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Neighborhood-level screening algorithms are increasingly being deployed to inform policy decisions. We evaluate one such algorithm, CalEnviroScreen - designed to promote environmental justice and used to guide hundreds of millions of dollars in public funding annually - assessing its potential for allocative harm. We observe the model to be sensitive to subjective model decisions, with 16% of tracts potentially changing designation, as well as financially consequential, estimating the effect of its positive designations as a 104% (62-145%) increase in funding, equivalent to \$2.08 billion (\$1.56-2.41 billion) over four years. We also observe allocative tradeoffs and susceptibility to manipulation, raising ethical concerns. We recommend incorporating sensitivity analyses to mitigate allocative harm and accountability mechanisms to prevent misuse.

BackgroundAlthough much of the public health effort to combat coronavirus disease 2019 (COVID-19) has focused on disease control strategies in public settings, transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within households remains an important problem. The nature and determinants of household transmission are poorly understood.MethodsTo address this gap, we gathered and analyzed data from 22 published and prepublished studies from 10 countries (20 291 household contacts) that were available through 2 September 2020. Our goal was to combine estimates of the SARS-CoV-2 household secondary attack rate (SAR) and to explore variation in estimates of the household SAR.ResultsThe overall pooled random-effects estimate of the household SAR was 17.1% (95% confidence interval [CI], 13.7–21.2%). In study-level, random-effects meta-regressions stratified by testing frequency (1 test, 2 tests, >2 tests), SAR estimates were 9.2% (95% CI, 6.7–12.3%), 17.5% (95% CI, 13.9–21.8%), and 21.3% (95% CI, 13.8–31.3%), respectively. Household SARs tended to be higher among older adult contacts and among contacts of symptomatic cases.ConclusionsThese findings suggest that SARs reported using a single follow-up test may be underestimated, and that testing household contacts of COVID-19 cases on multiple occasions may increase the yield for identifying secondary cases.

Additional file 2 Figure S1: Sensitivity analysis for economic feasibility analysis. Figure S2: Sensitivity of the proportion of counties with ω