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

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.