Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies
Summary: Background: Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to asses...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-10-01
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| Series: | The Lancet Public Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468266721001626 |
| _version_ | 1818576590874869760 |
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| author | Theresa Ryckman, PhD Elizabeth T Chin, BS Lea Prince, PhD David Leidner, PhD Elizabeth Long, MS David M Studdert, ProfScD Joshua A Salomon, ProfPhD Fernando Alarid-Escudero, PhD Jason R Andrews, MD Jeremy D Goldhaber-Fiebert, PhD |
| author_facet | Theresa Ryckman, PhD Elizabeth T Chin, BS Lea Prince, PhD David Leidner, PhD Elizabeth Long, MS David M Studdert, ProfScD Joshua A Salomon, ProfPhD Fernando Alarid-Escudero, PhD Jason R Andrews, MD Jeremy D Goldhaber-Fiebert, PhD |
| author_sort | Theresa Ryckman, PhD |
| collection | DOAJ |
| description | Summary: Background: Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities. Methods: We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days. Findings: If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23–74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2–54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced. Interpretation: Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable. Funding: Horowitz Family Foundation, National Institute on Drug Abuse, Centers for Disease Control and Prevention, National Science Foundation, Open Society Foundation, Advanced Micro Devices. |
| first_indexed | 2024-12-16T06:16:27Z |
| format | Article |
| id | doaj.art-d38093e1c6624cd58ec580504ef7c702 |
| institution | Directory Open Access Journal |
| issn | 2468-2667 |
| language | English |
| last_indexed | 2024-12-16T06:16:27Z |
| publishDate | 2021-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Public Health |
| spelling | doaj.art-d38093e1c6624cd58ec580504ef7c7022022-12-21T22:41:15ZengElsevierThe Lancet Public Health2468-26672021-10-01610e760e770Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policiesTheresa Ryckman, PhD0Elizabeth T Chin, BS1Lea Prince, PhD2David Leidner, PhD3Elizabeth Long, MS4David M Studdert, ProfScD5Joshua A Salomon, ProfPhD6Fernando Alarid-Escudero, PhD7Jason R Andrews, MD8Jeremy D Goldhaber-Fiebert, PhD9Stanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Correspondence to: Theresa Ryckman, Stanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USADepartment of Biomedical Data Science, Stanford University, Stanford, CA, USAStanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USACalifornia Department of Corrections and Rehabilitation, Elk Grove, CA, USAStanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USAStanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Law School, Stanford, CA, USAStanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USADivision of Public Administration, Center for Research and Teaching in Economics, Aguascalientes, MexicoDepartment of Medicine, Stanford University School of Medicine, Palo Alto, CA, USAStanford Health Policy, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USASummary: Background: Residents of prisons have experienced disproportionate COVID-19-related health harms. To control outbreaks, many prisons in the USA restricted in-person activities, which are now resuming even as viral variants proliferate. This study aims to use mathematical modelling to assess the risks and harms of COVID-19 outbreaks in prisons under a range of policies, including resumption of activities. Methods: We obtained daily resident-level data for all California state prisons from Jan 1, 2020, to May 15, 2021, describing prison layouts, housing status, sociodemographic and health characteristics, participation in activities, and COVID-19 testing, infection, and vaccination status. We developed a transmission-dynamic stochastic microsimulation parameterised by the California data and published literature. After an initial infection is introduced to a prison, the model evaluates the effect of various policy scenarios on infections and hospitalisations over 200 days. Scenarios vary by vaccine coverage, baseline immunity (0%, 25%, or 50%), resumption of activities, and use of non-pharmaceutical interventions (NPIs) that reduce transmission by 75%. We simulated five prison types that differ by residential layout and demographics, and estimated outcomes with and without repeated infection introductions over the 200 days. Findings: If a viral variant is introduced into a prison that has resumed pre-2020 contact levels, has moderate vaccine coverage (ranging from 36% to 76% among residents, dependent on age, with 40% coverage for staff), and has no baseline immunity, 23–74% of residents are expected to be infected over 200 days. High vaccination coverage (90%) coupled with NPIs reduces cumulative infections to 2–54%. Even in prisons with low room occupancies (ie, no more than two occupants) and low levels of cumulative infections (ie, <10%), hospitalisation risks are substantial when these prisons house medically vulnerable populations. Risks of large outbreaks (>20% of residents infected) are substantially higher if infections are repeatedly introduced. Interpretation: Balancing benefits of resuming activities against risks of outbreaks presents challenging trade-offs. After achieving high vaccine coverage, prisons with mostly one-to-two-person cells that have higher baseline immunity from previous outbreaks can resume in-person activities with low risk of a widespread new outbreak, provided they maintain widespread NPIs, continue testing, and take measures to protect the medically vulnerable. Funding: Horowitz Family Foundation, National Institute on Drug Abuse, Centers for Disease Control and Prevention, National Science Foundation, Open Society Foundation, Advanced Micro Devices.http://www.sciencedirect.com/science/article/pii/S2468266721001626 |
| spellingShingle | Theresa Ryckman, PhD Elizabeth T Chin, BS Lea Prince, PhD David Leidner, PhD Elizabeth Long, MS David M Studdert, ProfScD Joshua A Salomon, ProfPhD Fernando Alarid-Escudero, PhD Jason R Andrews, MD Jeremy D Goldhaber-Fiebert, PhD Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies The Lancet Public Health |
| title | Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies |
| title_full | Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies |
| title_fullStr | Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies |
| title_full_unstemmed | Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies |
| title_short | Outbreaks of COVID-19 variants in US prisons: a mathematical modelling analysis of vaccination and reopening policies |
| title_sort | outbreaks of covid 19 variants in us prisons a mathematical modelling analysis of vaccination and reopening policies |
| url | http://www.sciencedirect.com/science/article/pii/S2468266721001626 |
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