Addressing the COVID-19 Pandemic Among Persons Experiencing Homelessness: Steps to Protect a Vulnerable Population

The Homeless World Cup through storytelling: The narratives of Street Soccer players from Scotland and the USA

OBJECTIVES

The purpose of this paper was to explore: (a) What stories do the Street Soccer players draw upon to construct meaning around their experiences of trauma, social exclusion, and homelessness? and (b) What stories are linked to the subjective sport programming experience and resulting future orientations?

DESIGN

A longitudinal narrative approach was adopted with semi-structured interviews conducted with players from Scotland and the United States (n = 16, 7 female, 9 male, M age = 27.5) across three time points. Interviews were also conducted with significant others (n = 13) at time point three. All data were analyzed using thematic narrative analysis and represented in creative non-fiction approaches through three composite narratives.

RESULTS

These narratives depicted visceral accounts of complex and developmental trauma, along with consequential experiences that unfolded before, during, and after the Homeless World Cup. While both preparing for and attending the event, players recalled concurrent feelings of anxiety and pride which manifested in various resilient and maladaptive coping behaviors. As the stories progressed, players battled a post event crash by engaging in support seeking and/or self-destructive behaviors before positive implications of the Homeless World Cup materialized.

CONCLUSIONS

Through creative narrative approaches, this study presents novel and engaging accounts of players' experiences before, during, and after the event. We also identify potential safeguarding concerns that can be addressed through trauma-informed practices.

COVID-19 prevalence and infection control measures at homeless shelters and hostels in high-income countries: a scoping review

BACKGROUND

The COVID-19 pandemic has disproportionately impacted homeless populations and service workers, especially within homeless shelter/hostel settings. To date, there have been few evidence syntheses examining outbreaks of COVID-19 among both homeless shelter residents and service workers and no critical review of infection control and prevention (IPAC) measures. This scoping review offers a much-needed synthesis of COVID-19 prevalence within homeless shelters and a review of pertinent IPAC measures.  METHODS: We conducted a scoping review that aimed to synthesize academic and gray literature published from March 2020 to July 2021 pertaining to (1) the prevalence of COVID-19 among both residents and staff in homeless shelters and hostels in high-income countries and (2) COVID-19 IPAC strategies applied in these settings. Two reviewers independently screened the literature from several databases that included MEDLINE, PsycInfo, and the WHO's COVID-19 Global Health Portal. The extracted data was mapped, categorized, and thematically discussed.

RESULTS

Thematic analysis of 77 academic and gray literature documents revealed four key themes: (1) the demographics of COVID-19 in homeless shelters, (2) asymptomatic spread, (3) pre-existing vulnerability of people experiencing homelessness and shelters, and (4) the inconsistency and ineffectiveness of IPAC implementation.

CONCLUSION

This review offers a useful glimpse into the landscape of COVID-19 outbreaks in homeless shelters/hostels and the major contributing factors to these events. This review revealed that there is no clear indication of generally accepted IPAC standards for shelter residents and workers. This review also illustrated a great need for future research to establish IPAC best practices specifically for homeless shelter/hostel contexts. Finally, the findings from this review reaffirm that homelessness prevention is key to limiting disease outbreaks and the associated negative health outcomes in shelter populations. Limitations of this review included the temporal and database constraints of the search strategy, the exclusion of quality assessments of the literature, and the absence of investigation on the influence of emerging variants on public health policy.

SYSTEMATIC REVIEW REGISTRATION

This scoping review has not been registered on any database; the protocol is available on York University's Institutional Repository https://dx.doi.org/10.25071/10315/38513 .

Severe Acute Respiratory Syndrome Coronavirus 2 Reinfection Associates With Unstable Housing and Occurs in the Presence of Antibodies

BACKGROUND

The factors associated with severe acute respiratory coronavirus 2 (SARS-CoV-2) reinfection remain poorly defined.

METHODS

We identified patients with SARS-CoV-2 infection and at least 1 repeat reverse transcription polymerase chain reaction result a minimum of 90 days after the initial positive test and before 21 January 2021. Those with a repeat positive test were deemed to have reinfection (n = 75), and those with only negative tests were classified as convalescents (n = 1594). Demographics, coronavirus disease 2019 (COVID-19) severity, and treatment histories were obtained from the Boston Medical Center electronic medical record. Humoral responses were analyzed using SARS-CoV-2-specific enzyme-linked immunosorbent assays and pseudovirus neutralizations in a subset of reinfection (n = 16) and convalescent samples (n = 32). Univariate, multivariate, and time to event analyses were used to identify associations.

RESULTS

Individuals with reinfection had more frequent testing at shorter intervals compared with the convalescents. Unstable housing was associated with more than 2-fold greater chance of reinfection. Preexisting comorbidities and COVID-19 severity after the initial infection were not associated with reinfection. SARS-CoV-2 immunoglobulin G levels and pseudovirus neutralization were not different within the early weeks after primary infection and at a timepoint at least 90 days later in the 2 groups. In the convalescents, but not in those with reinfection, the late as compared with early humoral responses were significantly higher.

CONCLUSIONS

Reinfection associates with unstable housing, which is likely a marker for virus exposure, and reinfection occurs in the presence of SARS-CoV-2 antibodies.

