1
|
Wüsthoff LEC, Lund-Johansen F, Henriksen K, Wildendahl G, Jacobsen JA, Gomes L, Anjum HS, Barlinn R, Kran AMB, Munthe LA, Vaage JT. Seroprevalence of SARS-CoV-2 and humoral immune responses to COVID-19 mRNA vaccines among people who use drugs - in the light of tailored mitigating strategies. Harm Reduct J 2024; 21:120. [PMID: 38890611 PMCID: PMC11186241 DOI: 10.1186/s12954-024-01023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/14/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND During the initial wave of the COVID-19 pandemic, there was a surprisingly low incidence of SARS-CoV-2 among People Who Use Drugs (PWUD) in Oslo, Norway, despite their heightened vulnerability regarding risk of infection and severe courses of the disease.This study aims to investigate the seroprevalence of SARS-CoV-2 antibodies among PWUD, their antibody responses to relevant virus infections and COVID-19 mRNA vaccines, and their vaccination coverage compared to the general population. METHODS Conducted as a prospective cohort study, data was collected from residents in six institutions for homeless PWUD and users of a low-threshold clinic for opioid agonist treatment. Ninety-seven participants were recruited for SARS-CoV-2 seroprevalence analysis. Additional two participants with known positive SARS-CoV-2 test results were recruited for further analyses. Twenty-five participants completed follow-up. Data included questionnaires, nasal swabs and blood samples. Data on vaccination coverage was obtained from the National Vaccine Register. Serologic methods included detection of antibodies to relevant virus proteins, neutralizing antibodies to SARS-CoV-2, antibodies to the full-length spike protein, and receptor-binding domain from SARS-CoV-2. RESULTS Among PWUD, antibodies to SARS-CoV-2 were detected in 2 out of 97 samples before vaccines against SARS-CoV-2 were available, comparable to a 2.8% frequency in population-based screening. Levels of serum antibodies to seasonal coronaviruses and Epstein-Barr-Virus (EBV) in PWUD were similar to population-based levels. After the second vaccine dose, binding and neutralizing antibody levels to SARS-CoV-2 in PWUD were comparable to controls. Eighty-four of PWUD received at least one dose of COVID-19 mRNA vaccine, compared to 89% in the general population. CONCLUSION Results indicate that PWUD did not exhibit increased SARS-CoV-2 seroprevalence or elevated serum antibodies to seasonal coronaviruses and EBV. Moreover, vaccine responses in PWUD were comparable to controls, suggesting that vaccination is effective in conferring protection against SARS-CoV-2 also in this population.
Collapse
Affiliation(s)
- Linda Elise Couëssurel Wüsthoff
- Unit for Clinical Research on Addictions, Oslo University Hospital, PO Box 4959 Nydalen, Oslo, 0424, Norway.
- Norwegian Centre for Addiction Reasearch, Institute of Clinical Medicine, University of Oslo, PO Box 1039 Blindern, Oslo, 0315, Norway.
| | - Fridtjof Lund-Johansen
- Department of Immunology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
- ImmunoLingo Convergence Center, Institute of Clinical Medicine, University of Oslo, Gaustadalleen 21, Oslo, 0349, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, Oslo, 0318, Norway
- Precision Immunotherapy Alliance, Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318, Oslo, Norway
| | - Kathleen Henriksen
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
- Student Health Services, Student Welfare Services in Oslo, Problemveien 9, Oslo, 0313, Norway
| | - Gull Wildendahl
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Jon-Aksel Jacobsen
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Leni Gomes
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Hina Sarwar Anjum
- Agency for Social and Welfare Services, Oslo Municipality, PO Box 30 Sentrum, Oslo, 0101, Norway
| | - Regine Barlinn
- Department of Microbiology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
| | - Anne-Marte Bakken Kran
- Division of Infection Control, Norwegian Institute of Public Health, PO Box 222 Skøyen, Oslo, 0213, Norway
| | - Ludvig Andre Munthe
- Department of Immunology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
- KG Jebsen Centre for B cell Malignancies, and Precision Immunotherapy Alliance, Institute of Clinical Medicine, University of Oslo, PO Box 4950 Nydalen, Oslo, 0424, Norway
| | - John T Vaage
- Department of Immunology, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway
- Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, Oslo, 0318, Norway
| |
Collapse
|
2
|
Kerman N, Marshall CA, Polillo A, Voronov J, de Pass T, Easton C, Ward B, Noble A, Hwang SW, Kozloff N, Stergiopoulos V, Kidd SA. Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry. Soc Sci Med 2024; 348:116831. [PMID: 38574591 DOI: 10.1016/j.socscimed.2024.116831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.
Collapse
Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada.
| | - Carrie Anne Marshall
- Western University, School of Occupational Therapy, 1201 Western Road, London, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Timothy de Pass
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Corinna Easton
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada
| | - Brooklyn Ward
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1919 Riverside Drive, Ottawa, Ontario, Canada
| | - Amanda Noble
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Division of General Internal Medicine, 1 King's College Circle, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Meehan AA, Milazzo KE, Bien M, Nall SK, Vickery KD, Mosites E, Barocas JA. Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018-2019. BMC Public Health 2024; 24:1159. [PMID: 38664800 PMCID: PMC11044435 DOI: 10.1186/s12889-024-18681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The number of people experiencing unsheltered homelessness in the U.S. is increasing. Municipalities have responded with punitive responses such as involuntary displacement (i.e., encampment sweeps, move along orders), but little is known about the impact of involuntary displacement on health. The purpose of this study was to investigate the association between broadly defined experiences of involuntary displacement and self-reported health conditions among people experiencing homelessness. METHODS We used logistic regression models to generate odds ratios using publicly available data from a cross-sectional sample of people experiencing homelessness in Denver, Colorado, during September 2018-February 2019. Hosmer-Lemeshow Goodness of Fit tests were used to assess model fit. RESULTS Among 397 people experiencing homelessness, involuntary displacement was significantly associated with self-reported infectious diseases (adjusted odds ratio (aOR) 2.09, 95% CI 1.27, 3.41), substance and alcohol use (aOR 2.83; 95% CI 1.70, 4.73), climate-related conditions (aOR 2.27; 95% CI 1.35, 3.83), and worsening mental health (aOR 2.00; 95% CI 1.24, 3.24) after controlling for potential confounders. No statistically significant associations were identified between involuntary displacement and injuries, musculoskeletal issues, chronic conditions, and chronic mental and emotional issues. CONCLUSIONS This research quantifies the association between involuntary displacement and multiple infectious and non-infectious health outcomes. While city officials attempt to grapple with increasing unsheltered homelessness, it is important to understand what harms are occurring that are associated with current policies. Our research adds to the growing body of literature that involuntary displacement is a harmful response to unsheltered homelessness. Alternative approaches focused on connections to housing and social services should be prioritized.
