COVID-19 in the homeless population: a scoping review and meta-analysis examining differences in prevalence, presentation, vaccine hesitancy and government response in the first year of the pandemic

Abstract

Aims People experiencing homelessness (PEH) have been identified as being increasingly susceptible to Coronavirus disease (COVID-19), with policies enacted to test, isolate, increase hygiene practices and prioritise vaccines among this population. Here, we conduct a scoping review of the current evidence-base pertaining to the prevalence and presentation of COVID-19 in PEH, COVID-vaccine hesitancy rates and government interventions enacted within the first year of the pandemic for PEH. Materials and methods A systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 prevalence and clinical characteristics in PEH, vaccine uptake for PEH and policies enacted targeting PEH. Study qualities were assessed with The National Heart, Lung and Blood Institute’s set of Study Quality. Results Eighty-three studies were included in our final analysis. The overall prevalence of symptomatic COVID-19 infection in PEH is estimated at 35%. The most common symptoms found were cough and shortness of breath, followed by fever. Concerns regarding vaccine hesitancy amongst PEH related to thoroughness of COVID-19 vaccine clinical trials, side effects and mistrust of the government. The main strategies implemented by governments were mass testing, adaption of healthcare service provision, provision of alternative housing, encouraging personal hygiene (hand sanitation and mask wearing), and inter-organisational communication. Discussion In our meta-analysis, 35% of PEH with a COVID-19 infection presented symptomatically; the low prevalence of symptomatic COVID-19 infection suggests widespread testing following outbreaks would be beneficial for this group of individuals. Temporary recuperation units and measures for housing stability in the pandemic, namely provision of alternative housing and stopping evictions, were found to be highly effective. High rates of vaccine hesitancy means that education and encouragement towards vaccination would be beneficial for this vulnerable population, where comorbidities are common. Finally increased focus in research should be placed on the mental health burden of COVID-19 and the pandemic on PEH moving forwards.

Strengthening access to and confidence in COVID-19 vaccines among equity-deserving populations across Canada: An exploratory qualitative study

“…Similar findings were observed by enabling essential workers to get vaccinated in their place of work. These results also align with published articles (14,44). Still, our study also identified that the inadequate distribution of infrastructure across neighborhoods requires explicit attention to guarantee fair vaccine distribution more generally.…”

“…Another populationbased survey in Canada also identified that essential non-healthcare workers had lower intention to receive a COVID-19 vaccine than non-essential workers (12). Evidence from other studies from high-income countries also points to homelessness and disability influencing the acceptance of and access to COVID-19 vaccines (13)(14)(15).…”

Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic

“…In the present study, we found a high proportion of asymptomatic adults among the positive-COVID-19 participants who were homeless (42.7%). A recent meta-analysis reported a rate of 65% in the same population ( 48 ). These findings point to the need for broad and regular screening programs among the population experiencing homelessness to prevent clusters of infection in crowded or inadequate accommodations.…”

Respiratory Syncytial Virus, Influenza and SARS-CoV-2 in Homeless People from Urban Shelters: A Systematic Review and Meta-Analysis (2023)

“…Even in our study, the incidence for SARS-CoV-2 infections was disproportionately higher than that reported for RSV and influenza, although these figures were reasonably inflated by the oversampling of HP during the early stages of the pandemic. The retrieved reports stress how rapidly a SARS-CoV-2 outbreak could spread across the homeless shelters and the need for raising and maintaining appropriate preventive and containment measures even in post-pandemic settings-for example, by achieving and maintaining high vaccination rates [137,138].…”