The data showed varying COVID-19 spread in homeless shelters across the country, but underscored the impact the social determinants of health have on the disease spread.
New data from the Centers for Disease Control and Prevention (CDC) confirms what many in the healthcare industry long feared: homelessness is a key social determinant of health that increases the risk of COVID-19 contraction and mortality.
The data, published last week, looked at cluster coronavirus outbreaks in five cities across the United States: Boston (one shelter), San Francisco (one shelter), and Seattle (three shelters). Cluster outbreaks entailed at least two new cases in the span of two weeks among either residents or staff members.
The report also included data from 12 other homeless shelters in Seattle and one in Atlanta at which no residents or staff members had confirmed cases of coronavirus.
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Specifically, the researchers were looking to test all visitors to a homeless shelter, both staffer and resident, to understand the prevalence of the disease at the shelter. When an individual tested positive, irrespective of symptom emergence, that individual was either sent to a hospital or healthcare provider or relegated to self-isolation for 14 days.
On the whole, the analysis tested 1,192 residents and 313 staffers across the 19 shelters studied.
The researchers found coronavirus spread across all of the study shelters, although spread was more aggressive in the five that had already seen clusters.
Seventeen percent of staffers and residents each tested positive for the virus across all three Seattle shelters at which clusters had emerged. In Boston, 36 percent of residents and 30 percent of staffers tested positive for COVID-19, and in San Francisco those numbers hung at 66 percent and 16 percent, respectively.
Meanwhile, in the Seattle shelters where only one or no cases were reported, as well as in the Atlanta shelters with zero prevalence, the positive test rate was much lower. In low-incidence Seattle shelters, the positive test rate was 5 percent for residents and 1 percent for staffers. In Atlanta, those numbers were 4 percent and 2 percent, respectively.
Interestingly, community spread was not necessarily tied to high COVID-19 prevalence in shelters. For example, the average number of cases in Boston per 100,000 persons per day was 14.4, the highest of any of the cities studied. In San Francisco, which had the lowest community spread in the study, that number was at 5.7 cases.
Meanwhile, only about one-third of residents or staffers in the Boston shelter tested positive for the virus, while a whopping 66 percent of residents tested positive in San Francisco.
Although the study was limited in that it spanned a short test period and COVID-19 tests were limited, the researchers maintained that these results underscore the dangers of coronavirus spread among the homeless.
“Homelessness poses multiple challenges that can exacerbate and amplify the spread of COVID-19,” the researchers wrote. “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.”
Since the outbreak of the novel coronavirus, the CDC has been offering recommendations to help ease some of the challenges of keeping a homeless population healthy. Best practices include:
- Placing beds six feet apart
- Maintaining cleaning procedures
- Promoting use of cloth face coverings or masks in the facility
Testing may also be a solution to the noted spread in homeless shelters, although CDC did acknowledge that testing itself presents a number of problems.
“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,” the agency wrote. “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.”
This data comes as the healthcare industry continues to grapple with the impact the social determinants of health are playing on COVID-19 spread, mitigation, and mortality. As noted above, the homeless or housing insecure population is at high risk for contracting the disease because of difficulty remaining socially distanced.
Older populations, individuals who are low-income, and food insecure populations are also at high risk for the disease or will struggle with the social distancing protocol asserted to help stave off the disease.
Meanwhile, new data stores from the CDC and reports from individual states or municipalities confirm that ethnic minorities, specifically black and Latinx patients, are more likely to contract and die from the coronavirus.
Source: Patient Engagement Hit