Visual Model of COVID-19 Transmission in Correctional Facilities

Transcript

• 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.