consulta de enfermagem baseada no processo de enfermagem deve ser adotada como medida de saúde pública.
Descritores:
Enfermagem; Consulta de enfermagem; SARS-CoV-2; Prisioneiros
RESUMEN:
Objetivo: Estimar la prevalencia y los factores asociados a la realización de una consulta de enfermería de ingreso específica para SARS-CoV-2 en personas privadas de libertad con COVID-19 en unidades penitenciarias del Centro de Brasil.
Método: Estudio analítico transversal realizado entre mayo y septiembre de 2020 mediante entrevistas individuales y pruebas de inmunocromatografía de flujo lateral para detección de anticuerpos IgM/IgG contra SARS-CoV-2. El análisis se realizó mediante las pruebas de Chi-cuadrado o exacta de Fischer, considerando como resultado la consulta de enfermería específica de ingreso por SARS-CoV-2.
Resultados: Entre los 1.272 investigados, el 21,3%; (IC del 95%: 19,1-23,6) probaron reactivos para detectar anticuerpos contra el SARS-CoV-2. De ellos, el 10,3% (IC 95%: 7,0-14,6) realizó alguna consulta de enfermería específica por SARS-CoV-2. Los signos y síntomas más prevalentes fueron disminución del gusto (33,2%) y del olfato (32,8%), dolores corporales (28,8%) y fiebre (28,4%). El análisis mostró asociaciones entre el contacto con un caso sintomático de COVID-19 (p=0,039), el contacto en el patio con un preso con COVID-19 (p=0,012) y el dolor de garganta (p=0,010) con el desenlace.
Conclusiones: La baja prevalencia de consultas específicas de enfermería por SARS-CoV-2 y la alta prevalencia de COVID-19 refuerzan la necesidad de la implementación obligatoria de esta estrategia en grupos que viven en ambientes cerrados. Además, se debe adoptar como medida de salud pública la consulta de enfermería basada en el proceso de enfermería.
Descriptores:
Enfermería; Enfermería de Consulta; SARS-CoV-2; Prisioneros
INTRODUCTION
In January 2020, the new coronavirus (SARS-CoV-2) was identified by the International Committee on Taxonomy of Viruses (ICTV) as the causative agent of COVID-191-3, a disease with a wide spectrum of clinical manifestations4-7.After four years of research into this new etiological agent, there is extensive evidence that about 30% of those infected are asymptomatic, although they can transmit the virus7.The virus is spread through the air5,7, o which makes individuals living in closed environments vulnerable to infection8,9.
Globally, prisons, due to overcrowding and unsanitary and unhygienic architectural conditions, represent a favorable scenario for the spread of respiratory infectious diseases8,9, and, therefore, epicenters for SARS-CoV-2 infection10-16. Considering the conditions of imprisonment at a national level, the situation is similar, since Brazilian prisons have a capacity up to 10 times higher than established standards17.
Given the magnitude of the vulnerability of the Persons Deprived of Liberty (PDL), associated with the risk of transmission among workers in prison units and the surrounding community, several measures to prevent and control the spread of SARS-CoV-2 have been announced by government agencies worldwide18. In the same perspective, Brazil has reinforced preventive measures, especially through the National Justice Council19.These recommendations are similar to those for the general population, namely, individual protection measures (hand hygiene, respiratory etiquette, use of masks, etc.), environmental measures (ventilation, cleaning and disinfection procedures), physical distancing measures (especially for those at risk of exposure), access restrictions (lockdown), and movement limitations (social isolation)10,12-15.
Currently, in the penitentiary environment, individual, environmental and community prevention strategies have not proven to be effective and, therefore, still represent a significant challenge for global public health13,16,20,21. Thus, nursing consultations upon admission to prison units have been consolidated as the main strategy for cope with the pandemic and other respiratory diseases, since they provide continuity of care. A specific admission nursing consultation for SARS-CoV-2 is considered to be the clinical and epidemiological nursing assessment within the first 12 hours of admission to the prison unit with testing for IgM/IgG antibodies against SARS-CoV-2, which being a responsibility of the nurse, including legal support22-24.
