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，监狱和监狱中发生了爆炸性的感染传播。 监狱、监狱和周围社区之间的感染溢出是由监狱、监狱和周围社区的高流动性造成的。 监狱工作人员每天在监狱和社区之间往返。未能控制 惩教环境中的传播导致了显著的COVID-19发病率和死亡率， 造成了种族健康的持续差异。尽管有新的证据表明， SARS-CoV-2感染来自监狱和监狱，很少有研究检查在监狱和监狱中的传播动态。 矫正环境或评估干预措施，以降低COVID-19的发病率和死亡率。的目标 这个指导研究科学家发展奖（K 01）是装备博士莱文托与必要的培训， 刑事司法研究和传染病建模，以调查驱动 SARS-CoV-2传播和预防COVID-19发病率和死亡率的提前干预工作， 关注北卡罗来纳州的监狱。具体而言，K 01奖将提供有关 刑事司法系统和这方面的传染病（培训目标1）， 传染病动力学的数学建模（培训目标2），以及将系统级 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业知识，以评估 根据监狱特征预测NC监狱的人口流动、COVID-19检测和COVID-19病例 （研究目的1）。通过在数学的发展，校准和分析方面的强化培训， Levintow博士将估计NC监狱中SARS-CoV-2的发病率和相应的过度感染 相对于周围的社区（研究目标2）。随着对现有和拟议的 在监狱中的干预措施-再加上新的技能，严格评估其影响-博士莱文托将评估 这些干预措施对COVID-19发病率和死亡率的影响（研究目标3）。研究结果将告知 优先考虑对北卡罗来纳州监狱中的高度弱势群体及其 在全州的周边社区。这项研究将受益于 位于查佩尔山的北卡罗来纳州大学，将由领先专家组成的指导团队提供指导， 在研究刑事司法系统中的传染病和进行建模方面具有丰富的经验 进行分析，为预防感染蔓延的干预措施提供信息。该K 01奖项将提供所需的培训， 完成拟议的研究和必要的支持，以启动莱文托博士的独立性，作为一个 传染病流行病学家，为R 01级研究扩展到国家级奠定基础 以及其他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.