Effectiveness of interventions to reduce COVID-19 transmission in a large urban jail: a model-based analysis

  1. Giovanni S P Malloy
  2. Lisa Puglisi
  3. Margaret L Brandeau
  4. Tyler D Harvey
  5. Emily A Wang

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Abstract

We aim to estimate the impact of various mitigation strategies on COVID-19 transmission in a US jail beyond those offered in national guidelines.

Design

We developed a stochastic dynamic transmission model of COVID-19.

Setting

One anonymous large urban US jail.

Participants

Several thousand staff and incarcerated individuals.

Interventions

There were four intervention phases during the outbreak: the start of the outbreak, depopulation of the jail, increased proportion of people in single cells and asymptomatic testing. These interventions were implemented incrementally and in concert with one another.

Primary and secondary outcome measures

The basic reproduction ratio, R 0 , in each phase, as estimated using the next generation method. The fraction of new cases, hospitalisations and deaths averted by these interventions (along with the standard measures of sanitisation, masking and social distancing interventions).

Results

For the first outbreak phase, the estimated R 0 was 8.44 (95% credible interval (CrI): 5.00 to 13.10), and for the subsequent phases, R 0,phase 2 =3.64 (95% CrI: 2.43 to 5.11), R 0,phase 3 =1.72 (95% CrI: 1.40 to 2.12) and R 0,phase 4 =0.58 (95% CrI: 0.43 to 0.75). In total, the jail’s interventions prevented approximately 83% of projected cases, hospitalisations and deaths over 83 days.

Conclusions

Depopulation, single celling and asymptomatic testing within jails can be effective strategies to mitigate COVID-19 transmission in addition to standard public health measures. Decision makers should prioritise reductions in the jail population, single celling and testing asymptomatic populations as additional measures to manage COVID-19 within correctional settings.

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  1. ScreenIT

    SciScore for 10.1101/2020.06.16.20133280: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our analysis has several limitations. We used a compartmental model which assumes homogeneous mixing among the entire population. Correctional facilities in reality do not exhibit homogeneous mixing, especially across divisions. Our model does not have the granularity to capture the influence of individuals on transmission dynamics. Our model assumes a relatively stationary population and only accounts for mixing within the jail. In reality, jail populations are highly variable with frequent intakes and releases. Jailed individuals also have variable daily routines, such as where they eat or exercise, which are not accounted for in our model. We did not account for possible false positives, misdiagnosis, overreporting, or underreporting in the dataset. Finally, the many interventions undertaken by the jail make it difficult to determine the causal influence of any one particular intervention. Importantly, these limitations influence our estimates of β and R0. We model the jail as a closed system and thus neglect exogeneous infection (e.g., staff or new intake incarcerated individuals who contracted the disease in the community) that likely entered the jail before large-scale testing efforts. Because our analysis assumed that all new infections arise from internal transmission, we likely overestimate the true values of β and R0, particularly in the early phases of the epidemic in the jail. Thus, conclusions resulting from our analysis should focus on the relative reductions of...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1136/bmjopen-2020-042898
  3. Version published to 10.1101/2020.06.16.20133280v1 on medRxiv