Several authors point out that in the pandemic scenario, nursing care, with the use of the nursing process, significantly contributed to strengthening practices to combat viral spread in various environments, such as penitentiaries23,24.However, globally, the shortage of health professionals, particularly nurses, the absence of care protocols, and the structural, architectural and living conditions of prison units, as well as inequities in access and financial investments in health, contributed to the weakening of nursing consultations, impacting the high rates of morbidity and mortality from COVID-19 among inmates and prison system workers25.
There is a scarcity of studies on nursing consultations in the pandemic scenario in prison units, and the existing ones are methodological reports of experiences and case studies26,27.That said, the researchers have raised the question: What is the prevalence and factors associated with performing specific admission nursing consultations for SARS-CoV-2 in PDL with COVID-19?
It is believed that this study is innovative in expanding knowledge, as it seeks to understand a strategy that contributes to breaking the chain of introduction and dissemination of highly transmissible pathogens in incarceration environments, with subsequent systematic health care. It is expected to offer new perspectives and significant contributions to public health nursing practice, potentially used in prioritizing preventive strategies, evaluating public policies, and allocating human and financial resources for common epidemics in prison environment, such as tuberculosis and influenza, and for future pandemics.
In view of the above, the objective was to estimate the prevalence and factors associated with the implementation specific admission nursing consultations for SARS-CoV-2 in individuals deprived of liberty with COVID-19 in prison units in Central Brazil.
METHOD
This is a cross-sectional analytical study within a part of a larger study entitled “Epidemiological and clinical screening of SARS-CoV-2 infection in individuals deprived of liberty and workers in Central Brazil”. The study was conducted from May 10 to September 14, 2020, in the largest prison complex in the Central-West region of Brazil. Located in the rural area of the metropolitan region of the capital, it houses 5,267 individuals deprived of liberty, either provisionally or definitively, across seven prison units.
The sample for the larger study was calculated considering a prevalence of COVID-19 among PDL of 31.64% (95% CI: 28.44-34.83)21, an acceptable absolute margin of error for the prevalence of the disease of 5%, and a 95% confidence interval. Furthermore, 10% was added for losses and refusals, totaling 1,272 individuals. The following inclusion criteria were considered for data collection: being incarcerated in one of the prison units for more than six months, being over 18 years old, and testing positive for SARS-CoV-2. The exclusion criteria were: being visibly under the influence of alcohol and/or other drugs that compromise cognition; having severe hearing loss and/or speech impairment that made it difficult or impossible to conduct the interview and data collection, and also having a psychiatric illness that hindered the interview and data collection. This information was obtained with the support of the nurse responsible for the prison health unit through analysis of the PDL registration form at the Basic Health Unit.
The outcome variable was the specific admission nursing consultation for SARS-CoV-2 characterized by clinical and epidemiological evaluation in the first 12 hours of admission to the prison unit with testing for IgM/IgG antibodies against SARS-CoV-222.Predictor variables included sociodemographic characteristics (sex, age, education level, place of birth, religion, self-declared race/color, monthly income and marital status); clinical data (fever, chest pain, difficulty breathing, cough, sore throat, nausea/vomiting, loss of taste or smell, abdominal pain, myalgia, headache and diarrhea) and environmental data (contact time, in the yard, with the lawyer, with the family).
Before data collection, a pilot test was conducted with 20 individuals deprived of liberty to plan the operational stages of the study, establish biosafety measures in the pandemic context and adjust the data collection instrument. It is worth noting that these subjects were not part of the final sample of the study.
