Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study

Abstract

Background: Living conditions in homeless shelters may facilitate the transmission of COVID-19. Social determinants and pre-existing health conditions place homeless people at increased risk of severe disease. Described outbreaks in homeless shelters resulted in high proportions of infected residents and staff members. In addition to other infection prevention strategies, regular shelter-wide (universal) testing for COVID-19 may be valuable, depending on the level of community transmission and when resources permit. Methods: This was a prospective feasibility cohort study to evaluate universal testing for COVID-19 at a homeless shelter with 106 beds in Berlin, Germany. Co-researchers were recruited from the shelter staff. A PCR analysis of saliva or self-collected nasal/oral swab was performed weekly over a period of 3 weeks in July 2020. Acceptability and implementation barriers were analyzed by process evaluation using mixed methods including evaluation sheets, focus group discussion and a structured questionnaire. Results: Ninety-three out of 124 (75%) residents were approached to participate in the study. Fifty-one out of the 93 residents (54.8%) gave written informed consent. High retention rates (88.9% - 93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive. Language barriers were the main reason for non-participation. Flexibility of sample collection schedules, the use of video and audio materials, and concise written information were the main recommendations of the co-researchers for future implementation. Conclusion: Voluntary universal testing for COVID-19 is feasible in homeless shelters. Universal testing of high-risk facilities will require flexible approaches, considering the level of the community transmission, the available resources, and the local recommendations. Lack of human resources and laboratory capacity may be a major barrier for implementation of universal testing, requiring adapted approaches compared to standard individual testing. Assisted self-collection of specimens and barrier free communication may facilitate implementation in homeless shelters. Program planning must consider needs and life situation of homeless people, and guarantee confidentiality and autonomy.

Infektionsschutz für wohnungslose Menschen in Zeiten von Corona

“…Bei der Erfassung der COVID-19-Fälle nach § 36 Infektionsschutzgesetz (IfSG) werden Obdachlosenunterkünfte als einer von mehreren Einrichtungstypen aufgeführt. Ausgewiesen werden aber nur die Fälle aller Einrichtungstypen [7]. Für die Wohnungslosenhilfe ist eine differenzierte Erfassung unerlässlich.…”

Participatory development and implementation of inclusive digital health communication on COVID-19 with homeless people

“…In a previous COVID-19 project among PEH, we identified the necessity to address language barriers, to include digital information formats, and to use participatory approaches considering homeless people's needs and life situation (9). This follow-up project aimed a participatory development of inclusive health communication on COVID-19 to strengthen options for IPC for PEH.…”

Basic reproduction number projection for novel pandemics and variants. Ancestral SARS-CoV2 R0 projection

“…For example, South Korea's strategy of significantly increasing access to testing [124] in COVID-19, may have affected the signal quality. Conceivably, universal testing is more effective [125,126] but less efficient [127] than opportunistic, symptomatic testing [128][129][130][131]. Nevertheless, these strategies should converge when asymptomatic infection is rare.…”