Collapse
Affiliation(s)
- Ashley A Meehan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | | | - Michael Bien
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha K Nall
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, & Criminal Justice Lab, Hennepin Health Care Research Institute, Minneapolis, MN, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
4
|
Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024:333549241228525. [PMID: 38379269 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
Collapse
Affiliation(s)
- Caroline J Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
5
|
Mennis E, Hobus M, van den Muijsenbergh M, van Loenen T. COVID-19 related morbidity and mortality in people experiencing homelessness in the Netherlands. PLoS One 2024; 19:e0296754. [PMID: 38315711 PMCID: PMC10843097 DOI: 10.1371/journal.pone.0296754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 12/13/2023] [Indexed: 02/07/2024] Open
Abstract
INTRODUCTION People who are homeless might be more at risk for getting infected by the SARS-COV-2 virus or for experiencing severe course of the infection due to their often more fragile health, unmet health needs, and poorer living conditions. This study aims to gain insight into the morbidity and mortality of the SARS-COV-2 virus among the homeless population in the Netherlands. METHODS In this observational retrospective study, anonymized data about patients experiencing homelessness who contacted a street doctor were gathered in nine cities in the Netherlands from March 2020 until March 2021. Data included patient characteristics, COVID-19 -related symptoms, diagnosis, and disease course of a SARS-COV-2 infection. RESULTS Of the total 1419 patients in whom 1544 COVID-19 related consults were registered, 16% tested positive for a SARS-COV-2 infection, and an additional 12% were clinically suspected of having a SARS-COV-2 infection but were seen before there were any COVID-19 tests available in General Practice or for some other reason not tested. Significantly more (p = <0.001) patients born outside the European Union tested positive for a SARS-COV-2 infection (36%) compared to the remainder of the population (20%). The most discerning symptom for being tested positive was loss of taste and smell (29% vs 6% in the negative tested group and 2% in the suspected group), fever (24% vs 13% in the negative tested group but 18% in the suspected group), and headache (26% vs 17% resp 14%), and fatigue (29% vs 20 resp 17%). Cough, dyspnea and common cold were more often seen in the clinically suspected but not tested group). Of the group that tested positive for a SARS-COV-2 infection, 10% were hospitalized. Two patients were admitted to intensive care and one patient died. Of patients who were clinically suspected of a SARS-COV-2 infection, 5% were hospitalized. CONCLUSION COVID-19 was not widespread among people experiencing homelessness in the Netherlands, but the number of hospitalizations in this study was relatively high. Monitoring this population during a pandemic is necessary to take prompt action when needed.
Collapse
Affiliation(s)
- Eline Mennis
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Michelle Hobus
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pharos, Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Tessa van Loenen
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
- Pharos, Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| |
Collapse
|
6
|
Besrat BN, Mosites E, Montgomery MP, Garcia-Williams AG, Trautner E, Clarke KEN, Marshall B, Vassell C, Rutt C, Jones SL. A qualitative assessment of cleaning and hand hygiene practices at shelters serving people experiencing homelessness during the COVID-19 pandemic, Atlanta, GA - May-June, 2020. BMC Public Health 2024; 24:247. [PMID: 38254119 PMCID: PMC10801948 DOI: 10.1186/s12889-023-16504-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/10/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Cleaning practices and hand hygiene are important behaviors to prevent and control the spread of infectious disease, especially in congregate settings. This project explored hygiene- and cleaning-related experiences in shelters serving people experiencing homelessness (PEH) during May-June 2020 of the COVID-19 pandemic. METHODS We conducted qualitative, in-depth interviews by phone with 22 staff from six shelters in Atlanta, Georgia. The interview guide included questions about cleaning routines, cleaning barriers and facilitators, cleaning promotion, hand hygiene promotion, and hand hygiene barriers and facilitators. We analyzed interview transcripts using thematic analysis. RESULTS Multiple individuals, such as shelter individuals (clients), volunteers, and staff, played a role in shelter cleaning. Staff reported engaging in frequent hand hygiene and cleaning practices. Barriers to cleaning included staffing shortages and access to cleaning supplies. Staff reported barriers (e.g., differing perceptions of cleanliness) for clients who were often involved in cleaning activities. Barriers to hand hygiene included limited time to wash hands, forgetting, and inconvenient handwashing facilities. Specific guidance about when and how to clean, and what supplies to use, were requested. CONCLUSION During the early months of the COVID-19 pandemic, shelters serving PEH in the Atlanta-metro area needed resources and support to ensure sufficient staffing and supplies for cleaning activities. As part of future pandemic planning and outbreak prevention efforts, shelters serving PEH could benefit from specific guidance and training materials on cleaning and hand hygiene practices.