After meetings with the team of prison officers and healthcare professionals, the research subjects were randomly selected to move to the entrance door of their cell. At this time, the study objectives, risks and benefits of participating were read to the participants, and those who agreed signed the informed consent form. They were then sent to a private location, away from the prison officers to minimize response bias and discomfort, where a clinical evaluation was performed by the research nurses. In addition, an in-person interview was conducted using an instrument containing questions with sociodemographic variables (sex, age, education level, nationality, religion, self-declared race/color, monthly income and marital status); clinical (fever, chest pain, difficulty breathing, cough, sore throat, nausea/vomiting, loss of taste or smell, abdominal pain, myalgia, headache and diarrhea) and environmental (contact time, in the yard, with the lawyer, with the family).
Regardless of whether they were symptomatic or not, 10 ml of blood was collected from all 1,272 individuals deprived of liberty, using disposable syringes and needles. The blood obtained was stored in test tubes identified with the initials of the name and the identification code (ID) of the participant according to the number of the data collection instrument. The tubes with the blood were placed in thermal boxes and transported to the Multiuser Laboratory of Clinical Processing and Analysis of the Universidade Federal de Goiás, where they were centrifuged, and the serum was stored in aliquots.
Subsequently, laboratory tests were performed on all samples to detect IgM/IgG antibodies against SARS-CoV-2, using the lateral flow immunochromatographic test, according to the manufacturer's instructions. Although the tests could have been performed with whole blood, serum was chosen to enhance the sensitivity and specificity of detection5.
All results were sent to the health administration of the Goiás prison system, and subsequently, the research assistants carried out the notification through e-SUS (an online tool for recording notification of mild flu-like cases, suspected and confirmed cases of the new Coronavirus - COVID-19 in Brazil). Participants who presented a reactive result were sent to specific isolation areas and received care from the health teams of the prison units.
All data were entered, processed and analyzed using the SPSS program version 20.0 (SPSS Inc., Chicago, USA). Statistical analysis was performed with the description of the categorical variables, using absolute and relative frequencies. The prevalence of admission nursing consultation specific for SARS-CoV-2 infection was calculated with a 95% confidence interval (95% CI). The Kolmogorov-Smirnov test was used to verify whether the variables followed a normal distribution. Bivariate analysis was performed using the nonparametric chi-square test (x2) and Fisher's exact test to analyze the possible association between the predictor variables and the performance of the specific admission nursing consultation for SARS-CoV-2, considering a significance level of 5%.
Regarding ethical aspects, this research was approved by the Research Ethics Committee of the Universidade Federal de Goiás - Opinion No. 2,500,582. All research assistants, undergraduate or graduate nursing students, were duly qualified to perform COVID-19 tests and had previous experience in studies with PDL. Furthermore, throughout the process of data collection, processing, and laboratory analysis, biosafety, patient safety, and environmental cleaning measures were respected, as well as the guidelines to cope with the spread of SARS-CoV-28.
RESULTS
After applying the eligibility criteria, 1,272 participants responded to the data collection instrument and were tested for IgM/IgG antibodies against SARS-CoV-2. Of the total, 271 individuals deprived of liberty were reactive, resulting in a prevalence of COVID-19 of 21.3% (95% CI: 19.1-23.6). Of these, 10.3% (95% CI: 7.15%-12.2) underwent a specific admission nursing consultation for SARS-CoV-2, as observed in Figure 1.
Box-plot distribution of SARS-CoV-2 infection (2) and specific admission nursing consultation for SARS-CoV-2.Goiânia, Goiás, Brazil, 2020.
Table 1 presents the sociodemographic characteristics of 271 individuals deprived of liberty who tested positive for SARS-CoV-2 and categorized as those who underwent and those who did not undergo nursing consultation. Most participants were ≤ 29 years old (52.0%), had a monthly income in BRL ≤ 100 (68.2%), self-declared brown/dark skin color or race (66.0%), and were single (55.7%). There was no statistical association between undergoing a specific nursing consultation for SARS-CoV-2 and sociodemographic characteristics in this study (Table 1).
