The Epidemiological Implications of Incarceration Dynamics in Jails for Community, Corrections Officer, and Incarcerated Population Risks from COVID-19

Eric Lofgren; Kristian Lum; Aaron Horowitz; Brooke Madubuowu; Nina Fefferman

An increase in the detection of severe COVID-19 cases among incarcerated persons 255 from 95% to 100% (equivalent to the same detection of the need for medical treatment 256 available in the community) unsurprisingly increased the number of hospitalizations, as 257 5 out of every 100 incarcerated persons needing hospitalization were no longer missed, 258 either for lack of access to care, insufficient diagnostic capacity, or other reasons. 259 Similarly, owing to the vast reduction in the case fatality rate between hospitalized 260 (CFR = 5% for low risk and 33.3% for high risk) severe cases and unhospitalized severe 261 cases (CFR = 100% for both groups), the number of deaths dropped by 72.2% when the 262 detection of severe cases rose to the same level as the community. Between these 263 scenarios, the number of infections rose slightly with better detection, increasing by 264 0.6% (Fig 7) . This is likely due to the slightly longer time an untreated severe case 265 spends in the incarcerated population before they are removed due to death vs. when a 266 treated case is transferred for hospitalization. This effect will only be present if the level 267 , 2020 14/25 . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. These results clearly follow from the features of the jail system themselves in 284 challenging ways. While only 1% of the population entering into the jail system are 285 elderly [31] , incarceration in jail itself degrades the health of incarcerated people [16] [17] [18] , 286 leaving them more vulnerable to infection and severe outcomes from infection [32] . As 287 individual robustness to disease decreases, the epidemiological result is the increased 288 vulnerability of the whole jail population.