Lower Prevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Among People Experiencing Homelessness Tested in Outdoor Encampments Compared With Overnight Shelters: Denver, Colorado, June–July 2020

Abstract

Background A better understanding of the risk for COVID-19 that people experiencing homelessness (PEH) face in congregate shelters versus unsheltered encampments is critical for an effective pandemic response. Methods We analyzed factors associated with current and past SARS-CoV-2 infection among PEH in day and overnight shelters and encampments in Denver, Colorado, during June 2-July 28, 2020, and constructed multivariable logistic regression models to examine risk factors for SARS-CoV-2 RNA and seropositivity with age, race/ethnicity, testing location, testing month, and symptom status as predictor variables. Results A total of 823 participants were tested for SARS-CoV-2 RNA, and 276 individuals were tested for SARS-CoV-2 antibodies. A greater percentage of PEH at overnight shelters tested positive for SARS-CoV-2 RNA (8.6% vs 2.5%, p<0.01) and antibodies (21.5% vs 8.7%, p=0.03) compared to encampments. In regression models, testing at an overnight shelter compared to testing at encampments (OR=3.03, 95% CI 1.16-9.02) had increased odds of a positive SARS-CoV-2 RNA result. Age >60 years compared to age <40 years (OR=5.92, 95% CI 1.83-20.3), Hispanic ethnicity (OR=3.43, 95% CI 1.36-8.95) and non-Hispanic Black race compared to non-Hispanic White race (OR=3.07, 95% CI 1.16-8.26), and testing at an overnight shelter compared to testing at encampments (OR=2.45, 95% CI 1.04-6.17) had increased odds of a positive antibody result. Conclusions Our findings support the need for continuing assessment of mitigation strategies in shelters, increasing access to individual rooms and linkage to housing options for PEH, and supporting people to remain in encampments when these options are not available.

Ku-gaa-gii pimitizi-win, the COVID-19 cohort study of people experiencing homelessness in Toronto, Canada: a study protocol

“…Specific settings, including emergency shelters and those with overcrowding or communal sleeping arrangements, are associated with increased risk of infection, presumably due to greater exposure during outbreaks compared with PEH living outdoors or in private and/or well distanced accommodations 15–18 24–27. In Wales, where PEH were comprehensively housed in private settings during the pandemic, COVID-19 prevalence was lower than in the general population 30.…”

“…[8][9][10][11][12] To date, most studies describing incidence or prevalence of COVID-19 among PEH have been cross-sectional in design, many focussing on a convenience sample of shelters during the first or second waves (from March to December 2020). As a result, estimates from these studies vary widely depending on setting, timing and preventive measures in place, [13][14][15][16][17][18][19][20][21][22][23][24][25] with variability primarily determined by whether the settings, in most cases emergency shelters, were experiencing an outbreak. 13 15 16 19 26 One study using a longitudinal design estimated 6% prevalence in summer 2020, increasing to 18.9% within 90 days (coinciding with the early part of the second wave).…”

Incidence of SARS-CoV-2 Infection Among People Experiencing Homelessness in Toronto, Canada

“…[2][3][4] Moreover, people experiencing homelessness have intersecting physical, mental, and social burdens that increase morbidity and mortality relative to housed individuals, 5 including adverse outcomes following SARS-CoV-2 infection. 5 To date, seroprevalence estimates from studies describing SARS-CoV-2 infection rates among people experiencing homelessness 3,4,[6][7][8][9][10][11][12][13][14][15][16][17][18] have varied widely, reflecting the timing of data collection, the wider social and policy setting, infection prevention measures in place, and whether outbreaks were under way. These studies similarly show wide variability in individual-, network-, and systemlevel factors associated with infection, suggesting these too may be context-specific.…”

The clinical and genomic epidemiology of seasonal human coronaviruses in congregate homeless shelter settings: A repeated cross-sectional study

“…8 Respiratory virus transmission in shelters can occur because of difficulties with contact tracing, maintaining physical distance and providing effective ventilation. 7 , 9 , 10 , 11 , 12 PEH are disproportionately affected by chronic disease, mental health issues, substance use, limited financial resources and preventive healthcare access. 13 SARS-CoV-2 outbreaks in shelters highlight the risk of respiratory viral transmission in these settings.…”

“… 13 SARS-CoV-2 outbreaks in shelters highlight the risk of respiratory viral transmission in these settings. 12 , 14 However, little is known about HCoV epidemiology in homeless shelters.…”