An Isolation Hotel for People Experiencing Homelessness

MacKenzie, Onagh W.; Trimbur, M. Catherine; Vanjani, Rahul

doi:10.1056/nejmc2022860

Cited by 15 publications

(16 citation statements)

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“…Among guests with COVID-19, only 4% required hospital readmission owing to disease progression, a rate similar to that seen in other jurisdictions with similar programs. 8 In a subsample referred from the city’s safety-net hospital, the number of successful transfers to I/Q hotels far exceeded the number of COVID-19–related admissions. In addition, direct transfers to I/Q hotels from preinpatient locations increased, which was a factor associated with averting hospitalizations entirely.…”

Section: Discussionmentioning

confidence: 99%

“…Since the COVID-19 pandemic began, several jurisdictions have used private hotels to secure voluntary, temporary housing for individuals with suspected or confirmed COVID-19 who are recovering from mild to moderate disease. 8 , 9 Without this option, persons experiencing homelessness and requiring isolation might need prolonged hospitalization while they are infectious, straining valuable hospital capacity. Given the excess mortality in hospitals overwhelmed by admissions of patients with COVID-19, 10 , 11 maintaining alternative housing to meet the needs of patients with SARS-CoV-2 infection is a priority for safety-net hospitals caring for large numbers of homeless individuals.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

et al. 2021

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Key Points Question Can persons experiencing homelessness with confirmed or suspected coronavirus disease 2019 (COVID-19) and mild to moderate symptoms be safely monitored in designated isolation and quarantine (I/Q) hotels? Findings In this cohort study among 1009 I/Q hotel guests referred from hospitals, outpatient settings, and public health surveillance, 81% completed their recommended I/Q course, and only 4% of those transferred from the county hospital required readmission for COVID-19 progression. Meaning This study suggests that, during the COVID-19 pandemic, a hotel-based I/Q strategy that delivers integrated medical and behavioral health support to people experiencing homelessness can be done safely outside the hospital setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

et al. 2021

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“…Because adequate isolation for COVID-19 is not possible within congregate homeless shelters, care of individuals experiencing homelessness who have mild or moderate COVID-19 occurs either in hospitals or ACSs, such as large tents or nonhospital facilities with on-site medical staff. 11 , 12 ACSs reduce transmission and hospital use for people with mild or moderate illness. Temporary housing reduces transmission by preemptively moving everyone from shelters to individual living units (eg, hotel or dormitory rooms) for the entire simulation period.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic

Baggett

Scott

et al. 2020

JAMA Netw Open

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Key Points Question What are the projected clinical outcomes and costs associated with strategies for reducing severe acute respiratory syndrome coronavirus 2 infections among people experiencing sheltered homelessness? Findings In this decision analytic model, daily symptom screening with polymerase chain reaction (PCR) testing of individuals who had positive symptom screening paired with nonhospital care site management of people with mild to moderate coronavirus disease 2019 (COVID-19) was associated with a substantial decrease in infections and lowered costs over 4 months compared with no intervention across a wide range of epidemic scenarios. In a surging epidemic, adding periodic universal PCR testing to symptom screening and nonhospital care site management was associated with improved clinical outcomes at modestly increased costs. Meaning In this study, daily symptom screening with PCR testing of individuals who had positive symptom screening and use of alternative care sites for COVID-19 management among individuals experiencing sheltered homelessness were associated with substantially reduced new cases and costs compared with other strategies.

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“…Since adequate isolation for COVID-19 is not possible within congregate homeless shelters, care of homeless individuals with mild/moderate COVID-19 occurs either in hospitals or ACSs, such as large tents or non-hospital facilities with on-site medical staff. 11,12 ACSs reduce transmission and hospital use for people with mild/moderate illness. Temporary housing reduces transmission by preemptively moving everyone from shelters to individual living units (e.g., hotel or dormitory rooms) for the entire simulation period.…”

Section: Methodsmentioning

confidence: 99%

Management Strategies for People Experiencing Sheltered Homelessness during the COVID-19 Pandemic: Clinical Outcomes and Costs

Baggett

Scott

et al. 2020

Preprint

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Importance: Approximately 356,000 people stay in homeless shelters nightly in the US. These individuals are at high risk for COVID-19. Objective: To assess clinical outcomes, costs, and cost-effectiveness of strategies for COVID-19 prevention and management among sheltered homeless adults. Design: We developed a dynamic microsimulation model of COVID-19. We modeled sheltered homeless adults in Boston, Massachusetts, using cohort characteristics and costs from Boston Health Care for the Homeless Program. Disease progression, transmission, and clinical outcomes data were from published literature and national databases. We examined surging, growing, and slowing epidemics (effective reproduction numbers [Re] 2.6, 1.3, and 0.9). Costs were from a health care sector perspective; time horizon was 4 months. Setting & Participants: Simulated cohort of 2,258 adults residing in homeless shelters in Boston. Interventions: We assessed combinations of daily symptom screening with same-day polymerase chain reaction (PCR) testing of screen-positive individuals, universal PCR testing every 2 weeks, hospital-based COVID-19 care, alternate care sites [ACSs] for mild/moderate COVID-19 management, and moving people from shelters to temporary housing, compared to no intervention. Main Outcomes: Infections, hospital-days, costs, and cost-effectiveness. Results: Compared to no intervention, daily symptom screening with ACSs for those with pending tests or confirmed COVID-19 and mild/moderate disease leads to 37% fewer infections and 46% lower costs when Re=2.6, 75% fewer infections and 72% lower costs when Re=1.3, and 51% fewer infections and 51% lower costs when Re=0.9. Adding universal PCR testing every 2 weeks further decreases infections in all epidemic scenarios, with incremental cost per case prevented of $1,000 (Re=2.6), $27,000 (Re=1.3), and $71,000 (Re=0.9). In all scenarios, moving shelter residents to temporary housing with universal PCR testing every 2 weeks is most effective but substantially more costly than other options. Results are most sensitive to the cost and sensitivity of PCR testing and the efficacy of ACSs in preventing transmission. Conclusions & Relevance: Daily symptom screening and ACSs for sheltered homeless adults will substantially decrease COVID-19 cases and reduce costs compared to no intervention. In a surging epidemic, adding universal PCR testing every 2 weeks further decreases cases at modest incremental cost and should be considered. Keywords: Homelessness, COVID-19, cost-effectiveness analysis, simulation model

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An Isolation Hotel for People Experiencing Homelessness

Cited by 15 publications

References 0 publications

Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic

Management Strategies for People Experiencing Sheltered Homelessness during the COVID-19 Pandemic: Clinical Outcomes and Costs

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