Collapse
Grants
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
- 20-15-1671, 20-15-1682, 20-15-1678 Emergency Resource Request (ERR)
Collapse
Affiliation(s)
- Bethlehem N Besrat
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Emily Mosites
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Martha P Montgomery
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | | | - Kristie E N Clarke
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | - Brittany Marshall
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| | | | - Candace Rutt
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA.
| | - Shantrice L Jones
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, GA, USA
| |
Collapse
|
7
|
Ogbonna O, Bull F, Spinks B, Williams D, Lewis R, Edwards A. Interventions to mitigate the risks of COVID-19 for people experiencing homelessness and their effectiveness: a systematic review. Front Public Health 2024; 11:1286730. [PMID: 38239803 PMCID: PMC10794490 DOI: 10.3389/fpubh.2023.1286730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/29/2023] [Indexed: 01/22/2024] Open
Abstract
Objectives People experiencing homelessness also experience poorer clinical outcomes of COVID-19. Various interventions were implemented for people experiencing homelessness in 2020-2022 in different countries in response to varied national guidance to limit the impact of COVID-19. It is important to understand what was done and the effectiveness of such interventions. This systematic review aims to describe interventions to mitigate the risks of COVID-19 in people experiencing homelessness and their effectiveness. Methods A protocol was developed and registered in PROSPERO. Nine databases were searched for studies on interventions to mitigate the impact of COVID-19 on people experiencing homelessness. Included studies were summarised with narrative synthesis. Results From 8,233 references retrieved from the database searches and handsearching, 15 were included. There was a variety of interventions, including early identification of potential COVID-19 infections, provision of isolation space, healthcare support, and urgent provision of housing regardless of COVID-19 infection. Conclusion The strategies identified were generally found to be effective, feasible, and transferable. This review must be interpreted with caution due to the low volume of eligible studies and the low quality of the evidence available.
Collapse
Affiliation(s)
- Obianuju Ogbonna
- Health and Care Research Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Francesca Bull
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Bethany Spinks
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Denitza Williams
- Health and Care Research Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Adrian Edwards
- Health and Care Research Evidence Centre, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
8
|
Liang Y, Sun Q, Liu Q, Pang Y, Tang S. SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population: a systematic review and meta-analysis. Front Public Health 2023; 11:1044788. [PMID: 37900041 PMCID: PMC10600393 DOI: 10.3389/fpubh.2023.1044788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives SARS-CoV-2 infection and COVID-19 vaccination of homeless people are a serious public health concern during COVID-19 pandemic. We aimed to systematically assess SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in homeless people, which are important to inform resource allocation and policy adjustment for the prevention and control of COVID-19. Methods We searched PubMed, Web of Science, and the World Health Organization COVID-19 database for the studies of SARS-CoV-2 incidence, seroprevalence, and COVID-19 vaccination coverage in the homeless population. Subgroup analyses were conducted to pool SARS-CoV-2 incidence and seroprevalence in sheltered homeless, unsheltered homeless, and mixed population, respectively. Potential sources of heterogeneity in the estimates were explored by meta-regression analysis. Results Forty-nine eligible studies with a total of 75,402 homeless individuals and 5,000 shelter staff were included in the meta-analysis. The pooled incidence of SARS-CoV-2 infection was 10% (95% CI: 7 to 12%) in the homeless population and 8% (5 to 12%) for shelter staff. In addition, the overall estimated SARS-CoV-2 specific seroprevalence was 19% (8 to 33%) for homeless populations and 22% (3 to 52%) for shelter staff, respectively. Moreover, for the homeless subjects, the pooled incidence was 10% (4 to 23%) for asymptomatic SARS-CoV-2 infections, 6% (1 to 12%) for symptomatic SARS-CoV-2 infections, 3% (1 to 4%) for hospitalization for COVID-19, and 1% (0 to 2%) for severe COVID-19 cases, respectively while no COVID-19-related death was reported. Furthermore, the data derived from 12 included studies involving 225,448 homeless individuals revealed that the pooled proportion of one dose COVID-19 vaccination was 41% (35 to 47%), which was significantly lower than those in the general population. Conclusion Our study results indicate that the homeless people remain highly susceptible to SARS-CoV-2 infection, but COVID-19 vaccination coverage was lower than the general population, underscoring the need for prioritizing vaccine deployment and implementing enhanced preventive measures targeting this vulnerable group.
Collapse
Affiliation(s)
| | | | | | | | - Shixing Tang
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
| |
Collapse
|
9
|
Hanratty J, Keenan C, O'Connor SR, Leonard R, Chi Y, Ferguson J, Axiaq A, Miller S, Bradley D, Dempster M. Psychological and psychosocial determinants of COVID Health Related Behaviours (COHeRe): An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1336. [PMID: 37361553 PMCID: PMC10286725 DOI: 10.1002/cl2.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has resulted in illness, deaths and societal disruption on a global scale. Societies have implemented various control measures to reduce transmission of the virus and mitigate its impact. Individual behavioural changes are crucial to the successful implementation of these measures. Common recommended measures to limit risk of infection include frequent handwashing, reducing the frequency of social interactions and the use of face coverings. It is important to identify those factors that can predict the uptake and maintenance of these protective behaviours. Objectives We aimed to identify and map the existing evidence (published and unpublished) on psychological and psychosocial factors that determine uptake and adherence to behaviours aimed at reducing the risk of infection or transmission of COVID-19. Search Methods Our extensive search included electronic databases (n = 12), web searches, conference proceedings, government reports, other repositories including both published peer reviewed, pre-prints and grey literature. The search strategy was built around three