tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2020 Oct 12;7(11)
faa477.
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[SUP] 1 2 [/SUP], Elizabeth S Davis[SUP] 3 [/SUP], Stockton Mayer[SUP] 4 [/SUP], Karrie-Ann Toews[SUP] 1 2 [/SUP], Thomas D Huggett[SUP] 5 [/SUP], Nyssa Snow-Hill[SUP] 4 [/SUP], Omar Perez[SUP] 4 [/SUP], Mary K Hayden[SUP] 3 [/SUP], Seena Tehrani[SUP] 3 [/SUP], A Justine Landi[SUP] 3 [/SUP], Stephanie Crane[SUP] 3 [/SUP], Elizabeth Bell[SUP] 3 [/SUP], Joy-Marie Hermes[SUP] 3 [/SUP], Kush Desai[SUP] 3 [/SUP], Michelle Godbee[SUP] 3 [/SUP], Naman Jhaveri[SUP] 4 [/SUP], Brian Borah[SUP] 4 [/SUP], Tracy Cable[SUP] 4 [/SUP], Sofia Sami[SUP] 4 [/SUP], Laura Nozicka[SUP] 4 [/SUP], Yi-Shin Chang[SUP] 4 [/SUP], Aditi Jagadish[SUP] 1 4 [/SUP], Mark Chee[SUP] 1 6 [/SUP], Brynna Thigpen[SUP] 1 [/SUP], Christopher Llerena[SUP] 1 4 [/SUP], Minh Tran[SUP] 1 4 [/SUP], Divya Meher Surabhi[SUP] 1 4 [/SUP], Emilia D Smith[SUP] 1 4 [/SUP], Rosemary G Remus[SUP] 1 [/SUP], Roweine Staszcuk[SUP] 1 [/SUP], Evelyn Figueroa[SUP] 4 [/SUP], Paul Leo[SUP] 4 [/SUP], Wayne M Detmer[SUP] 5 [/SUP], Evan Lyon[SUP] 7 [/SUP], Sarah Carreon[SUP] 8 [/SUP], Stacey Hoferka[SUP] 9 [/SUP], Kathleen A Ritger[SUP] 1 [/SUP], Wilnise Jasmin[SUP] 1 [/SUP], Prathima Nagireddy[SUP] 1 [/SUP], Jennifer Y Seo[SUP] 1 [/SUP], Marielle J Fricchione[SUP] 1 [/SUP], Janna L Kerins[SUP] 1 [/SUP], Stephanie R Black[SUP] 1 [/SUP], Lisa Morrison Butler[SUP] 10 [/SUP], Kimberly Howard[SUP] 10 [/SUP], Maura McCauley[SUP] 10 [/SUP], Todd Fraley[SUP] 1 [/SUP], M Allison Arwady[SUP] 1 [/SUP], Stephanie Gretsch[SUP] 1 [/SUP], Megan Cunningham[SUP] 1 [/SUP], Massimo Pacilli[SUP] 1 [/SUP], Peter S Ruestow[SUP] 1 [/SUP], Emily Mosites[SUP] 2 [/SUP], Elizabeth Avery[SUP] 3 [/SUP], Joshua Longcoy[SUP] 3 [/SUP], Elizabeth B Lynch[SUP] 3 [/SUP], Jennifer E Layden[SUP] 1 [/SUP]
Affiliations
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.
. 2020 Oct 12;7(11)
faa477.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[SUP] 1 2 [/SUP], Elizabeth S Davis[SUP] 3 [/SUP], Stockton Mayer[SUP] 4 [/SUP], Karrie-Ann Toews[SUP] 1 2 [/SUP], Thomas D Huggett[SUP] 5 [/SUP], Nyssa Snow-Hill[SUP] 4 [/SUP], Omar Perez[SUP] 4 [/SUP], Mary K Hayden[SUP] 3 [/SUP], Seena Tehrani[SUP] 3 [/SUP], A Justine Landi[SUP] 3 [/SUP], Stephanie Crane[SUP] 3 [/SUP], Elizabeth Bell[SUP] 3 [/SUP], Joy-Marie Hermes[SUP] 3 [/SUP], Kush Desai[SUP] 3 [/SUP], Michelle Godbee[SUP] 3 [/SUP], Naman Jhaveri[SUP] 4 [/SUP], Brian Borah[SUP] 4 [/SUP], Tracy Cable[SUP] 4 [/SUP], Sofia Sami[SUP] 4 [/SUP], Laura Nozicka[SUP] 4 [/SUP], Yi-Shin Chang[SUP] 4 [/SUP], Aditi Jagadish[SUP] 1 4 [/SUP], Mark Chee[SUP] 1 6 [/SUP], Brynna Thigpen[SUP] 1 [/SUP], Christopher Llerena[SUP] 1 4 [/SUP], Minh Tran[SUP] 1 4 [/SUP], Divya Meher Surabhi[SUP] 1 4 [/SUP], Emilia D Smith[SUP] 1 4 [/SUP], Rosemary G Remus[SUP] 1 [/SUP], Roweine Staszcuk[SUP] 1 [/SUP], Evelyn Figueroa[SUP] 4 [/SUP], Paul Leo[SUP] 4 [/SUP], Wayne M Detmer[SUP] 5 [/SUP], Evan Lyon[SUP] 7 [/SUP], Sarah Carreon[SUP] 8 [/SUP], Stacey Hoferka[SUP] 9 [/SUP], Kathleen A Ritger[SUP] 1 [/SUP], Wilnise Jasmin[SUP] 1 [/SUP], Prathima Nagireddy[SUP] 1 [/SUP], Jennifer Y Seo[SUP] 1 [/SUP], Marielle J Fricchione[SUP] 1 [/SUP], Janna L Kerins[SUP] 1 [/SUP], Stephanie R Black[SUP] 1 [/SUP], Lisa Morrison Butler[SUP] 10 [/SUP], Kimberly Howard[SUP] 10 [/SUP], Maura McCauley[SUP] 10 [/SUP], Todd Fraley[SUP] 1 [/SUP], M Allison Arwady[SUP] 1 [/SUP], Stephanie Gretsch[SUP] 1 [/SUP], Megan Cunningham[SUP] 1 [/SUP], Massimo Pacilli[SUP] 1 [/SUP], Peter S Ruestow[SUP] 1 [/SUP], Emily Mosites[SUP] 2 [/SUP], Elizabeth Avery[SUP] 3 [/SUP], Joshua Longcoy[SUP] 3 [/SUP], Elizabeth B Lynch[SUP] 3 [/SUP], Jennifer E Layden[SUP] 1 [/SUP]
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.