Homeless Shelter Characteristics and Prevalence of SARS-CoV-2

Abstract

Introduction The unfolding COVID-19 pandemic has predictably followed the familiar contours of well established socioeconomic health inequities, exposing and often amplifying preexisting disparities. People living in homeless shelters are at higher risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared to the general population. The purpose of this study was to identify shelter characteristics that may be associated with higher transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods We conducted a cross-sectional assessment of five congregate shelters in Rhode Island. Shelter residents 18 years old and older were tested for SARS-CoV-2 from April 19–April 24, 2020. At time of testing, we collected participant characteristics, symptomatology, and vital signs. Shelter characteristics and infection control strategies were collected through a structured phone questionnaire with shelter administrators. Results A total of 299 shelter residents (99%, 299/302) participated. Thirty-five (11.7%) tested positive for SARS-CoV-2. Shelter-level prevalence ranged from zero to 35%. Symptom prevalence did not vary by test result. Shelters with positive cases of SARS-CoV-2 were in more densely populated areas, had more transient resident populations, and instituted fewer physical distancing practices compared to shelters with no cases. Conclusion SARS-CoV-2 prevalence varies with shelter characteristics but not individual symptoms. Policies that promote resident stability and physical distancing may help reduce SARS-CoV-2 transmission. Symptom screening alone is insufficient to prevent SARS-CoV-2 transmission. Frequent universal testing and congregate housing alternatives that promote stability may help reduce spread of infection.

Seroprevalence and risk factors of exposure to COVID-19 in homeless people in Paris, France: a cross-sectional study

“…6,7,20 Our findings show much higher seroprevalence compared with the general population, as reported by population-based surveys, which ranged between 9% and 11% in Ile-de-France in May, 2020. 2,3,9 The prevalence of asymptomatic or subclinical infections (up to 68%) in a younger population is consistent with other studies 6,7,21,22 but this fact combined with the very high exposure ratio, calls into question the utility of surveillance measures that only identify symptomatic cases and their contacts. Additional explanations might include difficulties in recalling symptoms and problems of selection, with previously symptomatic individuals potentially less willing or available to participate.…”

“…Important differences in sero prevalence were observed between regions: from only 1-3% in the least affected area (Nouvelle Aquitaine) to 9-11% in Ile-de-France, the region that includes Paris. [1][2][3] Differences in professions and living conditions also created uneven COVID-19 exposure risk, [4][5][6][7][8][9] with those experiencing homelessness particularly exposed to the disease.…”

Asymptomatic patients as a source of transmission of COVID-19 in homeless shelters

“…The large number of asymptomatic patients is an extremely important characteristic of SARS-CoV-2 infection; however, it becomes even more important in settings with specific vulnerabilities, such as homeless shelters, where the consequences on individual and public health may be dramatic ( Karb et al, 2020 ). In homeless shelters characterized by the physical proximity of residents, elevated population density, a limited use of face masks, and often precarious hygienic conditions outside the shelter, the reported prevalence of COVID-19 is higher than the general population ( Karb et al, 2020 ). Also, homeless persons have more physical and mental comorbidities, usually undiagnosed and uncontrolled, that may worsen the disease's course.…”

COVID-19 and homelessness: when crises intersect

“…Although subject to recall and reporting biases, similar findings have been documented in studies of PCR-confirmed SARS-CoV-2 infection among homeless populations elsewhere. 2 , 3 , 4 Following a cluster of COVID-19 cases emerging from a large homeless shelter in Boston, our team did universal testing of the 408 remaining shelter guests and found a 36% prevalence of SARS-CoV-2 infection, with 88% of infected individuals reporting no symptoms at the time of diagnosis. 2 The issue of asymptomatic infection is particularly important in congregate shelter settings because asymptomatically infected individuals can unknowingly transmit infection to large numbers of people in a short period of time, and a cornerstone of the US public health approach to mitigating COVID-19 among people experiencing homelessness has included routine symptom screening of shelter guests.…”

“…In the USA, heavily crowded or communal shelter settings appear to augment infection risk. 3 , 4 , 8 Conversely, emerging evidence has shown that unsheltered homeless individuals appear to be at lower risk for SARS-CoV-2 infection than are people residing in shelters. 7 On the basis of this body of evidence, we concur with the CDC's recommendations to avoid relocating unsheltered homeless individuals into congregate settings unless prevailing circumstances (eg, weather conditions) suggest there could be other important benefits to doing so, and decongesting existing congregate shelters where possible in favour of alternative housing arrangements with private or semi-private bedrooms and bathrooms.…”