COVID-19 and people experiencing homelessness: challenges and mitigation strategies

Perri, Melissa; Dosani, Naheed; Hwang, Stephen W.

doi:10.1503/cmaj.200834

Cited by 208 publications

(262 citation statements)

References 14 publications

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“…The 'bi-directional and compounding relationship between homelessness and health' occurs across different categories of homelessness (Wood, Flatau et al 2016: 12). People experiencing 'primary' homelessness ('rough sleeping') can be transient and geographically mobile (Perri, Dosani et al 2020); those experiencing 'secondary' homelessness are moving between different forms of accommodation, whether family, friends or SHS, while the 'tertiary' homeless are in shared, often short-term and insecure accommodation, that can be cramped (Zaretzky, Flatau et al 2013). These are not conducive to social distancing, quarantining and isolation (Perri, Dosani et al 2020).…”

Section: Health Homelessness and Pandemicsmentioning

confidence: 99%

Policy coordination and housing outcomes during COVID-19

Mason¹,

Moran²,

Earles³

2020

AHURI Final Report

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AHURI AHURI is a national independent research network with an expert not-for-profit research management company, AHURI Limited, at its centre. AHURI's mission is to deliver high quality research that influences policy development and practice change to improve the housing and urban environments of all Australians. Using high quality, independent evidence and through active, managed engagement, AHURI works to inform the policies and practices of governments and the housing and urban development industries, and stimulate debate in the broader Australian community. AHURI undertakes evidence-based policy development on a range of priority policy topics that are of interest to our audience groups, including housing and labour markets, urban growth and renewal, planning and infrastructure development, housing supply and affordability, homelessness, economic productivity, and social cohesion and wellbeing. AHURI Limited also gratefully acknowledges the contributions, both financial and in-kind, of its university research partners who have helped make the completion of this material possible. Disclaimer The opinions in this report reflect the views of the authors and do not necessarily reflect those of AHURI Limited, its Board, its funding organisations or Inquiry Panel members. No responsibility is accepted by AHURI Limited, its Board or funders for the accuracy or omission of any statement, opinion, advice or information in this publication. AHURI journal AHURI Final Report journal series is a refereed series presenting the results of original research to a diverse readership of policy-makers, researchers and practitioners. Peer review statement An objective assessment of reports published in the AHURI journal series by carefully selected experts in the field ensures that material published is of the highest quality. The AHURI journal series employs a double-blind peer review of the full report, where anonymity is strictly observed between authors and referees.

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Section: Health Homelessness and Pandemicsmentioning

confidence: 99%

Policy coordination and housing outcomes during COVID-19

Mason¹,

Moran²,

Earles³

2020

AHURI Final Report

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“…In the US, the recent Coronavirus Aid, Relief, and Economic Security Act (2020) pledged $4 billion (USD) "to prevent, prepare for, and respond to coronavirus, among individuals and families who are homeless or receiving homeless assistance and to support additional homeless assistance and homelessness prevention activities to mitigate the impacts created by coronavirus." Individual US states have also responded, announcing additional funding and other measures to house rough sleepers (e.g., Seattlesee Perri et al, 2020) and reduce their risk of exposure to the virus (e.g., San Franciscosee San Francisco Office of the Mayor, 2020).…”

Section: Introductionmentioning

confidence: 99%

“…The similar responses across numerous countries are supported by health evidence that illustrate homeless people's heightened vulnerabilities to COVID-19. Being homeless and living in shared homeless accommodation exacerbates the risk of contracting COVID-19 due to an inability to socially distance (Perri et al, 2020), inadequate access to hygiene and sanitation (Culhane et al, 2020), along with vulnerabilities that stem from the disproportionate extent of underlying health and medical conditions experienced by people who are homeless (Fazel et al, 2014). Indeed, clusters of SARs-CoV-2 infection have been found in numerous homeless shelters across the US (Baggett et al, 2020;Mosites et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Understanding responses to homelessness during COVID-19: an examination of Australia

2020

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Following the outbreak of COVID-19, governments have spent unprecedented sums of money to accommodate people experiencing homelessness, often in underutilized hotels. This intervention contrasts with the policy stasis and "poverty of ambition" that characterized responses to rising homelessness over the past decade in countries such as Australia, the UK, the US, and much of Europe. This is a situation that has prevailed despite rigorous evidence on both the harms of homelessness and the ability of policy to address it. Using Australia as a case study, this policy review examines this sudden change in approach. After detailing various initiatives to respond to COVID-19, we show how these interventions are rationalized by the threat posed to people who are homeless, and the threat posed by homeless populationswho are at high risk of contracting and transmitting the disease-to the health of the non-homeless population. We discuss how these findings contribute to debates about how the framing of homelessness as a problem shapes policy.

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“…The COVID-19 pandemic caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses great risk to people experiencing homelessness. Across the United States (US), the estimated 568,000 people who experience homelessness nightly (1) are likely to suffer a disproportionate disease burden and need for hospitalization (2,3) among people experiencing homelessness is still poorly understood. Given current understanding that SARS-CoV-2 virus is transmitted predominantly through respiratory droplets (with some possible airborne and fomite transmission) (8), there is a need to consider policies to limit transmission within high-density congregate living environments.…”

Section: Introductionmentioning

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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COVID-19 and people experiencing homelessness: challenges and mitigation strategies

Cited by 208 publications

References 14 publications

Policy coordination and housing outcomes during COVID-19

Policy coordination and housing outcomes during COVID-19

Understanding responses to homelessness during COVID-19: an examination of Australia

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

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