Congregate Shelter Characteristics and Prevalence of Asymptomatic SARS-CoV-2

AbstractBackgroundIndividuals experiencing homelessness residing in congregate shelters have increased risk for SARS-CoV-2 infection. Prevalence of asymptomatic SARS-CoV-2 in congregate shelters is high, but shelter characteristics associated with SARS-CoV-2 transmission are currently unknown.MethodsWe conducted a cross-sectional, multicenter cohort study across five congregate shelters in Rhode Island. We tested people 18 years of age and older staying in Rhode Island congregate shelters in April 2020 during the COVID-19 pandemic. A survey instrument was designed and implemented based on an a priori sample size. All consented participants reported basic demographics, recent travel, duration of time at the shelter, any symptomatology, and had their temperature and pulse oximetry measured. Each participant was tested for COVID-19 using nasopharyngeal swabbing. Shelter characteristics about location, occupancy, resident length of stay, and COVID-19 mitigation strategies were collected through structured phone questionnaire with shelter staff.ResultsA total of 302 individuals were screened and 299 participated across five homeless shelters. The median age was 47.9 (range 18-85) and 20% were female. Of the 299 participants, 35 (11.7%) were positive for SARS-CoV-2; rates varied among shelters, ranging from 0% to 35%. Among the participants in the study, 5% had a new cough, 4% shortness of breath, and 3% reported loss of taste or smell. Symptom prevalence did not vary significantly between positive and negative SARS-CoV-2 groups. Regular symptom screening was not associated with lower infection rates. Shelters with higher rates of positivity were in more densely populated areas, cared for a more transient populations, and instituted fewer social distancing practices for sleeping arrangements or mealtimes.Conclusions and RelevanceResidents of congregate shelters are at increased risk for asymptomatic transmission of SARS-CoV-2. To reduce transmission and enable continuation of low-threshold shelter services, there is a need for universal testing, implementation of infection control and physical distancing measures within congregate shelters, and expansion of non-congregate supportive housing.

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Shelter Characteristics, Infection Prevention Practices, and Universal Testing for SARS-CoV-2 at Homeless Shelters in 7 US Urban Areas

American Journal of Public Health ◽

10.2105/ajph.2021.306198 ◽

2021 ◽

pp. e1-e6

Author(s):

Julie L. Self ◽

Martha P. Montgomery ◽

Karrie-Ann Toews ◽

Elizabeth A. Samuels ◽

Elizabeth Imbert ◽

...

Keyword(s):

Urban Areas ◽

Infection Prevention ◽

The United States ◽

Homeless Shelters ◽

Infection Prevalence ◽

Universal Testing ◽

Modifiable Factors ◽

High Infection ◽

Sleeping Arrangements ◽

Risk Ratios

Objectives. To examine shelter characteristics and infection prevention practices in relation to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection point prevalence during universal testing at homeless shelters in the United States. Methods. SARS-CoV-2 testing was offered to clients and staff at homeless shelters, irrespective of symptoms. Site assessments were conducted from March 30 to June 1, 2020, to collect information on shelter characteristics and infection prevention practices. We assessed the association between SARS-CoV-2 infection prevalence and shelter characteristics, including 20 infection prevention practices by using crude risk ratios (RRs) and exact unconditional 95% confidence intervals (CIs). Results. Site assessments and SARS-CoV-2 testing results were reported for 63 homeless shelters in 7 US urban areas. Median infection prevalence was 2.9% (range = 0%–71.4%). Shelters implementing head-to-toe sleeping and excluding symptomatic staff from working were less likely to have high infection prevalence (RR = 0.5; 95% CI = 0.3, 0.8; and RR = 0.5; 95% CI = 0.4, 0.6; respectively); shelters with medical services available were less likely to have very high infection prevalence (RR = 0.5; 95% CI = 0.2, 1.0). Conclusions. Sleeping arrangements and staffing policies are modifiable factors that might be associated with SARS-CoV-2 infection prevalence in homeless shelters. Shelters should follow recommended practices to reduce the risk of SARS-CoV-2 transmission. (Am J Public Health. Published online ahead of print March 18, 2021: e1–e6. https://doi.org/10.2105/AJPH.2021.306198 )

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Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

10.1101/2020.09.28.20203166 ◽

2020 ◽

Author(s):

Lloyd A.C. Chapman ◽

Margot Kushel ◽

Sarah N. Cox ◽

Ashley Scarborough ◽

Caroline Cawley ◽

...