concepts of interest including (1) context (terms relating to COVID-19), (2) behaviours of interest and (3) terms related to psychological and psychosocial determinants of COVID Health-Related Behaviours and adherence or compliance with recommended behaviours, to capture both malleable and non-malleable determinants (i.e. determinants that could be changed and those that could not). Selection Criteria This Evidence and Gap Map (EGM) includes all types of studies examining determinants of common recommended behaviours aimed at mitigating human-to-human spread of COVID-19. All potential malleable and non-malleable determinants of one or more behaviours are included in the map. As part of the mapping process, categories are used to group determinants. The mapping categories were based on a previous rapid review by Hanratty 2021. These include: 'behaviour', 'cognition', 'demographics', 'disease', 'emotions', 'health status', 'information', 'intervention', and 'knowledge'. Those not suitable for categorisation in any of these groups are included in the map as 'other' determinants. Data Collection and Analysis Results were imported to a bibliographic reference manager where duplications of identical studies gathered from multiple sources were removed. Data extraction procedures were managed in EPPI-Reviewer software. Information on study type, population, behaviours measured and determinants measured were extracted. We appraised the methodological quality of systematic reviews with AMSTAR-2. We did not appraise the quality of primary studies in this map. Main Results As of 1 June 2022 the EGM includes 1034 records reporting on 860 cross-sectional, 68 longitudinal, 78 qualitative, 25 reviews, 62 interventional, and 39 other studies (e.g., mixed-methods approaches). The map includes studies that measured social distancing (n = 487), masks and face coverings (n = 382), handwashing (n = 308), physical distancing (n = 177), isolation/quarantine (n = 157), respiratory hygiene/etiquette (n = 75), cleaning surfaces (n = 59), and avoiding touching the T-zone (n = 48). There were 333 studies that assessed composite measures of two or more behaviours. The largest cluster of determinants was 'demographics' (n = 730 studies), followed by 'cognition' (n = 496 studies) and determinants categorised as 'other' (n = 447). These included factors such as 'beliefs', 'culture' and 'access to resources'. Less evidence is available for some determinants such as 'interventions' (n = 99 studies), 'information' (n = 101 studies), and 'behaviour' (149 studies). Authors' Conclusions This EGM provides a valuable resource for researchers, policy-makers and the public to access the available evidence on the determinants of various COVID-19 health-related behaviours. The map can also be used to help guide research commissioning, by evidence synthesis teams and evidence intermediaries to inform policy during the ongoing pandemic and potential future outbreaks of COVID-19 or other respiratory infections. Evidence included in the map will be explored further through a series of systematic reviews examining the strength of the associations between malleable determinants and the uptake and maintenance of individual protective behaviours.
Collapse
Affiliation(s)
- Jennifer Hanratty
- School of PsychologyQueen's University BelfastBelfastUK
- Centre for Effective ServicesBelfastUK
| | | | | | | | - Yuan Chi
- Cochrane Global AgeingShanghaiChina
| | - Janet Ferguson
- School of PsychologyQueen's University BelfastBelfastUK
- Applied Behaviour Research ClinicUniversity of GalwayGalwayIreland
| | - Ariana Axiaq
- School of PsychologyQueen's University BelfastBelfastUK
| | - Sarah Miller
- School of Education, Social Sciences and Social WorkQueen's University BelfastBelfastUK
| | | | | |
Collapse
|
10
|
Thomas I, Mackie P. Assessing the coverage and timeliness of coronavirus vaccination among people experiencing homelessness in Wales, UK: a population-level data-linkage study. BMC Public Health 2023; 23:1494. [PMID: 37543593 PMCID: PMC10403942 DOI: 10.1186/s12889-023-16432-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 08/01/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND People experiencing homelessness have elevated morbidity, increasing their risk of COVID-19 related complications and mortality. Achieving high vaccination coverage in a timely manner among homeless populations was therefore important during the mass vaccination programme in Wales to limit adverse outcomes. However, no systematic monitoring of vaccinations among people experiencing homelessness in Wales has been undertaken. METHODS Retrospective cohort analysis was conducted using de-identified administrative data. Study cohort members were adults (≥ 18 years old) living in Wales on the 2 December 2020 and who had recently experienced homelessness, defined as experiencing homelessness between 1 July 2020 and 2 December 2020. The outcome of interest was first coronavirus vaccine dose. Follow-up started on 2 December 2020, and ended if the participant died, had a break in address history > 30 days, reached the end of follow up (30 November 2021), or had the outcome of interest. Median-time-to-vaccination was used as a crude measure of 'timeliness' of vaccine uptake. To account for competing risk of death prior to vaccination, vaccine coverage was described using cumulative incidence at 350-days, and at 50-day increments over follow-up (2 December 2020 to 17 November 2021). As a benchmark, all time-to-event measures were generated for the adult population in Wales with similar baseline individual and residential characteristics as the study cohort. RESULTS 1,595 people with recent experiences of homelessness were identified and included in analysis. The study cohort were disproportionately male (68.8%) and concentrated in the most deprived areas in Wales. Median time-to-vaccination for the study cohort was 196 days (95% CI.: 184-209 days), compared to 141 days (95% CI.: 141-141 days) among the matched adult population in Wales. Cumulative incidence of vaccination after 350-days of follow-up was 60.4% (95% CI.: 57.8-62.8%) among the study cohort, compared to 81.4% (95% CI.: 81.3-81.5%) among the matched adult population. Visual analysis of cumulative incidence over time suggests that vaccine inequality, i.e., difference between study cohort and matched adult population, peaked after 200-days of follow-up, and declined slightly until last follow-up at 350-days. CONCLUSIONS Despite being prioritised for vaccination, people experiencing homelessness in Wales appear to have been under-engaged, leading to lower vaccination coverage and greater time unvaccinated, potentially increasing their risk of COVID-19 complications and mortality.
Collapse
Affiliation(s)
- Ian Thomas
- Administrative Data Research Wales/Cardiff University, School of Social Sciences, SPARK, Maindy Road, CF24 4HQ, Cardiff, UK.
