Seroprevalence of SARS-CoV-2 Antibodies Among Homeless People Living Rough, in Shelters and Squats: A Large Population-Based Study in France

Abstract

Background: Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in France, taking into account different community settings. Methods: A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to receive a validated rapid assay for immunoglobulins M (IgM) and G (IgG) antibodies and to answer a questionnaire on medical health conditions, comorbidities, historic of symptoms compatible with COVID-19, with a retrospective calendar of types of accommodation since COVID-19 crisis. Results: From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. Seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3–7.0), with a range of 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P=0.009). Around one third of the seropositive participants reported symptoms with COVID-19. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced an significant increased risk of SARS-CoV-2 infection (|z|=3.65 > 1.96). Conclusion: These results highlight the need for organizing regular screening to prevent clusters forming in homeless accommodations and for providing basic resources for health maintenance.

“Locked down outside”: Perception of hazard and health resources in COVID-19 epidemic context among homeless people

“…), physical items in the building being touched permanently (door handles, furniture, common TV rooms). Effectively, we observed statistically higher rates of infection in emergency shelters in our seroprevalence study (Loubière et al, 2021), consistent with other studies in emergency shelters (Dubost et al, 2020;Kirby, 2020). In spite of a good application of barrier measures in emergency shelters, the density and organization of such places do not permit the protection of the people accommodated from COVID-19, as was correctly perceived by interviewees.…”

“…The quantitative study design and sample size has been described elsewhere (Loubière et al, 2021). In brief, participants were enrolled between June 1 and August 5, 2020.…”

Low prevalence of current and past SARS-CoV-2 infections among visitors and staff members of homelessness services in Amsterdam at the end of the second wave of infections in the Netherlands

“…The proportion of past infection (i.e. SARS-CoV-2 2 antibodies) in our study was also substantially lower than found in other countries such as France (22,23). A cross-sectional study conducted during the lockdown of the rst wave in Paris, SARS-CoV-2 seroprevalence ranged from 28% to 89% among 818 PEH and was highest among PEH who lived in densely populated worker residences (22).…”

“…A cross-sectional study conducted during the lockdown of the rst wave in Paris, SARS-CoV-2 seroprevalence ranged from 28% to 89% among 818 PEH and was highest among PEH who lived in densely populated worker residences (22). Another community-based study in June 2020 among 1,156 PEH in Marseille, France showed antibody positivity ranging from 2.2% in people who lived on the streets to 8.1% in people living in emergency shelters (23), which is more in line with our ndings. Considering the mixed results from these studies, SARS-CoV-2 (sero-)prevalence needs to be evaluated with at a country-speci c level and monitored at different timepoints among PEH.…”

Drivers and prevalence of COVID-19 vaccine uptake among homeless and precariously housed people in France: a cross-sectional population-based study

“…Evidence from the early COVID-19 waves suggests that population subgroups, such as people experiencing homelessness (PEH) or precariously housed (PH), are disproportionately exposed to infection [1-3] and the severe forms of disease [4-6], as well as suffering from greater mental health and social impacts [7]. Transmission risk is worsened by factors specific to these groups, such as precarious living conditions, high population density, need to access food distribution services, poor access to sanitation and hygiene, and difficulties accessing care [1, 2, 3, 5, 7]. COVID-19 prevention measures such as social distancing and self-isolation are challenging to maintain for such groups [1, 3, 5].…”