SARS-Cov-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters: Systematic review and meta-analysis

Mohsenpour, Amir; Bozorgmehr, Kayvan; Rohleder, Sven; Stratil, Jan M.; Costa, Diogo

doi:10.1016/j.eclinm.2021.101032

Cited by 49 publications

(46 citation statements)

References 59 publications

(109 reference statements)

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“…COVID-19 outbreaks have been observed in homeless shelters with high proportions of infected residents and staff, including a high number of asymptomatic individuals [ 8 , 12 , 36 , 37 ]. Homeless people should be considered particularly vulnerable to SARS-CoV-2 infection and its complications [ 7 ], and a comprehensive infection prevention strategy is required.…”

Section: Discussionmentioning

confidence: 99%

“…Congregate living settings in community shelters for homeless people that have shared bedrooms and sanitary facilities, facilitate the transmission of COVID-19 [ 11 , 12 ]. The German infectious diseases notification system does not allow identification of homeless status and to our knowledge there is no data on the prevalence of COVID-19 among homeless people in Germany.…”

Section: Introductionmentioning

confidence: 99%

“…A systematic review and meta-analysis on SARS-CoV-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters concluded that homeless people are at high risk of SARS-CoV-2 infection. During outbreaks in shelters, the pooled SARS-CoV-2 prevalence was 32% in homeless people and 15% in staff [ 12 ]. A low prevalence of symptoms at time of SARS-CoV-2 diagnosis was reported [ 13 – 15 ].…”

Section: Introductionmentioning

confidence: 99%

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

Lindner

Sarma

Rust³

et al. 2021

BMC Infect Dis

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Background Living conditions in homeless shelters 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; thus 41.1% (51 out of 124) of all residents were included in the study. Among these, high retention rates (88.9–93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. Around 48 person-hours were necessary for the sample collection including the preparation of materials. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive by RT-PCR. 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. Conclusions 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 homeless people’s needs and life situation, and guarantee confidentiality and autonomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Lindner

Sarma

Rust³

et al. 2021

BMC Infect Dis

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“…Homeless shelter workers provide critical infrastructure services [5] and often work in shared spaces with the potential for prolonged close contact with other staff and clients. A meta-analysis of COVID-19 in homeless shelters estimated a pooled prevalence among shelter workers of 14.8% during outbreaks and 1.55% during non-outbreak situations [6]. Homeless shelter workers may be at increased risk for COVID-19 due to frequent exposure to disease and infectious agents in the workplace.…”

Section: Introductionmentioning

confidence: 99%

Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19

et al. 2021

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Objective To describe the work environment and COVID-19 mitigation measures for homeless shelter workers and assess occupational risk factors for COVID-19. Methods Between June 9-August 10, 2020, we conducted a self-administered survey among homeless shelter workers in Washington, Massachusetts, Utah, Maryland, and Georgia. We calculated frequencies for work environment, personal protective equipment use, and SARS-CoV-2 testing history. We used generalized linear models to produce unadjusted prevalence ratios (PR) to assess risk factors for SARS-CoV-2 infection. Results Of the 106 respondents, 43.4% reported frequent close contact with clients; 75% were worried about work-related SARS-CoV-2 infections; 15% reported testing positive. Close contact with clients was associated with testing positive for SARS-CoV-2 (PR 3.97, 95%CI 1.06, 14.93). Conclusions Homeless shelter workers may be at risk of being exposed to individuals with COVID-19 during the course of their work. Frequent close contact with clients was associated with SARS-CoV-2 infection. Protecting these critical essential workers by implementing mitigation measures and prioritizing for COVID-19 vaccination is imperative during the pandemic.

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“…COVID-19 outbreaks have been reported in homeless shelters across the United States ( 1 ). Many persons experiencing homelessness are older adults or persons with underlying medical conditions, placing them at increased risk for severe COVID-19–associated illness.…”

mentioning

confidence: 99%

Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness — Six U.S. Jurisdictions, December 2020–August 2021

Montgomery¹,

Meehan²,

Cooper³

et al. 2021

MMWR Morb. Mortal. Wkly. Rep.

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COVID-19 outbreaks have been reported in homeless shelters across the United States (1). Many persons experiencing homelessness are older adults or persons with underlying medical conditions, placing them at increased risk for severe COVID-19-associated illness. The proportion of persons experiencing homelessness who are fully vaccinated against COVID-19 in the United States is currently unknown. Many persons experiencing homelessness express a willingness to receive the COVID-19 vaccine (2,3).Through conversations with public health and housing assistance partners, CDC identified six* urban public health jurisdictions with data on vaccination coverage among persons experiencing homelessness. These six jurisdictions reported data on COVID-19 vaccinations † administered to persons experiencing intermittent homelessness during December 13, 2020-August 31, 2021. Full vaccination status § and evidence of coverage with at least 1 COVID-19 vaccine dose ¶ among persons experiencing homelessness were obtained by performing data linkage between immunization information systems and homeless services data systems or through data collection during vaccination events at homeless service sites. Total populations of persons experiencing homelessness were estimated using either the total number of persons accessing homeless * The six jurisdictions included

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SARS-Cov-2 prevalence, transmission, health-related outcomes and control strategies in homeless shelters: Systematic review and meta-analysis

Cited by 49 publications

References 59 publications

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

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

Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19

Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness — Six U.S. Jurisdictions, December 2020–August 2021

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