Keyword(s):

High Risk ◽

Infection Control ◽

Local Community ◽

Control Strategies ◽

The United States ◽

Homeless Shelters ◽

Homeless Shelter ◽

Cross Sectional ◽

Risk Environments ◽

Symptom Screening

AbstractBackgroundMultiple COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.MethodsWe developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase-chain-reaction (PCR) surveys conducted during COVID-19 outbreaks in five shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak in a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing and universal mask wearing.ResultsThe proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6% to 51.6%, which translated to basic reproduction number (R0) estimates of 2.9−6.2. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. With moderate community incidence (∼30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0=1.5), moderate-risk (R0=2.9), and high-risk (R0=6.2) shelter were, respectively: 0.33, 0.11 and 0.03 for daily symptom-based screening; 0.52, 0.27, and 0.04 for twice-weekly PCR testing; 0.47, 0.20 and 0.06 for universal masking; and 0.68, 0.40 and 0.08 for these strategies combined.ConclusionsIn high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom-screening, frequent PCR testing and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be adopted to reduce outbreak risk.

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SARS-CoV-2 seroprevalence among Vancouver public school staff in British Columbia, Canada

10.1101/2021.06.16.21258861 ◽

2021 ◽

Author(s):

David M Goldfarb ◽

Louise C Mâsse ◽

Allison W Watts ◽

Sarah M Hutchison ◽

Lauren Muttucomaroe ◽

...

Keyword(s):

British Columbia ◽

Blood Donors ◽

Close Contact ◽

Geographic Location ◽

Mitigation Strategies ◽

Contact Tracing ◽

School Staff ◽

Cross Sectional ◽

School Year ◽

Increased Risk

Importance: Contact-tracing studies suggest minimal secondary transmission in schools. However, there are limited school data accounting for asymptomatic cases, particularly late in the 2020/21 school year, and in the context of uninterrupted in-person schooling and widespread community transmission. Objectives: To determine the SARS-CoV-2 seroprevalence in a sample of school staff, compared to the community, and to COVID-19 rates among all students and staff within the same school population. Design: Incident COVID-19 cases among students and school staff using public health data, with an embedded cross-sectional serosurvey among school staff sampled from February 10 to May 15, 2021, comparing to age, sex and geographic location-matched blood donors sampled in January 2021. Setting: Vancouver School District (British Columbia, Canada) from kindergarten to grade 12. Participants: Active school staff enrolled from February 3 to April 23, 2021. Main outcome measures: SARS-CoV-2 antibodies in a sample of school staff using spike (S)-based testing (unvaccinated staff) or N-based serology testing (vaccinated staff). Results: The incidence of COVID-19 cases among students attending in-person was 9.8 per 1,000 students during the 2020/21 school year (N = 47,280 students), and among staff was 13 per 1,000 since the beginning of the pandemic (N = 7,071 active school staff). In total, 1,689 school staff (64% elementary, 28% secondary, 8.3% school board staff or multiple grades) completed the questionnaire, 78.2% had classroom responsibilities, and spent a median of 17.6 hours in class per week [IQR: 5.0 - 25 hours]. Although 21.5% (363/1,686) reported close contact with a COVID-19 case, only 1.4% (24/1688) of the school staff reported having had a positive viral nucleic acid test. Of this group, five believed they acquired the infection at school. The adjusted seroprevalence in staff who gave blood (1,556/1,689, 92.1%) was 2.3% [95%CI: 1.6 - 3.2%] compared to 2.3% [95%CI: 1.7 - 3.0%] in blood donors. Conclusion and relevance: Despite high reported COVID-19 cases among students and staff, and frequent within-school exposures, we found no detectable increase in seroprevalence among school staff above the community seroprevalence. These findings corroborate claims that, with appropriate mitigation strategies, in-person schooling is not associated with significantly increased risk for school staff.

