COVID-19 challenges the daily function of nearly every institution of society. It is the duty of any society to be responsive to such challenges by relying on the best tools and logic available to analyze the costs and benefits of any mitigative action. We here provide a mathematical model to explore the epidemiological consequences of allowing standard intake and unaltered within-jail operational dynamics to be maintained during the ongoing COVID-19 pandemic, and contrast this with proposed interventions to reduce the burden of negative health outcomes. In this way, we provide estimates of the infection risks, and likely loss of life, that arise from current incarceration practices. We provide estimates for in-custody deaths and show how the within-jail dynamics lead to spill-over risks, not only affecting the incarcerated people, but increasing the exposure, infection, and death rates for both corrections officers with whom they interact within the jail system, and the broader community beyond the justice system. We show that, given a typical jail-community dynamic, operating in a business as usual way will result in significant and rapid loss of life. Large scale reductions in arrest and speeding of releases are likely to save the lives of incarcerated people, staff and the community at large.As the COVID-19 pandemic sweeps the globe, one of the critical functions of 2 epidemiology is to consider how society can transform current practice to increase the 3 health and safety of the public. The widespread risk of infection and the high case 4 fatality rates, especially in older or medically compromised populations, mean that we, 5 as a society, must be willing to consider structural reforms to our institutions to 6 promote an overall greater good. To these ends, we have already seen systemic shifts in 7 institutional practices that would be unthinkable under normal conditions: 8 , 2020

Objective The evolution of antibiotic resistance is far outpacing the development of new antibiotics, causing global public health concern about infections that will increasingly be unresponsive to antimicrobials. This risk of emerging antibiotic resistance may be meaningfully altered in highly AIDS-immunocompromised populations. Such populations fundamentally alter the bacterial evolutionary landscape in two ways, which we seek to model and analyze. First, widespread, population-level immunoincompetence creates a novel host environment with disrupted selective pressures. Second, within AIDS-prevalent populations, the recommendation that antibiotics be taken to treat and prevent opportunistic infection raises the risk of selection for drug-resistant pathogens. Design To determine the impact of HIV/AIDS on the emergence of antibiotic resistance–specifically in the developing world where high prevalence and economic challenges complicate disease management. Methods We present an SEIR epidemiological model of bacterial infection, and parametrize it to capture HIV/AIDS-attributable emergence of resistance under conditions of both high and low HIV/AIDS prevalence. Results We demonstrate that HIV/AIDS-immunocompromised hosts can be responsible for a disproportionately greater contribution to emergence of resistance than would be expected based on population-wide HIV/AIDS prevalence alone. Conclusions As such, the AIDS-immunocompromised have the potential become wellsprings of novel, resistant, opportunistic pathogen strains that can propagate into the broader global community. We discuss how public health policies for HIV/AIDS management can shape the evolutionary environment for opportunistic bacterial infections.

Chemoprophylaxis (antibiotic prophylaxis) is a long relied-upon means of opportunistic infection management among HIV/AIDS patients, but its use represents an evolutionary tradeoff: Despite the benefits of chemoprophylaxis, widespread use of antibiotics creates a selective advantage for drug-resistant bacterial strains. Especially in the developing world, with combined resource limitations, antibiotic misuse, and often-poor infection control, the emergence of antibiotic resistance may pose a critical health risk. Extending previous work that demonstrated that this risk is heightened when a significant proportion of the population is HIV/AIDS-immunocompromised, we work to address the relationship between HIV/AIDS patients' use of antibiotic chemoprophylaxis and the emergence of resistance. We apply an SEIR compartmental model, parameterized to reflect varying percentages of chemoprophylaxis use among HIV/AIDS+ patients in a resource-limited setting, to investigate the magnitude of the risk of prophylaxis-associated emergence versus the individual-level benefits it is presumed to provide. The results from this model suggest that, while still providing tangible benefits to the individual, chemoprophylaxis is associated with negligible decreases in population-wide morbidity and mortality from bacterial infection, and may also fail to provide assumed efficacy in reduction of TB prevalence.