Homeless people more vulnerable to coronavirus as 25 percent living in shelters test positive: CDC report
A large number of America’s homeless people, who live in shelters, as well as their staff members, have been impacted by the coronavirus pandemic. An estimated 25 percent of homeless people — 293 out of 1,192 tested — in the US have contracted COVID-19, according to a new report by the US Centers for Disease Control and Prevention (CDC). Additionally, 11 percent or 33 out of 313 staff members at these shelters also tested positive for COVID-19.
Shelters for homeless people are densely populated environments, similar to long-term care facilities. According to experts, homelessness poses multiple challenges that can worsen and intensify the spread of infectious diseases, including COVID-19. Homeless shelters are often crowded, making social distancing difficult. Many persons experiencing homelessness are older or have underlying medical conditions, placing them at higher risk for severe COVID-19-associated illness, says the CDC.
The current study was conducted across homeless shelters in four US cities: Boston, Massachusetts (one shelter); San Francisco, California (one); Seattle, Washington (three), and Atlanta, Georgia (two shelters). Healthcare workers conducted SARS-CoV-2 testing among residents and staff members at 19 homeless shelters all across the four cities with community transmission of COVID-19, from March 27-April 15.
“In the US, approximately 1.4 million persons access emergency shelter or transitional housing each year. These settings can pose risks for communicable disease spread. In late March and early April 2020, public health teams responded to clusters (two or more cases in the preceding two weeks) of COVID-19 in residents and staff members from five homeless shelters,” says the report.
The investigations were performed in coordination with academic partners, healthcare providers, and homeless service providers. Investigations included testing at commercial and public health laboratories for SARS-CoV-2, the virus that causes COVID-19, over approximately 1–2 weeks for residents and staff members at the five shelters.
“During the same period, the team in Seattle, Washington, also tested residents and staff members at 12 shelters where a single case in each had been identified. In Atlanta, Georgia, a team proactively tested residents and staff members at two shelters with no known COVID-19 cases in the preceding 2 weeks. In each city, the objective was to test all shelter residents and staff members at each assessed facility, irrespective of symptoms. Persons who tested positive were transported to hospitals or predesignated community isolation areas,” say experts.
Overall, 1,192 residents and 313 staff members were tested in 19 homeless shelters. According to the analysis, when testing followed identification of a cluster, high proportions of residents and staff members had positive test results for SARS-CoV-2 in Seattle (17% of residents; 17% of staff members), Boston (36%; 30%), and San Francisco (66%; 16%).
Testing in Seattle shelters, where only one previous case had been identified in each shelter, found a low prevalence of infection (5% of residents; 1% of staff members). The researchers say that among shelters in Atlanta where no cases had been reported, a low prevalence of infection was also identified (4% of residents; 2% of staff members). “Community incidence in the four cities (the average number of reported cases in the county per 100,000 persons per day during the testing period) varied, with the highest (14.4) in Boston and the lowest (5.7) in San Francisco (2),” says the study.
To protect homeless shelter residents and staff members, CDC recommends that homeless service providers implement recommended infection control practices, apply social distancing measures including ensuring residents’ heads are at least 6 feet (2 meters) apart while sleeping, besides promoting the use of cloth face coverings among all residents.
“These measures become especially important once ongoing COVID-19 transmission is identified within communities where shelters are located. Given the high proportion of positive tests in the shelters with identified clusters and evidence for presymptomatic and asymptomatic transmission of SARS-CoV-2, testing of all residents and staff members regardless of symptoms at shelters where clusters have been detected should be considered,” say experts.
They add, “If testing is easily accessible, regular testing in shelters before identifying clusters should also be considered. Testing all persons can facilitate isolation of those who are infected to minimize ongoing transmission in these settings.”