Screening of SARS-CoV-2 among homeless people, asylum-seekers and other people living in precarious conditions in Marseille, France, March–April 2020

Abstract

150/150 words)Surveillance of SARS-CoV-2 infection among sheltered homeless and other vulnerable people might provide the information needed to prevent its spread within accommodation centres. In March-April, we enrolled 411 homeless individuals, 77 asylum-seekers, 58 people living in precarious conditions, and 152 employees working in these accommodation centres and collected nasal samples. SARS-CoV-2 carriage was assessed by quantitative PCR. Overall, 49 (7.0%) people were positive for SARS-CoV-2, including 37 homeless individuals (of 411, 9.0%), 12 employees (of 152, 7.9%). SARS-CoV-2 positivity correlated with symptoms, although 51% of positive patients did not report respiratory symptoms or fever. Among homeless people, being young (18-34 years) (OR: 3.83 [1.47-10.0], p=0.006) and being housed in one specific shelter ], p<0.0001) were independent factors associated with the SARS-CoV-2 positivity rates (11.4% and 20.6%, respectively). The survey reveals the role of collective housing in relation to viral transmission within centres.

Proportion of asymptomatic infection among COVID-19 positive persons and their transmission potential: A systematic review and meta-analysis

“…Overall, 22 unique cohorts of participants described in 24 studies (15 cohorts, 7 cross sectional) reported the proportion of asymptomatic infection at initial testing and/or the proportion of COVID-19 infections remaining asymptomatic throughout follow-up; study characteristics are summarized in Table 1 . Study cohorts were from the USA (n = 10) [ 6 , 9 , 60 – 62 , 66 , 69 , 73 , 75 , 78 , 80 , 81 ], Europe (n = 8) [ 63 , 67 , 68 , 70 , 72 , 74 , 76 , 77 ], and Asia (n = 4) [ 65 , 70 , 79 , 84 ]. Definition of asymptomatic infection was variable among studies, ranging from absence of symptoms in the previous 14 days to only absence of symptoms at time of testing.…”

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

“…Eight of the cross-sectional quantitative studies were conducted in the USA [18][19][20][21][22][23][24][25] , one in Canada 26 and one in France 27 . All studies collected data from March to early May 2020 during the first wave of the SARS-Cov-2 pandemic, except one 20 , conducted from April to August 2020.…”

“…Nine articles reported PCR-based estimates of SARS-Cov-2 prevalence (with some offering additional data on other health or living conditions of homeless people), while one study 24 researched shelter tenants' knowledge and perception of COVID-19 and their adherence to behavioural rules. A total of six articles reported prevalence estimates for staff working at the homeless facilities 18,[21][22][23]26,27 . Studies' characteristics are presented in Table 1 Prevalence of SARS-Cov2 in homeless shelters…”

“…In this systematic review including a total of 13 empirical studies, we identified a baseline Regarding health-related outcomes, specific symptoms, e.g. cough, shortness of breath or fever, were either uncommon or did not differ significantly from the overall tested population of PEH 19,21,22,24,25,27 , neither did comorbidities 25 . One study reported 12% treat-and-release emergency department visits, 8% hospitalization and 1% death among All steps of the review have been conducted by two reviewers for quality assurance.…”

“…The nature and direction of the infectious disease spread is unclear but staff working at shelters are at increased risk as well, reinforcing the importance of adherence to strategies of IPC in congregate shelters and the expansion of provision of non-congregate housing for PEH.Due to the absence or low prevalence of symptoms (e.g. fever) at the time of diagnosis of SARS-Cov-2 among PEH19,21,25,27 , symptom screening alone is not suitable, i.e. not sensitive enough for adequately capturing the extent of disease transmission in such high-risk settings.…”