| | - Peter Mackie
- Cardiff University, School of Geography and Planning, Glamorgan Building, King Edward VII Avenue, CF10 3WA, Cardiff, UK
| |
Collapse
|
11
|
van Rüth V, Hajek A, Heinrich F, Ondruschka B, Püschel K, Bertram F. [Health of homeless individuals during the COVID-19 pandemic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023:10.1007/s00103-023-03739-8. [PMID: 37466653 PMCID: PMC10372111 DOI: 10.1007/s00103-023-03739-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/15/2023] [Indexed: 07/20/2023]
Abstract
The living situation and health of homeless people differs from the general population in many ways. It is reasonable to assume that the homeless population has been particularly vulnerable during the coronavirus disease 2019 (COVID-19) pandemic. This narrative review will summarize the current literature on the health and care of homeless people during the COVID-19 pandemic. The literature research was performed between December 2022 and February 2023. In addition to the current national and international literature, findings from the "National Survey on the Psychiatric and Somatic Health of Homeless Individuals" (NAPSHI study) will be synopsized, examining psychiatric and somatic diseases as well as the care for homeless people in Germany.Homeless individuals are often mentally and physically ill and have limited access to the regular medical care system. Facilities with group rooms and dormitories pose a risk for outbreaks during the COVID-19 pandemic. As suspected, evidence of Severe Acute Respiratory Syndrome Coronavirus Type 2 (SARS-CoV‑2) infections emerged more frequently in homeless individuals than in the general population during the pandemic. Many of the infected individuals were asymptomatic. High rates of those unknowingly infected homeless individuals may have contributed to the spread of the viral disease. However, uncontrolled COVID-19 outbreaks, as feared by some researchers at the beginning of the pandemic, were not observed.
Collapse
Affiliation(s)
- Victoria van Rüth
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - André Hajek
- Institut für Gesundheitsökonomie und Versorgungsforschung, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland, Martinistr. 52, 20246
| | - Fabian Heinrich
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - Benjamin Ondruschka
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - Klaus Püschel
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland
| | - Franziska Bertram
- Institut für Rechtsmedizin, Universitätsklinikum Hamburg-Eppendorf, Butenfeld 34, 22529, Hamburg, Deutschland.
| |
Collapse
|
12
|
Rogers JH, Cox SN, Link AC, Nwanne G, Han PD, Pfau B, Chow EJ, Wolf CR, Boeckh M, Hughes JP, Halloran ME, Uyeki TM, Shim MM, Duchin J, Englund JA, Mosites E, Rolfes MA, Starita LA, Chu HY. Incidence of SARS-CoV-2 infection and associated risk factors among staff and residents at homeless shelters in King County, Washington: an active surveillance study. Epidemiol Infect 2023; 151:e129. [PMID: 37424310 PMCID: PMC10540173 DOI: 10.1017/s0950268823001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/16/2023] [Accepted: 06/12/2023] [Indexed: 07/11/2023] Open
Abstract
Homeless shelter residents and staff may be at higher risk of SARS-CoV-2 infection. However, SARS-CoV-2 infection estimates in this population have been reliant on cross-sectional or outbreak investigation data. We conducted routine surveillance and outbreak testing in 23 homeless shelters in King County, Washington, to estimate the occurrence of laboratory-confirmed SARS-CoV-2 infection and risk factors during 1 January 2020-31 May 2021. Symptom surveys and nasal swabs were collected for SARS-CoV-2 testing by RT-PCR for residents aged ≥3 months and staff. We collected 12,915 specimens from 2,930 unique participants. We identified 4.74 (95% CI 4.00-5.58) SARS-CoV-2 infections per 100 individuals (residents: 4.96, 95% CI 4.12-5.91; staff: 3.86, 95% CI 2.43-5.79). Most infections were asymptomatic at the time of detection (74%) and detected during routine surveillance (73%). Outbreak testing yielded higher test positivity than routine surveillance (2.7% versus 0.9%). Among those infected, residents were less likely to report symptoms than staff. Participants who were vaccinated against seasonal influenza and were current smokers had lower odds of having an infection detected. Active surveillance that includes SARS-CoV-2 testing of all persons is essential in ascertaining the true burden of SARS-CoV-2 infections among residents and staff of congregate settings.
Collapse
Affiliation(s)
- Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Sarah N. Cox
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Amy C. Link
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Gift Nwanne
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Eric J. Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Michael Boeckh
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - M. Elizabeth Halloran
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - M. Mia Shim
- Public Health – Seattle & King County, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Jeffrey Duchin
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, Seattle, WA, USA
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lea A. Starita
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| |
Collapse
|
13
|
Hörig M, Klaes SM, Krasovski-Nikiforovs S, van Loon W, Murajda L, Rodriguez RCO, Schade C, Specht A, Equihua Martinez G, Zimmermann R, Mockenhaupt FP, Seybold J, Lindner AK, Sarma N. A COVID-19 isolation facility for people experiencing homelessness in Berlin, Germany: a retrospective patient record study. Front Public Health 2023; 11:1147558. [PMID: 37346103 PMCID: PMC10281190 DOI: 10.3389/fpubh.2023.1147558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction People experiencing homelessness (PEH) are disproportionately affected by the COVID-19 pandemic. For many PEH it is impossible to isolate due to the lack of permanent housing. Therefore, an isolation facility for SARS-CoV-2 positive PEH was opened in Berlin, Germany, in May 2020, offering medical care, opioid and alcohol substitution therapy and social services. This study aimed to assess the needs of the admitted patients and requirements of the facility. Materials and methods This was a retrospective patient record study carried out in the isolation facility for PEH in Berlin, from December 2020 to June 2021. We extracted demographic and clinical data including observed psychological distress from records of all PEH tested positive for SARS-CoV-2 by RT-PCR. Data on duration and completion of isolation and the use of the facilities' services were analyzed. The association of patients' characteristics with the completion of isolation was assessed by Student's t-test or Fisher's exact test. Results A total of 139 patients were included in the study (89% male, mean age 45 years, 41% with comorbidities, 41% non-German speakers). 81% of patients were symptomatic (median duration 5 days, range 1-26). The median length of stay at the facility was 14 days (range 2-41). Among the patients, 80% had non-COVID-19 related medical conditions, 46% required alcohol substitution and 17% opioid substitution therapy. Three patients were hospitalized due to low oxygen saturation. No deaths occurred. Psychological distress was observed in 20%, and social support services were used by 65% of PEH. The majority (82%) completed the required isolation period according to the health authority's order. We did not observe a statistically significant association between completion of the isolation period and sociodemographic characteristics. Conclusion The specialized facility allowed PEH a high compliance with completion of the isolation period. Medical care, opioid and alcohol substitution, psychological care, language mediation and social support are essential components to address the specific needs of PEH. Besides contributing to infection prevention and control, isolation facilities may allow better access to medical care for SARS-CoV-2 infected PEH with possibly positive effects on the disease course.
