Investigating SARS-CoV-2 transmission dynamics in jails to address the COVID-19 public health emergency

摘要 在整个SARS-CoV-2大流行期间，监狱和监狱中都发生了感染的爆炸性传播。 监狱、监狱和周围社区之间的感染溢出是由高流失率推动的 被监禁的人口和惩教人员每天在设施和社区之间骑车。未能控制 惩教场所的传播导致严重的新冠肺炎发病率和死亡率 造成持续的种族健康差距。尽管出现了新的证据表明， 从监狱和监狱引起的SARS-CoV-2感染，很少有研究考察在监狱中的传播动力学 矫正环境或评估干预措施，以降低新冠肺炎的发病率和死亡率。的目标是 这项指导研究科学家发展奖(K01)是为了使Levintow博士在以下方面获得基本培训 刑事司法研究和传染病建模，以调查推动 SARS-CoV-2传播和预防新冠肺炎发病率和死亡率的超前干预努力， 关注北卡罗来纳州(NC)的监狱。具体地说，K01奖将提供关于 在这方面的刑事司法系统和传染病(培训目标1)， 传染病动力学的数学建模(培训目标2)，以及系统级联系的新技能 流行病学结果的政策和干预措施(培训目标3)。利用这次培训，莱文托博士 将在刑事司法系统中应用有关传染病的新专门知识，以评估 根据监狱特征预测NC监狱的人口流动、新冠肺炎测试和新冠肺炎案件 (研究目标1)。在开发、校准和分析数学的强化培训的指导下 模型，Levintow博士将估计北卡罗来纳州监狱中SARS-CoV-2的发病率和相应的过度感染 相对于周围社区(研究目标2)。具有现有和建议的新知识 监狱干预--再加上严格评估其效果的新技能--莱文托博士将评估 这些干预措施对新冠肺炎发病率和死亡率的影响(研究目标3)。研究结果将为 优先采取干预措施，对北卡罗来纳州监狱中的高度脆弱人群及其 全州各地的周边社区。这项研究将受益于世界银行的机构资源 位于教堂山的北卡罗来纳大学，将由一个由领先专家组成的指导团队进行指导， 在刑事司法系统中检查传染病和进行建模的丰富经验 为感染传播的干预措施提供信息的分析。这一K01奖项将提供所需的培训 完成提议的研究和必要的支持，以启动Levintow博士作为 传染病流行病学家，为扩大到国家一级的R01级研究奠定基础 以及其他有可能在监狱和监狱中爆发的传染病。

ABSTRACT Throughout the SARS-CoV-2 pandemic, explosive transmission of infection has occurred in jails and prisons. The spillover of infection between jails, prisons, and surrounding communities is fueled by high churn of the incarcerated population and daily cycling of correctional staff between facility and community. Failure to control transmission in correctional settings has resulted in significant COVID-19 morbidity and mortality and contributed to continuing racial health disparities. Despite emerging evidence of disproportionate spread of SARS-CoV-2 infection arising from jails and prisons, few studies have examined transmission dynamics in correctional settings or evaluated interventions to reduce COVID-19 morbidity and mortality. The objective of this Mentored Research Scientist Development Award (K01) is to equip Dr. Levintow with essential training in criminal justice research and infectious disease modeling to investigate the dynamic processes that drive SARS-CoV-2 transmission and advance intervention efforts to prevent COVID-19 morbidity and mortality, focusing on jails in North Carolina (NC). Specifically, a K01 award will provide substantive knowledge of the criminal justice system and infectious diseases in that context (Training Aim 1), methodological expertise in mathematical modeling of infectious disease dynamics (Training Aim 2), and new skills in linking system-level policy and interventions to epidemiological outcomes (Training Aim 3). Leveraging this training, Dr. Levintow will apply new expertise about infectious diseases in the criminal justice system to assess the extent to which population movement, COVID-19 testing, and COVID-19 cases in NC jails are predicted by jail characteristics (Research Aim 1). Guided by intensive training in the development, calibration, and analysis of mathematical models, Dr. Levintow will estimate SARS-CoV-2 incidence in NC jails and corresponding excess infection relative to surrounding communities (Research Aim 2). With new knowledge of existing and proposed interventions in jails – coupled with new skills to rigorously assess their effects – Dr. Levintow will evaluate the impact of those interventions on COVID-19 morbidity and mortality (Research Aim 3). Study findings will inform prioritization of interventions with greatest impact for the highly vulnerable populations in NC jails and their surrounding communities across the state. This study will benefit from the institutional resources of the University of North Carolina at Chapel Hill and will be guided by a mentoring team of leading experts with extensive experience examining infectious disease in the criminal justice system and conducting modeling analyses to inform interventions on spread of infection. This K01 award will provide both the training needed to accomplish the proposed research and the support necessary to launch Dr. Levintow's independence as an infectious disease epidemiologist, laying the groundwork for R01-level research expanded to the national level and to other infectious diseases with potential for explosive outbreaks in jails and prisons.