Open Forum Infect Dis
. 2020 Oct 12;7(11):ofaa477.
doi: 10.1093/ofid/ofaa477. eCollection 2020 Nov.
Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Homeless Shelters in Chicago, Illinois-March-May, 2020
Isaac Ghinai 1 2 , Elizabeth S Davis 3 , Stockton Mayer 4 , Karrie-Ann Toews 1 2 , Thomas D Huggett 5 , Nyssa Snow-Hill 4 , Omar Perez 4 , Mary K Hayden 3 , Seena Tehrani 3 , A Justine Landi 3 , Stephanie Crane 3 , Elizabeth Bell 3 , Joy-Marie Hermes 3 , Kush Desai 3 , Michelle Godbee 3 , Naman Jhaveri 4 , Brian Borah 4 , Tracy Cable 4 , Sofia Sami 4 , Laura Nozicka 4 , Yi-Shin Chang 4 , Aditi Jagadish 1 4 , Mark Chee 1 6 , Brynna Thigpen 1 , Christopher Llerena 1 4 , Minh Tran 1 4 , Divya Meher Surabhi 1 4 , Emilia D Smith 1 4 , Rosemary G Remus 1 , Roweine Staszcuk 1 , Evelyn Figueroa 4 , Paul Leo 4 , Wayne M Detmer 5 , Evan Lyon 7 , Sarah Carreon 8 , Stacey Hoferka 9 , Kathleen A Ritger 1 , Wilnise Jasmin 1 , Prathima Nagireddy 1 , Jennifer Y Seo 1 , Marielle J Fricchione 1 , Janna L Kerins 1 , Stephanie R Black 1 , Lisa Morrison Butler 10 , Kimberly Howard 10 , Maura McCauley 10 , Todd Fraley 1 , M Allison Arwady 1 , Stephanie Gretsch 1 , Megan Cunningham 1 , Massimo Pacilli 1 , Peter S Ruestow 1 , Emily Mosites 2 , Elizabeth Avery 3 , Joshua Longcoy 3 , Elizabeth B Lynch 3 , Jennifer E Layden 1
Affiliations
- PMID: 33263069
- PMCID: PMC7665740
- DOI: 10.1093/ofid/ofaa477
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.
Keywords: COVID-19; SARS-CoV-2; congregate settings; homeless; transmission.