Collapse
Affiliation(s)
- Merle Hörig
- Charité Center for Global Health, Institute of International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Welmoed van Loon
- Charité Center for Global Health, Institute of International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Anabell Specht
- Charité Center for Global Health, Institute of International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriela Equihua Martinez
- Charité Center for Global Health, Institute of International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Frank P. Mockenhaupt
- Charité Center for Global Health, Institute of International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Seybold
- Medical Directorate, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas K. Lindner
- Charité Center for Global Health, Institute of International Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Navina Sarma
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| |
Collapse
|
14
|
Shariff SZ, Reid JN, Boozary AS, Booth R. SARS-CoV-2 Testing and Complications Across 6 Waves of the COVID-19 Pandemic Among Individuals Recently Experiencing Homelessness in Ontario, Canada. JAMA Netw Open 2023; 6:e2312394. [PMID: 37155172 PMCID: PMC10167569 DOI: 10.1001/jamanetworkopen.2023.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
This cohort study compares the rates of SARS-CoV-2 testing and complications across 6 waves of the COVID-19 pandemic in Ontario, Canada, between individuals recently experiencing homelessness, low-income residents, and the general population.
Collapse
Affiliation(s)
- Salimah Z Shariff
- ICES (formerly the Institute for Clinical Evaluative Sciences) Western, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Jennifer N Reid
- ICES (formerly the Institute for Clinical Evaluative Sciences) Western, London, Ontario, Canada
| | - Andrew S Boozary
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard Booth
- ICES (formerly the Institute for Clinical Evaluative Sciences) Western, London, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| |
Collapse
|
15
|
Roederer T, Mollo B, Vincent C, Leduc G, Sayyad-Hilario J, Mosnier M, Vandentorren S. Estimating COVID-19 vaccine uptake and its drivers among migrants, homeless and precariously housed people in France. COMMUNICATIONS MEDICINE 2023; 3:30. [PMID: 36801917 PMCID: PMC9939372 DOI: 10.1038/s43856-023-00257-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/07/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Migrants, people experiencing homelessness (PEH), or precariously housed (PH) are at high risk for COVID-19 infection, hospitalization, and death from COVID-19. However, while data on COVID-19 vaccine uptake in these populations are available in the USA, Canada, and Denmark, we are lacking, to the best of our knowledge, data from France. METHODS In late 2021, we carried out a cross-sectional survey to determine COVID-19 vaccine coverage in PEH/PH residing in Ile-de-France and Marseille, France, and to explore its drivers. Participants aged over 18 years were interviewed face-to-face where they slept the previous night, in their preferred language, and then stratified for analysis into three housing groups (Streets, Accommodated, and Precariously Housed). Standardized vaccination rates were computed and compared to the French population. Multilevel univariate and multivariable logistic regression models were built. RESULTS We find that 76.2% (95% confidence interval [CI] 74.3-78.1) of the 3690 participants received at least one COVID-19 vaccine dose while 91.1% of the French population did so. Vaccine uptake varies by stratum, with the highest uptake (85.6%; reference) in PH, followed by Accommodated (75.4%; adjusted odds-ratio = 0.79; 95% CI 0.51-1.09 vs. PH) and lowest in Streets (42.0%; AOR = 0.38; 95%CI 0.25-0.57 vs. PH). Use for vaccine certificate, age, socioeconomic factors, and vaccine hesitancy is associated with vaccination coverage. CONCLUSIONS In France, PEH/PH, and especially the most excluded, are less likely than the general population to receive COVID-19 vaccines. While vaccine mandate has proved an effective strategy, targeted outreach, on-site vaccinations, and sensitization activities are strategies enhancing vaccine uptake that can easily be replicated in future campaigns and other settings.
Collapse
Affiliation(s)
| | - Bastien Mollo
- grid.452373.40000 0004 0643 8660Epicentre, Paris, France ,grid.452373.40000 0004 0643 8660Médecins Sans Frontières, Paris, France ,grid.411119.d0000 0000 8588 831XInfectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | | | - Ghislain Leduc
- grid.452373.40000 0004 0643 8660Epicentre, Paris, France
| | | | | | - Stéphanie Vandentorren
- grid.493975.50000 0004 5948 8741Santé Publique France, Saint Maurice, France ,grid.508062.90000 0004 8511 8605University of Bordeaux, INSERM UMR 1219-Bordeaux Population Health, Bordeaux, France
| |
Collapse
|
16
|
Mattsson E, Lindblad M, Kneck Å, Salzmann-Eriksson M, Klarare A. Voices of women in homelessness during the outbreak of the COVID-19 pandemic: a co-created qualitative study. BMC Womens Health 2023; 23:11. [PMID: 36627642 PMCID: PMC9830620 DOI: 10.1186/s12905-023-02157-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Women in homelessness face extreme health- and social inequities. It could be postulated that during societal crises, they become even more vulnerable. Thus, the aim was to explore experiences related to the COVID-19 pandemic among women in homelessness. METHODS Ten interviews were conducted with women in homelessness, in Stockholm, Sweden, using researcher-driven photo elicitation. The data analysis was guided by the DEPICT model for collaborative data analysis and a qualitative content analysis was performed. A collaborative reference group of women with lived experience of homelessness contributed to the research process through designing the data collection, performing the data analysis, and providing feedback during report writing. RESULTS For women in homelessness, the COVID-19 pandemic was adding insult to injury, as it significantly affected everyday life and permeated most aspects of existence, leading to diminished interactions with others and reduced societal support. Thus, in an already dire situation, the virus amplified health- and social issues to another level. The women strived to find their balance on the shifting sands of guidelines and restrictions due to the pandemic. Adhering to the new social distancing rules and guidelines in line with the rest of society, was simply impossible when experiencing homelessness. However, for some women the pandemic was nothing but a storm in a teacup. The harsh reality continued irrespectively, living one day at a time and prioritizing provision for basic human needs. CONCLUSIONS The COVID-19 pandemic and homelessness can be viewed as two intersecting crises. However, the women's aggregated experiences were greater than the sum of experiencing homelessness and meeting the threat of the virus. Gender, exposure to violence, poverty, social isolation, and substance use were additional factors that further marginalized the women during the pandemic. To rebuild a better and more sustainable post-pandemic future for all, global commitment to ending homelessness is crucial. In addition, addressing social determinants of health must be the number one health intervention.
