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

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

10.1101/2020.10.04.20205401 ◽

2020 ◽

Author(s):

Andreas K. Lindner ◽

Navina Sarma ◽

Luise Marie Rust ◽

Theresa Hellmund ◽

Svetlana Krasovski-Nikiforovs ◽

...

Keyword(s):

Cohort Study ◽

Program Planning ◽

Retention Rates ◽

Homeless Shelters ◽

Homeless Shelter ◽

Major Barrier ◽

Oral Swab ◽

Universal Testing ◽

Increased Risk ◽

Community Transmission

AbstractBackgroundLiving conditions in homeless shelters may 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.MethodsThis 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.ResultsNinety-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. High retention rates (88.9% – 93.6%) of a weekly respiratory specimen were reached, but repeated collection attempts, as well as assistance were required. A self-collected nasal/oral swab was considered easier and more hygienic to collect than a saliva specimen. No resident was tested positive. 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.ConclusionVoluntary 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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79. Detroit’s Response to COVID-19 in Homeless Shelters

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.389 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S171-S171

Author(s):

Gina Maki ◽

David Bowser ◽

Anita Shallal ◽

Tyler Prentiss ◽

Marcus Zervos ◽

...

Keyword(s):

At Risk ◽

Healthcare Access ◽

Health Department ◽

Poverty Rate ◽

Homeless Shelters ◽

Homeless Shelter ◽

Surveillance Strategy ◽

Hospital System ◽

Transient Nature ◽

Universal Testing

Abstract Background Detroit, Michigan has a poverty rate nearly three times the national average. Homeless shelters are at risk for infectious outbreaks due to reduced healthcare access for residents, compounded by overcrowding, hygienic challenges, lack of resources, and transient nature of residents. Prior to the first reported COVID-19 case in Michigan, the Detroit Health Department prioritized screening of both asymptomatic and symptomatic homeless residents residing in the city’s shelters. Early identification of COVID-19 positive cases allowed for implementation of strategies to halt further spread. Methods A surveillance strategy was implemented prior to the first confirmed COVID-19 case in Michigan. Surveillance involved temperature and symptom checks at each homeless shelter, three times weekly. 24 shelters were screened for symptoms, 13 shelters had universal testing performed. Two city-operated quarantine sites for COVID-positive and –suspected homeless individuals were organized. If a shelter resident tested positive, that shelter was placed in quarantine, and new referrals stopped for 14 days. Temperature and symptom check frequency increased to daily for 14 days. If a patient was positive for fever or symptoms, they were transferred to the quarantine center for testing and isolation. Results Over 23,000 temperature and symptom checks occurred in 24 shelters across Detroit since February 22. This identified 15 patients who were referred to the quarantine site. From April 11 to May 31, 721 residents from 13 homeless shelters were screened with universal testing for COVID-19, and 93 (12.9%) tested positive (Figure 1). Of 95 homeless residents who were referred through shelter surveillance, from the local hospital system and via unsheltered street outreach, and tested on-site at the quarantine and isolation shelter, 29 (31%) tested positive for COVID-19, and 66 (69%) tested negative. Figure 1. System-wide homeless shelter testing of COVID-19 Conclusion Homeless populations across the US are especially vulnerable to COVID-19, with high risk for rapid spread due to crowding and difficulty with physical distancing. The need for increased testing- and prevention-based strategies in this population is crucial. The process performed in Detroit’s homeless shelters can be a model for other communities at risk for COVID-19 outbreaks. Disclosures Marcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)

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Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Homeless Shelters in Chicago, Illinois—March–May, 2020

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa477 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Isaac Ghinai ◽

Elizabeth S Davis ◽

Stockton Mayer ◽

Karrie-Ann Toews ◽

Thomas D Huggett ◽

...

Keyword(s):

Risk Factors ◽

Severe Acute Respiratory Syndrome ◽

Prevalence Ratio ◽

Homeless Shelters ◽

Specimen Collection ◽

Increased Risk ◽

High Prevalence ◽

Community Transmission ◽

Facility Level ◽

Available Information

Abstract Background People experiencing homelessness are at increased risk of coronavirus disease 2019 (COVID-19), but little is known about specific risk factors for infection within homeless shelters. Methods We performed widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction testing and collected risk factor information at all homeless shelters in Chicago with at least 1 reported case of COVID-19 (n = 21). Multivariable, mixed-effects log-binomial models were built to estimate adjusted prevalence ratios (aPRs) for SARS-CoV-2 infection for both individual- and facility-level risk factors. Results During March 1 to May 1, 2020, 1717 shelter residents and staff were tested for SARS-CoV-2; 472 (27%) persons tested positive. Prevalence of infection was higher for residents (431 of 1435, 30%) than for staff (41 of 282, 15%) (prevalence ratio = 2.52; 95% confidence interval [CI], 1.78–3.58). The majority of residents with SARS-CoV-2 infection (293 of 406 with available information about symptoms, 72%) reported no symptoms at the time of specimen collection or within the following 2 weeks. Among residents, sharing a room with a large number of people was associated with increased likelihood of infection (aPR for sharing with >20 people compared with single rooms = 1.76; 95% CI, 1.11–2.80), and current smoking was associated with reduced likelihood of infection (aPR = 0.71; 95% CI, 0.60–0.85). At the facility level, a higher proportion of residents leaving and returning each day was associated with increased prevalence (aPR = 1.08; 95% CI, 1.01–1.16), whereas an increase in the number of private bathrooms was associated with reduced prevalence (aPR for 1 additional private bathroom per 100 people = 0.92; 95% CI, 0.87–0.98). Conclusions We identified a high prevalence of SARS-CoV-2 infections in homeless shelters. Reducing the number of residents sharing dormitories might reduce the likelihood of SARS-CoV-2 infection. When community transmission is high, limiting movement of persons experiencing homelessness into and out of shelters might also be beneficial.

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