Considering the 271 individuals who tested positive for SARS-CoV-2, it was observed that 35.6% had some type of contact with another symptomatic inmate for COVID-19 within the prison unit. Analyzing this data, compared to the total number of individuals who underwent nursing consultation, the highest frequency of contact was among individuals who underwent nursing consultation (p=0.039). We can also highlight that the most frequent type of contact was contact with PDL in the prison unit yard (5.5%), when compared to those who underwent the specific admission nursing consultation for SARS-CoV-2 (4.0%) (p=0.012) (Table 2).
Table 3 shows the signs and symptoms presented by the PDL participating in the study, and categorized into those who underwent and those who did not undergo a specific admission nursing consultation for SARS-CoV-2. The most frequent clinical manifestations were loss of taste (33.2%) and smell (32.8%), body aches (28.8%) and fever (28.4%). Only sore throat was reported more by those who had a nursing consultation upon admission to the prison than by those who did not (p=0.010).
DISCUSSION
Prevention and control measures for SARS-CoV-2 infection in penitentiary environments have been the subject of extensive debate in both national21,27and international17-25,28-30literature since the beginning of the pandemic, especially nursing consultation with serological screening upon admission of PDL to prison units. That said, our findings provide important scientific evidence and lessons for nursing to face future outbreaks of respiratory diseases.
SARS-CoV-2 was detected in 271 participants, resulting in a prevalence of 21.3% (95% CI: 19.1-23.7). According to information from the National Penitentiary Department, in 2020, the period in which this investigation was conducted, 41,971 cases of COVID-19 were recorded in this population. This means that the prevalence of COVID-19 in the Brazilian prison population at that time was 5.98% (95% CI: 5.73-6.23)25, that is, much lower than that estimated in this study. Considering that Brazilian prisons have the same structural and architectural deficiencies, this higher estimated prevalence of SARS-CoV-2 compared to the national rate of the Brazilian prison population may be related to the low coverage of specific admission nursing consultations, and demonstrates the need for investments in this low-cost, easy-to-implement strategy that does not require advanced technologies and provides continuity of care21,22,27.
Although the National Policy for Comprehensive Health Care for Persons Deprived of Liberty (Política Nacional de Atenção Integral à Saúde das Pessoas Privadas de Liberdade - PNAISP) is based on the principles of comprehensiveness and intersectorality, effectively guaranteeing the constitutional right to health of PDL is still a significant challenge. Thus, discussions are necessary about strategies that contribute to the implementation of the PNAISP, with admission nursing consultations being a successful experience in controlling the high rates of disease in this group16,22.
It was found that among individuals deprived of liberty infected with SARS-CoV-2, 10.3% (95% CI: 7.0-14.6) underwent a specific nursing consultation upon admission. This rate is extremely low, worrying and indicative of the failure by prison system managers, as several authors demonstrate that the lack of prioritization of nursing consultation and subsequent interventions in a timely manner can substantially impact the increase in viral spread rates in prisons and the quality of services provided17,25,29-30. It is possible to report that the prevalence of specific admission nursing consultation and the prevalence of SARS-CoV-2 infection were inversely proportional in the units investigated, evidencing that the diagnosis of COVID-19 was made without clinical criteria and care plans, and not by a trained professional capable of planning and evaluating interventions that meet the human needs of the affected PDL. It is worth emphasizing that the nursing team represents the largest workforce in prisons, and nurses are the professionals with the largest number of consultations23.
In this sense, it is necessary to develop health technologies and standardize nursing consultation through the nursing process, enabling the direction of care and improvements in the quality of care and comprehensiveness of care23,24. Nursing consultations specifically for individuals deprived of liberty upon admission have proven to be the most effective measure, as they provide early diagnosis and interruption of the chain of viral transmission, as well as clinical management of symptomatic cases, and even complications and deaths21,23,24,28,30.Nursing consultations have an impact on the health of PDL and on all workers in the penitentiary system and the community surrounding prison units. Moreover, they support nurses in the nursing process and, consequently, in making more assertive interventions22-24.