Collapse
Affiliation(s)
- Elisabet Mattsson
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Healthcare Sciences and e-Health, Uppsala University, 751 85 Uppsala, Sweden ,grid.412175.40000 0000 9487 9343Department of Health Care Sciences, Marie Cederschiöld University, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | - Marléne Lindblad
- Department of Health Sciences, Swedish Red Cross University, Box 1059, 141 21 Huddinge, Sweden
| | - Åsa Kneck
- grid.412175.40000 0000 9487 9343Department of Health Care Sciences, Marie Cederschiöld University, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | - Martin Salzmann-Eriksson
- grid.69292.360000 0001 1017 0589Department of Caring Sciences, Faculty of Health an Occupational Studies, University of Gävle, 801 76 Gävle, Sweden
| | - Anna Klarare
- grid.8993.b0000 0004 1936 9457Department of Women’s and Children’s Health, Healthcare Sciences and e-Health, Uppsala University, 751 85 Uppsala, Sweden ,grid.412175.40000 0000 9487 9343Department of Health Care Sciences, Marie Cederschiöld University, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | | |
Collapse
|
17
|
Liu CY, Smith S, Chamberlain AT, Gandhi NR, Khan F, Williams S, Shah S. Use of surveillance data to elucidate household clustering of SARS-CoV-2 in Fulton County, Georgia a major metropolitan area. Ann Epidemiol 2022; 76:121-127. [PMID: 36210009 PMCID: PMC9536872 DOI: 10.1016/j.annepidem.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Households are important for SARS-CoV-2 transmission due to high intensity exposure in enclosed spaces over prolonged durations. We quantified and characterized household clustering of COVID-19 cases in Fulton County, Georgia. METHODS We used surveillance data to identify all confirmed COVID-19 cases in Fulton County. Household clustered cases were defined as cases with matching residential address. We described the proportion of COVID-19 cases that were clustered, stratified by age over time and explore trends in age of first diagnosed case within households and subsequent household cases. RESULTS Between June 1, 2020 and October 31, 2021, 31,449(37%) of 106,233 cases were clustered in households. Children were the most likely to be in household clusters than any other age group. Initially, children were rarely (∼ 10%) the first cases diagnosed in the household but increased to almost 1 of 3 in later periods. DISCUSSION One-third of COVID-19 cases in Fulton County were part of a household cluster. Increasingly children were the first diagnosed case, coinciding with temporal trends in vaccine roll-out among the elderly and the return to in-person schooling in Fall 2021. Limitations include restrictions to cases with a valid address and unit number and that the first diagnosed case may not be the infection source for the household.
Collapse
Affiliation(s)
- Carol Y Liu
- Emory University Rollins School of Public Health, Atlanta, GA.
| | | | | | - Neel R Gandhi
- Emory University Rollins School of Public Health, Atlanta, GA; Emory School of Medicine, Atlanta, GA
| | - Fazle Khan
- Fulton County Board of Health, Atlanta, GA
| | | | - Sarita Shah
- Emory University Rollins School of Public Health, Atlanta, GA; Emory School of Medicine, Atlanta, GA
| |
Collapse
|
18
|
Wiens K, Rosella LC, Kurdyak P, Chen S, Aubry T, Stergiopoulos V, Hwang SW. Determinants of Hospital Use and Physician Services Among Adults With a History of Homelessness. Health Serv Insights 2022; 15:11786329221127150. [PMID: 36325379 PMCID: PMC9618755 DOI: 10.1177/11786329221127150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/01/2022] [Indexed: 11/07/2022] Open
Abstract
Background: People experiencing homelessness have diverse patterns of healthcare use. This study examined the distribution and determinants of healthcare encounters among adults with a history of homelessness. Methods: Administrative healthcare records were linked with survey data for a general cohort of adults with a history of homelessness and a cohort of homeless adults with mental illness. Binary and count models were used to identify factors associated with hospital admissions, emergency department visits and physician visits for comparison across the 2 cohorts. Results: During the 1-year follow-up period, a higher proportion of people in the cohort with a mental illness used any inpatient (27% vs 14%), emergency (63% vs 53%), or physician services (90% vs 76%) compared to the general homeless cohort. People from racialized groups were less likely use nearly all health services, most notably physician services. Other factors, such as reporting of a regular source of care, poor perceived general health, and diagnosed chronic conditions were associated with higher use of all health services except psychiatric inpatient care Conclusion: When implementing interventions for patients with the greatest health needs, we must consider the unique factors that contribute to higher healthcare use, as well as the barriers to healthcare access.
Collapse
Affiliation(s)
- Kathryn Wiens
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Kathryn Wiens, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 1P8, Canada.
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Tim Aubry
- School of Psychology & Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | | | - Stephen W Hwang
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, ON, Canada
| |
Collapse
|
19
|
Levesque J, Babando J, Loranger N, Johnson S, Pugh D. COVID-19 prevalence and infection control measures at homeless shelters and hostels in high-income countries: a scoping review. Syst Rev 2022; 11:223. [PMID: 36243764 PMCID: PMC9569412 DOI: 10.1186/s13643-022-02089-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
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 .