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Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

BMC Medicine ◽

10.1186/s12916-021-01965-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Lloyd A. C. Chapman ◽

Margot Kushel ◽

Sarah N. Cox ◽

Ashley Scarborough ◽

Caroline Cawley ◽

...

Keyword(s):

High Risk ◽

Infection Control ◽

Local Community ◽

Control Strategies ◽

The United States ◽

Homeless Shelters ◽

Homeless Shelter ◽

Cross Sectional ◽

Symptom Screening ◽

Exposed Individual

Abstract Background COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks. Methods We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing. Results The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0 = 1.5), moderate-risk (R0 = 2.9), and high-risk (R0 = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community. Conclusions In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.

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A Silenced Population

Crisis ◽

10.1027/0227-5910/a000470 ◽

2017 ◽

Vol 38 (6) ◽

pp. 433-442 ◽

Cited By ~ 1

Author(s):

Kim Gryglewicz ◽

Melanie Bozzay ◽

Brittany Arthur-Jordon ◽

Gabriela D. Romero ◽

Melissa Witmeier ◽

...

Keyword(s):

At Risk ◽

Depressive Symptomatology ◽

The United States ◽

Future Research ◽

At Risk Youth ◽

Peer Relationship ◽

Student Records ◽

Cross Sectional ◽

Increased Risk ◽

Method Student

Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.

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Family History of Diabetes Is Associated with Increased Risk of Recurrent DKA in Pediatric Patients in Rhode Island

Diabetes ◽

10.2337/db18-1378-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1378-P

Author(s):

JANAKI D. VAKHARIA ◽

SUNGEETA AGRAWAL ◽

JANINE BACIC ◽

LISA S. TOPOR

Keyword(s):

Family History ◽

Rhode Island ◽

Pediatric Patients ◽

Family History Of Diabetes ◽

Increased Risk ◽

History Of

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Family Type Predicts Mental Health Problems in Young Adults: A Survey of Students at a University in Botswana

SOUTHERN AFRICAN JOURNAL OF SOCIAL WORK AND SOCIAL DEVELOPMENT ◽

10.25159/2415-5829/6823 ◽

2020 ◽

Vol 32 (2) ◽

Author(s):

Kennedy Amone-P'Olak ◽

Boniface Kealeboga Ramotuana

Keyword(s):

Mental Health ◽

Young Adults ◽

Mental Health Problems ◽

Single Mother ◽

Health Problems ◽

Family Type ◽

Cross Sectional ◽

Intact Family ◽

Increased Risk ◽

Family Types

In Africa, the structure of the family is changing rapidly. The effects of this change on mental health remain unknown. This study investigated the extent to which different family types (intact, single-mother, and multiple) predict mental health problems in young adults in Botswana (N = 264, mean age = 21.31, SD = 2.40). In a cross-sectional design, the study sampled students registered at various faculties at the University of Botswana. The revised symptoms checklist (SCL-90-R) was used to assess symptoms of mental health problems (depression, anxiety and hostility). Binary logistic regression analyses were performed to obtain odds ratios (ORs) and 95 per cent confidence intervals (CIs) of mental health problems for mother-only and multiple family types relative to the intact family type. Compared to the intact family type, single-mother (OR = 2.34; 95% CI: 1.21, 4.51) and multiple family types (OR = 1.56; CI: 0.88, 2.78) were associated with an increased risk of depression. For anxiety, the ORs were 2.27 (CI: 1.18, 4.38) and 1.10 (CI: 0.56, 1.82) for single-mother and multiple family types respectively. For hostility, the ORs were 2.60 (CI: 1.34, 5.04), and 0.79 (CI: 0.44, 1.42) for single-mother and multiple family types, respectively. Family types predict mental health problems in young adults and therefore the interventions to mitigate the effects should consider family backgrounds and the ramifications of family types for treatment and care.