Therefore, it is essential that nurses acquire competencies to implement the nursing process in a deliberate and systematic manner, in every socio-environmental context in which nursing care occurs, Furthermore, there should be ongoing education policies for nurses working in high-risk and unsanitary environments, such as prisons16,22.
It is believed that specific nursing admission consultation with serological testing, clinical and epidemiological evaluation, along with early detection and isolation can delay the transmission of SARS-CoV-2 in detention units17,29,30).Additionally, as overcrowding, lack of ventilation and poor hygiene are unfortunately a characteristic of the penitentiary system, the consultation carried out by the nurse has the potential to minimize the impacts of isolation of positive cases, in particular overcrowding and health inequities17,25-27.
Moreover, the lack of nursing consultation with SARS-CoV-2 detection may lead to underreporting of cases, as well as underestimating the true magnitude of the disease within the prison system, impacting the distribution of resources for prophylactic measures, hiring of nurses, and care for infected individuals. In this context, a meta-analysis showed that approximately 30% of those infected with SARS-CoV-2 are asymptomatic, but they maintained a transmissibility of 75% compared to symptomatic individual17. These data are relevant for understanding the dynamics of virus transmission, and reinforce the importance of nursing consultations, regardless of whether they are symptomatic with respiratory symptoms, and of contact tracing for early identification of potential transmitters.
Despite the aforementioned evidence, the global prison system has not received adequate public attention during the pandemic. Many human rights organizations, including the International Human Rights Commission19, have been installed as authorities to adopt measures to protect the rights and health of PDL. However, there were also deficiencies in the scope of effective implementation, and it is important to highlight the broader and systematic approach of the actions to be taken to improve the architectural conditions and healthcare network of prisons in Brazil and worldwide. During this period of international public health emergency, there was no increase in the number of nursing staff, which hindered nursing consultations and, in turn, the monitoring of infected PDL and their contacts, as well as care for other diseases.
It is hoped that the evidence presented here can be used to strengthen the argument with prison health managers about the need for trained nurses to face the challenges related to the transmission of respiratory viruses in prison facilities and serve as a reference for future analyses and the development of nursing care protocols.
Regarding sociodemographic characteristics, the predominance of young individuals, with low monthly income, mixed-race and single, corroborates national15,18,21and international studies17,20,29,30, reaffirming a profile of economic and racial exclusion. Although all publications demonstrate that age is considered an important risk factor for severe forms of COVID-19 and, therefore, a priority population for preventive measures, there was no significant relevance among the age group of the individuals investigated who underwent a specific admission nursing consultation for SARS-CoV-2. This finding represents a public health problem since it contradicts all policies to combat the pandemic, since age is a predictor of vulnerability to infection by the new coronavirus. It is worth noting that other risk behaviors for the severe form of COVID-19, such as smoking, use of other legal and illegal drugs, and chronic non-communicable diseases, are prevalent among PDL17.
Regarding contact with suspected and/or confirmed cases of COVID-19 in the prison unit, the data show that 35.6% had some type of contact, with a frequency of 50% in individuals who underwent a nursing consultation (p=0.039), corroborating the effectiveness of nursing in the care for PDL. This information reinforces once again how essential it is to have a nurse who carries out routine consultations when people enter the prison system, and that this is articulated with the National Policy for Comprehensive Health Care for Persons Deprived of Liberty.
Having contact with another individual deprived of liberty suspected and/or confirmed to have COVID-19 in the prison block yard was statistically significant in providing a specific nursing consultation for SARS-CoV-2 (p=0.012), possibly related to greater proximity to health professionals and local leaders. Studies indicate that individuals who circulate in prison units have greater interaction with the prison population, increasing the chances of having their health demands addressed26-27. Socialization areas are also common for establishing connections and greater access to health education among PDL21,26, enabling awareness of nursing consultations. Although it is not the focus of the study, during the observations that were noted in the field diary, the PDL desire to be seen by a nurse upon admission to prison units was unanimous.
