Visual Model of COVID-19 Transmission in Correctional Facilities

May 22, 2020

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Emily Wang, MD, MA Associate Professor of Medicine (General Medicine); Co-Director, Center for Research Engagement, Internal Medicine

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00:00I would like to now introduce our
00:03next speaker, doctor Emily Wong,
00:04but along is an associate professor
00:06in the Yale School of Madison and
00:09directs the health justice lab.
00:11The health dresses lab is a collaborative,
00:13innovative and introduce laneri team
00:15focused on improving the health of
00:17individuals and communities who have
00:19been affected by mass incarceration
00:21act along thank you for being.
00:25Thank you so much, Daniel,
00:26and thank you to the Dean for the
00:28invitation to speak on this web and R
00:30to share some of the work that our team
00:32is taking on at in order to dress code
00:34at 19 and the criminal justice system.
00:36Next slide. I start today with a photo
00:39of Cook County Jail in Chicago where
00:42according to the New York Times,
00:44is the side of the largest
00:46outbreak of COVID-19 in the US.
00:48As we're all witnessing,
00:50this pandemic is unearthing persistent
00:51structural inequities in our country.
00:53No more so obvious than those that exist
00:55in the criminal justice system there.
00:582.2 million people who are currently
00:59behind bars who are disproportionately
01:01of racial and ethnic minority
01:03backgrounds poor and have high
01:05rates of chronic health conditions,
01:06including those which put people
01:08at risk for covert. Next slide.
01:11Cover 19 is disproportionately
01:13represented in our jails and prisons,
01:15and many have taken on the task
01:17of measuring Cove infection rates
01:19in the criminal justice system.
01:21I highlight here the work of doctors
01:23Lauren Brinkley, Rubenstein,
01:24Doctor Catherine Novotney and a
01:26graduate student, Aaron Macaulay,
01:28among others who have been working
01:29on the COVID-19 prison project.
01:31This website provides a daily reporting
01:34of the number of cases in state
01:36prisons each day and compared it to
01:38the rates in the general population.
01:40So the blue bars here.
01:42Are the rate in the general population
01:45for 1000 people or residents and
01:47the orange bars represent the prison
01:49infection rate again for 1000 people
01:52incarcerated in the Red Arrow?
01:53I highlight that Connecticut has four
01:55times the number of infections in our
01:58Connecticut Department of Corrections
02:00compared with the general population.
02:02Correctional facilities present an
02:04ideal setting for infections to
02:06spread new individuals frequently
02:08enter and exit the facilities.
02:10Many facilities don't have access to
02:12alcohol based sanitizers or enough
02:14soap and social distancing measures are
02:17difficult or nearly impossible to implement.
02:19Further,
02:20the vast majority of correctional
02:22facilities aren't built to handle
02:24large scale infectious outbreaks,
02:26or to deliver health care
02:28during respiratory pandemics.
02:29Next slide.
02:30This is a photo taken prior to
02:32COVID-19 of a patient with chronic
02:35obstructive pulmonary disease,
02:36requires oxygen and is being
02:38held in solitary confinement.
02:39The patient spends 23 hours a day in his
02:42cell with little to no human contact,
02:45and you're going to note that the
02:47oxygen tank is outside of his door
02:49because of safety concerns forcing
02:51him to bang on his door each and
02:54every time the tubing is kinked
02:56when he can't breathe.
02:57This picture is a reminder that while
02:59prisons and jails are currently managing.
03:02Outbreaks of COVID-19.
03:03They simply aren't equipped to
03:05take on the strain that it presents
03:08to their health care systems,
03:10and that, fundamentally,
03:11prisons and jails are places which
03:14prioritized safety over help.
03:16Next slide.
03:17So what can correctional systems do
03:19to mitigate these high rates of infection?
03:23the CDC has recently provided
03:25basic guidance which highlights 7
03:26different strategies to mitigate
03:28COVID-19 in correctional facilities.
