“…Many of the most severe COVID-19 outbreaks in the US have occurred in carceral settings, where the risk of acquiring a COVID-19 infection is more than four-fold higher and the rate of COVID-19-associated death is more than three-fold higher than the non-incarcerated population (Mukherjee & El-Bassel, 2020 ; Schnepel et al, 2021 ). COVID-19’s transmission and severity in carceral settings may be mediated by limited spatial autonomy, overcrowded congregate living environments, hygiene restrictions, frequent exposure to community contacts (e.g., incoming residents, staff, site visitors), poor baseline health status, and living conditions that undermine immune functioning (e.g., chronic stress, social isolation, poor nutrition, persistent sleep disruption) (Chandra, 1997 ; Cook et al, 2015 ; Morris et al, 2021 ; Mukherjee & El-Bassel, 2020 ; Pressman et al, 2005 ; Sawyer, 2017 ; Segerstrom & Miller, 2004 ; Wurcel et al, 2020 ; Zee & Turek, 2006 ). Persons with a history of OUD have additional risks for COVID-19, with 2.4 times higher likelihood of acquiring COVID-19 and 1.4 times higher mortality from the infection than persons without OUD (Baillargeon et al, 2021 ; Wang et al, 2020 ).…”