The signs and symptoms of COVID-19 observed were similar to those mentioned by the major government health institutions13,14,21,the general population and other global studies with the prison population19,25,30, with the most frequent being: loss of taste (33.2%), loss of smell (32.8%), body aches or myalgia (28.8%), temperature ≥ 37.8C (28.4%) and dyspnea (22.1%). However, none of them showed significant relevance with the specific admission nursing consultation for SARS-CoV-2, most likely because it is a nonspecific symptomatology and common in other acute respiratory syndromes with high incidence in prison units, such as tuberculosis, influenza, and complications due to drug use, humidity and poor ventilation in cells. In this context, it is imperative that prison health services use diagnostic and clinical management protocols for respiratory diseases to minimize the spread of pathogens and clinical complications.
Only sore throat showed statistical significance (p=0.010) with specific nursing admission consultation for SARS-CoV-2 (p=0.010), which corroborates the interaction between respiratory pathogens, since sore throat is not a classic symptom of tuberculosis and influenza. Although it is not possible to compare it at a statistical level with the scientific literature due to the lack of studies, authors have already demonstrated that sore throat is a very frequent symptom in viral infections7,27, indicating that the nursing consultation conducted in this study, though preliminary, was quite timely. It is believed that if there were a higher prevalence of consultations, nurses could direct their interventions to alleviate COVID-19 symptoms, establish care flows, and protocols for long-term COVID follow-up.
The study has some limitations. The prevalence of specific nursing consultation for SARS-CoV-2 was low, most likely due to the low number of nurses, and the data are self-reported, subject to memory bias and underestimation. Furthermore, the pandemic context may have influenced the PDL responses.
On the other hand, this research is relevant at the public health level, since it was the first study to relate specific nursing admission consultation and COVID-19 in PDL using primary data. In addition, it showed the occurrence rates of this infection, as well as the opportunity and relevance of the effective implementation of nursing consultation in the investigated group, highlighting the potential associated factors. Such findings, in addition to exposing vulnerabilities, may contribute to improving nursing care, creating follow-up flows and planning preventive measures for this and other infectious diseases with similar transmission.
CONCLUSION
The estimated prevalence of specific nursing admission consultations for SARS-CoV-2 among incarcerated individuals was low at 10.3% (95% CI: 7.0-14.06), ratifying the inadequacy of public authorities to manage the COVID-19 pandemic in prison units and a weakness for continuous and effectivenursing care.
On the other hand, a high prevalence of SARS-CoV-2 infection at 21.3% (95% CI: 19.1-23.6) was estimated among the participants, demonstrating, therefore, that preventive actions are crucial to reduce viral dissemination, both among the PDL and the population involved in prisons environments. It is essential to emphasize the importance of nurses using standardized language in nursing consultations to promote better monitoring of PDL in care practice, being able to provide greater coverage for health promotion and prevention services, fostering changes and improving the quality of interventions.
Given these findings, the magnitude of the COVID-19 pandemic within prison walls becomes evident and reinforces the importance of improving health care for PDL. It is also recommended that nursing consultations be emphatically included in the protocols for actions to cope with COVID-19 and other infectious diseases for all those who access and circulate through the units and services that are part of the deprivation of liberty facilities, since they may be sources of this and other diseases for the PDL. It is hoped that the discussion on this topic will continue, especially when it proposes to reflect on health in prison units in order to ensure this right to people deprived and restricted of liberty.
Acknowledgments:
Call MCTIC/CNPq/FNDCT/MS/SCTIE/Decit No. 07/2020 - Research to combat COVID-19, its consequences and other severe acute respiratory syndromes.
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