03:30These include intensified cleaning
03:32masks and infection control training,
03:34but the guidance really doesn't
03:36provide a specific surround strategies
03:38that many correctional facilities
03:40are grappling with these days,
03:42so how do jails and prisons take on testing?
03:45Who should they test?
03:47When should they test?
03:49Do they test everyone I should they consider
03:52large scale population reduction or release?
03:54Or should they be releasing medically
03:57vulnerable patients next slide?
03:59In the past few weeks we saw a
04:01patient have been released from
04:03the Connecticut Department of
04:05Corrections in our transitions clinic
04:07network program here in New Haven.
04:09And this is, uh,
04:11one of about 40 programs that exist
04:13around that country for people
04:15just released from corrections.
04:17So this man had severe heart failure,
04:19an ejection fraction of 10%,
04:21and had been released back home to
04:24Connecticut under medical parole.
04:26I'm given his high risk of death where
04:28he to contract kovid while incarcerated.
04:31All over the country,
04:32facilities are deciding whether
04:34to release medically vulnerable
04:35patients an in some places,
04:37like in the federal system,
04:39the Bureau of Prisons Attorney
04:41General Bar has ordered home
04:43combine Minton for elderly,
04:44medical vulnerable patients who
04:46are incarcerated in Connecticut
04:48and contrast each individual case
04:50is being considered and only a
04:52handful of people have been released
04:54like our patient and so the bottom
04:56line is that there isn't official
04:58guidance nor data to guide the
05:01implementation of these policies.
05:02That protect medically vulnerable patients.
05:04I like the ones that we're seeing
05:07in clinic and without this guidance,
05:09many people are being placed behind
05:12bars placed at at risk behind bars.
05:15Next slide.
05:16So we're working with Margaret Brando.
05:19She's a professor of engineering and
05:22medicine at Stanford University in
05:24her graduate student Giovanni Malloy
05:26to develop a stochastic dynamic
05:28transmission model of the spread of
05:31COVID-19 in correctional facilities.
05:33This is a modified SCR model at
05:36Professor Pittser talked about this earlier,
05:38where we're able to estimate
05:40transmission among those that who are
05:43susceptible than exposed asymptomatic.
05:45An infected symptomatic, infected,
05:47quarantined hospitalised.
05:48And recover,
05:49our goal is to compare the relative
05:51effectiveness of these different
05:53strategies to mitigate COVID-19 in
05:55correctional facilities and ultimately
05:57to create models that allow us
05:59to simulate how individuals with
06:01chronic health conditions can best be
06:03protected in corrections and build
06:05an easy to use tool for correctional
06:07systems to make such decisions.
06:10Next slide.
06:13So to start, we're creating partnerships
06:15with jails and prisons around the
06:17country to obtain anonymized data.
06:18An infection rates.
06:19This has been an important
06:21but labor intensive task.
06:22As you can imagine, prisons and jails
06:25aren't always that down to share their data,
06:27but I share with you here data from one
06:30of the jails that we're working with.
06:32So on the Y axis,
06:34what you can see here are the
06:36percentage of individuals with
06:38koven infections here in the red or
06:40those who are detained in the green.
06:42The staff that her working there.
06:44And what you can see here is in
06:47the course of a large outbreak.
06:49The jail undertook many interventions
06:51in an attempt to spread to
06:54mitigate the spread of Coke at 19,
06:56and this includes large scale
06:57release on day six,
06:59placing people in single cells on Day 14,
07:02testing asymptomatic people at Day 30.
07:04And so as a first step,
07:06we're measuring how these interventions
07:08have change transmission rates in jail.
07:10Next slide.
07:12So again,
07:12the basic statistic that we're
07:14measuring is the reproduction ratio,
07:16and this is how many people one person is
07:19likely to infect in this infographic here.
07:21They are not is 3,
07:23and so it's important to note,
07:25as has been mentioned previously,
07:27Arnotts our context an location
07:28dependent so they change overtime.