COVID-19 in Homelessness: A Worldwide Scoping Review on Vulnerabilities, Risks, and Risk Management

Homeless individuals are at greater risk of death due to social inequalities during Covid-19 pandemic. Strategies taken for general population to prevent the spread of Covid-19, such as social distance, staying at home, and observing personal hygiene are not possible for this group of people. This is a scoping review on articles published and other credible resources published analyze studies done on homeless people during the COVID-19 pandemic. In this scoping review, for the first time, we studied published articles on the situation of the homeless during the Covid-19 epidemic and by extracting and categorizing vulnerabilities, risks, as well as risk management plans, Finally we presented, useful guidance for organizations providing health and social services during the spread of diseases.

Lower Prevalence of SARS-CoV-2 Infection Among People Experiencing Homelessness Tested in Outdoor Encampments Compared with Overnight Shelters - Denver, Colorado, June - July 2020

BACKGROUND

A better understanding of the risk for COVID-19 that people experiencing homelessness (PEH) face in congregate shelters versus unsheltered encampments is critical for an effective pandemic response.

METHODS

We analyzed factors associated with current and past SARS-CoV-2 infection among PEH in day and overnight shelters and encampments in Denver, Colorado, during June 2-July 28, 2020, and constructed multivariable logistic regression models to examine risk factors for SARS-CoV-2 RNA and seropositivity with age, race/ethnicity, testing location, testing month, and symptom status as predictor variables.

RESULTS

A total of 823 participants were tested for SARS-CoV-2 RNA, and 276 individuals were tested for SARS-CoV-2 antibodies. A greater percentage of PEH at overnight shelters tested positive for SARS-CoV-2 RNA (8.6% vs 2.5%, p<0.01) and antibodies (21.5% vs 8.7%, p=0.03) compared to encampments. In regression models, testing at an overnight shelter compared to testing at encampments (OR=3.03, 95% CI 1.16-9.02) had increased odds of a positive SARS-CoV-2 RNA result. Age >60 years compared to age <40 years (OR=5.92, 95% CI 1.83-20.3), Hispanic ethnicity (OR=3.43, 95% CI 1.36-8.95) and non-Hispanic Black race compared to non-Hispanic White race (OR=3.07, 95% CI 1.16-8.26), and testing at an overnight shelter compared to testing at encampments (OR=2.45, 95% CI 1.04-6.17) had increased odds of a positive antibody result.

CONCLUSIONS

Our findings support the need for continuing assessment of mitigation strategies in shelters, increasing access to individual rooms and linkage to housing options for PEH, and supporting people to remain in encampments when these options are not available.

Orange County, California COVID-19 Vaccine Equity Best Practices Checklist: A Community-Centered Call to Action for Equitable Vaccination Practices

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated longstanding inequities throughout the United States, disproportionately concentrating adverse social, economic, and health-related outcomes among low-income communities and communities of color. Inequitable distribution, prioritization, and uptake of COVID-19 vaccines due to systemic and organizational barriers add to these disproportionate impacts across the United States. Similar patterns have been observed within Orange County, California (OC). Methods: In response to COVID-19 vaccine inequities unfolding locally, the Orange County Health Equity COVID-19 community-academic partnership generated a tool to guide a more equitable vaccine approach. Contents of the OC vaccine equity best practices checklist emerged through synthesis of community-level knowledge about vaccine inequities, literature regarding equitable vaccination considerations, and practice-based health equity guides. We combined into a memo: the checklist, a written explanation of its goals and origins, and three specific action steps meant to further strengthen the focus on vaccine equity. The memo was endorsed by partnership members and distributed to county officials. Discussion: Since the initial composition of the checklist, the local vaccine distribution approach has shifted, suggesting that equitable pandemic responses require continual re-evaluation of local needs and adjustments to recommendations as new information emerges. To understand and address structural changes needed to reduce racial and socioeconomic inequities exacerbated by the pandemic, authentic partnerships between community, academic, and public health practice partners are necessary. Conclusion: As we face continued COVID-19 vaccine rollout, booster vaccination, and future pandemic challenges, community knowledge and public health literature should be integrated to inform similar equity-driven strategic actions.

How Could POCT be a Useful Tool for Migrant and Refugee Health?

Point of care testing (POCT) represents an important step forward in the clinical management of patients. POC assays are easy to use and do not require skilled personnel; therefore they are particularly useful in low resource settings where diagnostics laboratories equipped with complex instruments that require well trained technicians are not available. Samples can be processed immediately overcoming the problems related to the stability of the sample, storage and shipping to a centralized laboratory hospital based. Furthermore, results are delivered in real-time, usually less than 1 hr; thus, a clinical decision can be taken earlier. A prompt diagnosis is crucial in the case of contagious diseases allowing a rapid isolation of the infected patient and treatment; thus, reducing the risk of transmission of the pathogen. In this report, we address the use of POC assays in the diagnosis of infectious pathogens including hepatitis B and C viruses, human immunodeficiency virus-type 1, human papillomavirus, chlamydia trachomatis, neisseria gonorrhea, trichomonas vaginalis, mycobacterium tuberculosis and the parasite plasmodium. These pathogens are commonly detected among vulnerable people such as refugees and migrants. The described POC assays are based on nuclei acid amplification technology (NAAT) that is generally characterized by a high sensitivity and specificity.