Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020

Mosites, Emily; Parker, Erin; Clarke, Kristie E N; Gaeta, Jessie M.; Baggett, Travis P.; Imbert, Elizabeth; Sankaran, Madeline; Scarborough, Alexander; Huster, Karin; Hanson, Matthew; Gonzales, Elysia; Rauch, Jody; Page, Libby C.; McMichael, Temet M.; Keating, Ryan; Marx, Grace E; Andrews, Tom; Schmit, Kristine M; Morris, Sapna Bamrah; Dowling, Nicole F.; Peacock, Georgina

doi:10.15585/mmwr.mm6917e1

Cited by 210 publications

(219 citation statements)

References 3 publications

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“…In a homeless shelter in Boston, all residents were offered viral testing following identification of symptomatic cases, and 147 (36%) of 408 were positive. 2 Similar mass screening was done in shelters in Seattle, San Francisco, and Atlanta, 1 , 31 with high prevalence in shelters that reported cases before screening. Many cases were asymptomatic, leading to recommendations for universal testing in homeless settings to inform outbreak control.…”

Section: Discussionmentioning

confidence: 98%

“…Outbreaks of COVID-19 have been documented in shelters in the USA. 1 , 2 Similarly, during historic pandemic influenza seasons, particularly large spikes in hospitalisations have been observed in homeless populations. 3 In addition to risks related to infection, people experiencing homelessness might be at increased risk of severe COVID-19 due to high prevalence of long-term health conditions.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 among people experiencing homelessness in England: a modelling study

Lewer

Braithwaite

Bullock

et al. 2020

The Lancet Respiratory Medicine

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Background People experiencing homelessness are vulnerable to COVID-19 due to the risk of transmission in shared accommodation and the high prevalence of comorbidities. In England, as in some other countries, preventive policies have been implemented to protect this population. We aimed to estimate the avoided deaths and health-care use among people experiencing homelessness during the so-called first wave of COVID-19 in England—ie, the peak of infections occurring between February and May, 2020—and the potential impact of COVID-19 on this population in the future. Methods We used a discrete-time Markov chain model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that included compartments for susceptible, exposed, infectious, and removed individuals, to explore the impact of the pandemic on 46 565 individuals experiencing homelessness: 35 817 living in 1065 hostels for homeless people, 3616 sleeping in 143 night shelters, and 7132 sleeping outside. We ran the model under scenarios varying the incidence of infection in the general population and the availability of prevention measures: specialist hotel accommodation, infection control in homeless settings, and mixing with the general population. We divided our scenarios into first wave scenarios (covering Feb 1–May 31, 2020) and future scenarios (covering June 1, 2020–Jan 31, 2021). For each scenario, we ran the model 200 times and reported the median and 95% prediction interval (2·5% and 97·5% quantiles) of the total number of cases, the number of deaths, the number hospital admissions, and the number of intensive care unit (ICU) admissions. Findings Up to May 31, 2020, we calibrated the model to 4% of the homeless population acquiring SARS-CoV-2, and estimated that 24 deaths (95% prediction interval 16–34) occurred. In this first wave of SARS-CoV-2 infections in England, we estimated that the preventive measures imposed might have avoided 21 092 infections (19 777–22 147), 266 deaths (226–301), 1164 hospital admissions (1079–1254), and 338 ICU admissions (305–374) among the homeless population. If preventive measures are continued, we projected a small number of additional cases between June 1, 2020, and Jan 31, 2021, with 1754 infections (1543–1960), 31 deaths (21–45), 122 hospital admissions (100–148), and 35 ICU admissions (23–47) with a second wave in the general population. However, if preventive measures are lifted, outbreaks in homeless settings might lead to larger numbers of infections and deaths, even with low incidence in the general population. In a scenario with no second wave and relaxed measures in homeless settings in England, we projected 12 151 infections (10 718–13 349), 184 deaths (151–217), 733 hospital admissions (635–822), and 213 ICU admissions (178–251) between June 1, 2020, and Jan 31, 2021. Interpretation Outbreaks of SARS-CoV-2 in homeless settings can lead to a high attack rate among people experiencing h...

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

COVID-19 among people experiencing homelessness in England: a modelling study

Lewer

Braithwaite

Bullock

et al. 2020

The Lancet Respiratory Medicine

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“…Cases of COVID-19 have been observed in other congregate settings, including long-term care facilities (5), acute care hospitals (6), correctional facilities (7), and homeless shelters (8). Similarly, the crowded conditions for workers in meat and poultry processing facilities could result in high risk for SARS-CoV-2 transmission.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Among Workers in Meat and Poultry Processing Facilities ― 19 States, April 2020

Dyal¹,

Grant²,

Broadwater³

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

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364

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“…! values are also likely not entirely representative of general transmission potential in shelters as non-outbreaks and smaller outbreaks are undetected or less likely to be reported, and some shelters have reported only low numbers of infections (4,45). For these !…”

Section: Discussionmentioning

confidence: 99%

Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

Chapman

Kushel

Cox

et al. 2020

Preprint

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Background: Multiple COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks. Objective: To estimate the probability of averting outbreaks in homeless shelters under different infection control strategies. Design: Microsimulation model of COVID-19 transmission in a representative homeless shelter over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly polymerase-chain-reaction (PCR) testing and universal mask wearing. Setting: A shelter of 250 residents and 50 staff. Patients: Residents and staff of homeless shelters in the US. Model calibrated to data from cross-sectional PCR surveys during COVID-19 outbreaks in five shelters in three US cities. Measurements: Probability of averting a COVID-19 outbreak (≥3 infections in 14 days). Results: Basic reproduction number (R0) estimates for the observed outbreaks ranged from 2.9 to 6.2. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing transmission intensity in the local community. With moderate transmission intensity in the local community, the estimated probabilities of averting an outbreak in a low-risk (R0=1.5), moderate-risk (R0=2.9), and high-risk (R0=6.2) shelter were: 0.33, 0.11 and 0.03 for daily symptom-based screening; 0.52, 0.27, and 0.04 for twice-weekly PCR testing; 0.47, 0.20 and 0.06 for universal masking; and 0.68, 0.40 and 0.08 for these strategies combined. Limitations: R0 values calibrated to reported outbreaks may be higher than for average shelter due to smaller outbreaks going unreported. Conclusion: In high-risk homeless shelter environments and locations with high community incidence of COVID-19 most infection control strategies are unlikely to prevent outbreaks. In lower-risk environments, combined interventions should be adopted to reduce outbreak risk. Primary Funding Source: University of California, San Francisco; UCSF Benioff Homelessness and Housing Initiative.

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Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020

Cited by 210 publications

References 3 publications

COVID-19 among people experiencing homelessness in England: a modelling study

COVID-19 among people experiencing homelessness in England: a modelling study

COVID-19 Among Workers in Meat and Poultry Processing Facilities ― 19 States, April 2020

Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

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