07:30They differ from jail to jail,
07:32prison to prison,
07:33but the goal is to get the
07:35are not less than one,
07:37so new infections will decline
07:39and wait again.
07:40We wanted to do was to test how.
07:42Each of these interventions would
07:44change the basic reproduction ratio,
07:46so jails are present biting
07:48us demographic information.
07:50The location of who symptomatic
07:51with COVID-19 or who test positive
07:54hospitalization rates and deaths,
07:56and in this first example we
07:58divided the outbreak timeline
07:59into for intervention phases,
08:01so marked by the start of the outbreak.
08:04Then the start of mass release
08:07the start of single selling and
08:09then the start of larger scale,
08:12asymptomatic testing.
08:13We've calibrated the estimates
08:14for COVID-19 transmission rates
08:16to the daily incidents.
08:17Confirmed cases in the model,
08:19and then used previous estimates from
08:21the literature of asymptomatic rates,
08:23incubation time, length of infection,
08:25an recovery rates in the model
08:26and then we used next generation
08:28method to estimate the basic
08:30reproduction ratio under each
08:32intervention as a function of
08:34the change in transmission rates.
08:36Next slide.
08:37So here I show preliminary
08:39results of the basic difference in
08:41reproduction ratio as a function
08:43of time under each intervention
08:46as both the transmission rate
08:48and the size of the susceptible
08:50population is changing overtime.
08:52What you can see here is that
08:54transmission rate first drop by about
08:5760% after the period marking the
08:59beginning of large scale release when
09:01compared to the beginning of the outbreak,
09:04it dropped again by 60% after the jail began.
09:07An effort to start single
09:09selling individuals.
09:10And then again by another 30% after the
09:14testing of asymptomatic individuals.
09:16Next slide.
09:17Simultaneously were creating
09:19a visual model at COVID-19
09:21for correctional policymakers and so,
09:23essentially, correctional
09:24leaders could enter a simple
09:26information about their facility.
09:28So the number of people in single cells,
09:31double cells living in the gymnasium,
09:34identify how many people need to be
09:36released or move to single cells to reduce
09:40their reproduction ratio using data,
09:42hopefully by creating a visual model.
09:44This will move our research
09:46findings much more quickly.
09:48Into action
09:50next slide. Next steps here are two
09:53account for data on testing and the
09:57transmission model will incorporate
09:59individual data on COVID-19 into our
10:03model and specifically look at race,
10:06ethnicity, age, chronic health conditions,
10:08serious mental illness,
10:10and create a microsimulation model to
10:13really look at what interventions may
10:16affect at decrease transmission for
10:18those with chronic health conditions.
10:21Or these specific variables.
10:22Will integrate data from more
10:24jails and prisons with a focus
10:27on different geographies,
10:28especially looking at the difference
10:30from rule and urban settings.
10:32Next slide.
10:34And so even though our early results
10:37may suggest the importance of release,
10:39a larger scale release in
10:41reducing COVID-19 transmission,
10:42the risks the health risks of
10:45release are not inconsequential
10:47from more than a decade of research.
10:49We know that in times prior to COVID-19
10:51release from correctional facilities
10:53is associated with significantly high
10:56risks of hospitalizations and deaths
10:58in the immediate post release period.
11:00This op Ed piece came out a few
11:03days ago in the Washington Post.
11:05Where the author wrote that early
11:08release of incarcerated people
11:09may look like clemency,
11:10but it can endanger lives.
11:12And she details the story of her
11:15uncle who had an alcohol use disorder,
11:17was released to homelessness without
11:19the supports that he needed to
11:22be successful in the community.
11:24Individuals just released from
11:26correctional facilities face unique
11:27barriers to coming home in the time of Covad.
11:30They're more likely to be living
11:33in densely populated neighborhoods,
11:34homes, or congregate settings,
11:36including homeless shelters.
11:37In halfway houses,
11:38they can't work from home,
11:40they can afford to take
11:42private transportation,
11:43they don't have phones for Talla,
11:46Medison, and many distrust
11:47messaging coming from public health.