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Association of Circulating Cholesterol Level with Cognitive Function and Mild Cognitive Impairment in the Elderly: A Community-based Population Study

Current Alzheimer Research ◽

10.2174/1567205017666200810165758 ◽

2020 ◽

Vol 17 (6) ◽

pp. 556-565

Author(s):

Yujie Guo ◽

Pengfei Li ◽

Xiaojun Ma ◽

Xiaochen Huang ◽

Zhuoheng Liu ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cognitive Function ◽

Cholesterol Level ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cross Sectional ◽

Increased Risk ◽

Aging Adults ◽

Female Subjects

Background: The present study was designed to examine the association of circulating cholesterol with cognitive function in non-demented community aging adults. Methods: This was a cross-sectional study including 1754 Chinese adults aged 55-80 years. The association between serum cholesterol levels and cognitive function was examined. Participants were categorized into four groups according to the quartile of circulating TC (total cholesterol), High Density Lipoprotein Cholesterol (HDL-c), Low Density Lipoprotein Cholesterol (LDL-c) levels and HDLc/ LDL-c ratio. The difference in cognitive performance among the groups was compared. Logistic regression model was used to determine the association of circulating cholesterol level with the risk of Mild Cognitive Impairment (MCI). Results: Mild increase of serum LDL-c level correlated with better visual and executive, language, memory and delayed recall abilities. Higher circulating TC and HDL-c levels were found to be associated with poorer cognitive function, especially in aging female subjects. Higher circulating TC, HDL-c and HDL/LDL ratio indicated an increased risk of MCI, especially in female subjects. Conclusion: Slight increase in circulating LDL-c level might benefit cognitive function in aging adults. However, higher circulating TC and HDL-c levels might indicate a decline of cognitive function, especially in aging female subjects.

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SARS-CoV-2 seroprevalence and asymptomatic viral carriage in healthcare workers: a cross-sectional study

Thorax ◽

10.1136/thoraxjnl-2020-215414 ◽

2020 ◽

Vol 75 (12) ◽

pp. 1089-1094 ◽

Cited By ~ 22

Author(s):

Adrian Shields ◽

Sian E Faustini ◽

Marisol Perez-Toledo ◽

Sian Jossi ◽

Erin Aldera ◽

...

Keyword(s):

Intensive Care ◽

Healthcare Workers ◽

Venous Blood ◽

Cross Sectional Study ◽

Nasopharyngeal Swab ◽

Sectional Study ◽

University Hospitals ◽

Cross Sectional ◽

General Internal ◽

Increased Risk

ObjectiveTo determine the rates of asymptomatic viral carriage and seroprevalence of SARS-CoV-2 antibodies in healthcare workers.DesignA cross-sectional study of asymptomatic healthcare workers undertaken on 24/25 April 2020.SettingUniversity Hospitals Birmingham NHS Foundation Trust (UHBFT), UK.Participants545 asymptomatic healthcare workers were recruited while at work. Participants were invited to participate via the UHBFT social media. Exclusion criteria included current symptoms consistent with COVID-19. No potential participants were excluded.InterventionParticipants volunteered a nasopharyngeal swab and a venous blood sample that were tested for SARS-CoV-2 RNA and anti-SARS-CoV-2 spike glycoprotein antibodies, respectively. Results were interpreted in the context of prior illnesses and the hospital departments in which participants worked.Main outcome measureProportion of participants demonstrating infection and positive SARS-CoV-2 serology.ResultsThe point prevalence of SARS-CoV-2 viral carriage was 2.4% (n=13/545). The overall seroprevalence of SARS-CoV-2 antibodies was 24.4% (n=126/516). Participants who reported prior symptomatic illness had higher seroprevalence (37.5% vs 17.1%, χ2=21.1034, p<0.0001) and quantitatively greater antibody responses than those who had remained asymptomatic. Seroprevalence was greatest among those working in housekeeping (34.5%), acute medicine (33.3%) and general internal medicine (30.3%), with lower rates observed in participants working in intensive care (14.8%). BAME (Black, Asian and minority ethnic) ethnicity was associated with a significantly increased risk of seropositivity (OR: 1.92, 95% CI 1.14 to 3.23, p=0.01). Working on the intensive care unit was associated with a significantly lower risk of seropositivity compared with working in other areas of the hospital (OR: 0.28, 95% CI 0.09 to 0.78, p=0.02).Conclusions and relevanceWe identify differences in the occupational risk of exposure to SARS-CoV-2 between hospital departments and confirm asymptomatic seroconversion occurs in healthcare workers. Further investigation of these observations is required to inform future infection control and occupational health practices.

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