11:49Officials, doctors and health systems.
11:51Next slide.
11:56Next slide.
12:01So. Great. Sorry it's the previous slide,
12:07so while we continue to push forward
12:10with the science of who and how
12:12we ought to release people from
12:14Correctional Systems in the time of
12:16Cove it we've adapted our national
12:18model of primary care transitions clinic
12:20for individuals just released from
12:22correctional facilities here at Yale.
12:24This is being led by our community
12:26health workers here in the pictures,
12:28Jerry, Smart Doctor Lisa Puglisi,
12:30who is the director of our
12:32transitions clinic network programs
12:33in Connecticut and a patient,
12:35and we've adapted this such that.
12:37Primary care is adaptable and low barrier,
12:39which means providing Beeper
12:41Northing over tell a Medison
12:43meeting patients on the green,
12:45whatever they need.
12:46We've also started a statewide
12:48COVID-19 hotline so that parole
12:50halfway houses and apartments of
12:52Corrections has a single number to call
12:55to create a medical discharge plan.
12:57This includes a getting 90 days
12:59of medications for patients,
13:01medical records,
13:02and the appropriate referrals
13:03to primary care and specialist.
13:05We've also been working with
13:07community agencies.
13:08In New Haven and throughout the
13:10state to get basic needs.
13:13Met telephones with video capabilities.
13:15Rapid ho telling through the states
13:17I am RP and the Connecticut coalition
13:19to end homelessness and we're
13:22hiring community leaders with their
13:24own histories of incarceration to
13:26disseminate public health guidance and
13:28tackle counter narratives about COVID-19.
13:31About public health guidance
13:32that are indeed health harming.
13:34Next slide.
13:38So you know I I'm ending with this.
13:40Hopefully I've convinced you
13:42that there are real injustices
13:43in the criminal justice system.
13:45Certainly at large.
13:46And now in the time of COVID-19 and
13:48for many through the years of notice
13:51that this can maybe feel remote
13:53from the work that you're doing.
13:55That is the work that's ongoing happening
13:57in our communities or New Haven at large.
14:00And so I end with this,
14:02which is that not long ago,
14:03the New Haven independent published
14:05an important story highlighting
14:07the work of so many at this school
14:09of Madison across the University.
14:11Focused on exposing the persistent
14:13racial and ethnic disparities in
14:15Cove at 19th and hear the headline
14:17is black and Brown.
14:19New Haven ours are
14:20disproportionately impacted.
14:21The story featured this beautiful
14:23quote from our Department chair Gary
14:25Desear shining light on racial and
14:27ethnic disparities in our communities,
14:29and what was notable about this story
14:32was that nearly every patient all but
14:34one in that article was a patient of arson.
14:38Transitions clinic.
14:39In other words,
14:40people that had.
14:41Recent histories of incarceration,
14:42highlighting this important fact that
14:44we will not be able to address an
14:47attend to racial ethnic disparities
14:49in our community without addressing
14:51the criminal justice system.
14:53Next slide.
14:57So I get asked often. How can you get a?
15:00How can a person get involved
15:03either locally and nationally?
15:04And here I share with you some resources
15:06to learn more about COVID-19 infections
15:09within the criminal justice system,
15:11but I want to end also by highlighting that
15:14there so many across the University that
15:17have are doing profound work in this domain.
15:20Here, Judith Resnik, and Hope Metcalf,
15:22the Yale Law School,
15:23have filed an even one big court cases
15:26to insist on the release of medically
15:28vulnerable people who are incarcerated.
15:30Jamie Myron Gregans.
15:31All this have shined a light on.
15:34Injustice is behind bars writing
15:35Apfa David's letters to the governor
15:37successfully getting people out one by
15:39one and organizing in partnership with
15:41community organizations across the state
15:43against the unjust treatment behind bars.
15:45There's so much to be done,
15:47infinitely grateful to be
15:49doing this work with my lab,
15:51and with those across the University.
15:53Thank you for the time.
15:55Thank you very much.