Collapse
Affiliation(s)
- Justine Levesque
- The Canadian Observatory On Homelessness 6Th Floor Kaneff Tower, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada.
| | - Jordan Babando
- Institute of Criminology and Criminal Justice, Carleton University, Ottawa, ON, K1S 5B6, Canada
| | - Nathaniel Loranger
- York University School of Social Work, S880 Ross Building, 4700 Keele St, Toronto, ON, M3J1P3, Canada
| | - Shantel Johnson
- The Canadian Observatory On Homelessness 6Th Floor Kaneff Tower, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - David Pugh
- The Canadian Observatory On Homelessness 6Th Floor Kaneff Tower, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| |
Collapse
|
20
|
Nilsson SF, Laursen TM, Osler M, Hjorthøj C, Benros ME, Ethelberg S, Mølbak K, Nordentoft M. Adverse SARS-CoV-2-associated outcomes among people experiencing social marginalisation and psychiatric vulnerability: A population-based cohort study among 4,4 million people. Lancet Reg Health Eur 2022; 20:100421. [PMID: 35789954 PMCID: PMC9242846 DOI: 10.1016/j.lanepe.2022.100421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Knowledge of the adverse problems related to SARS-CoV-2 infection in marginalised and deprived groups may help to prioritise more preventive efforts in these groups. We examined adverse outcomes associated with SARS-CoV-2 infection among vulnerable segments of society. Methods Using health and administrative registers, a population-based cohort study of 4.4 million Danes aged at least 15 years from 27 February 2020 to 15 October 2021 was performed. People with 1) low educational level, 2) homelessness, 3) imprisonment, 4) substance abuse, 5) supported psychiatric housing, 6) psychiatric admission, and 7) severe mental illness were main exposure groups. Chronic medical conditions were included for comparison. COVID-19-related outcomes were: 1) hospitalisation, 2) intensive care, 3) 60-day mortality, and 4) overall mortality. PCR-confirmed SARS-CoV-2 infection and PCR-testing were also studied. Poisson regression analysis was used to compute adjusted incidence and mortality rate ratios (IRRs, MRRs). Findings Using health and administrative registers, we performed a population-based cohort study of 4,412,382 individuals (mean age 48 years; 51% females). In all, 257,450 (5·8%) individuals had a PCR-confirmed SARS-CoV-2 infection. After adjustment for age, calendar time, and sex, we found that especially people experiencing homelessness had high risk of hospitalisation (IRR 4·36, 95% CI, 3·09-6·14), intensive care (IRR 3·12, 95% CI 1·29-7·52), and death (MRR 8·17, 95% CI, 3·66-18·25) compared with people without such experiences, but increased risk was found for all studied groups. Furthermore, after full adjustment, including for status of vaccination against SARS-CoV-2 infection, individuals with experiences of homelessness and a PCR-confirmed SARS-CoV-2 infection had 41-times (95% CI, 24·84-68·44) higher risk of all-cause death during the study period compared with individuals without. Supported psychiatric housing was linked to almost 3-times higher risk of hospitalisation and 60-day mortality following SARS-CoV-2 infection compared with the general population with other living circumstances. Interpretation Socially marginalised and psychiatrically vulnerable individuals had substantially elevated risks of adverse health outcomes following SARS-CoV-2 infection. The results highlight that pandemic preparedness should address inequalities in health, including infection prevention and vaccination of vulnerable groups. Funding Novo Nordisk Foundation.
Collapse
|
21
|
Dale AP, Almendares O, Howard B, Burnett E, Prasai S, Arons M, Collins J, Duffy N, Pandit U, Brady S, White J, Garrett B, Kirking HL, Sunenshine R, Tate JE, Scott SE. Investigation of a Severe Acute Respiratory Syndrome Coronavirus 2 Delta (B.1.617.2) Variant Outbreak Among Residents of a Skilled Nursing Facility and Vaccine Effectiveness Analysis: Maricopa County, Arizona, June-July 2021. Clin Infect Dis 2022; 75:e20-e26. [PMID: 35413107 PMCID: PMC9047249 DOI: 10.1093/cid/ciac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Short-term rehabilitation units present unique infection control challenges because of high turnover and medically complex residents. In June 2021, the Maricopa County Department of Public Health was notified of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta outbreak in a skilled nursing facility short-term rehabilitation unit. We describe the outbreak and assess vaccine effectiveness (VE). METHODS Facility electronic medical records were reviewed for residents who spent > 1 night on the affected unit between June 10 and July 23, 2021, to collect demographics, SARS-CoV-2 test results, underlying medical conditions, vaccination status, and clinical outcomes. Coronavirus disease 2019 VE estimates using Cox proportional hazards models were calculated. RESULTS Forty (37%) of 109 short-stay rehabilitation unit residents who met inclusion criteria tested positive for SARS-CoV-2. SARS-CoV-2-positive case-patients were mostly male (58%) and White (78%) with a median age of 65 (range, 27-92) years; 11 (27%) were immunocompromised. Of residents, 39% (10 cases, 32 noncases) received 2 doses and 9% (4 cases, 6 noncases) received 1 dose of messenger RNA (mRNA) vaccine. Among nonimmunocompromised residents, adjusted 2-dose primary-series mRNA VE against symptomatic infection was 80% (95% confidence interval, 15-95). More cases were hospitalized (33%) or died (38%) than noncases (10% hospitalized; 16% died). CONCLUSIONS In this large SARS-CoV-2 Delta outbreak in a high-turnover short-term rehabilitation unit, a low vaccination rate and medically complex resident population were noted alongside severe outcomes. VE of 2-dose primary-series mRNA vaccine against symptomatic infection was the highest in nonimmunocompromised residents. Health departments can use vaccine coverage data to prioritize facilities for assistance in preventing outbreaks.
Collapse
Affiliation(s)
- Ariella P Dale
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
- Maricopa County Department of Public Health, Phoenix, AZ, United States
- Arizona Department of Health Services, Phoenix, AZ, United States
| | | | - Brandon Howard
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | | | - Siru Prasai
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Melissa Arons
- CDC COVID-19 Response, Atlanta, Georgia, United States
| | - Jennifer Collins
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | | | - Urvashi Pandit
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Shane Brady
- Arizona Department of Health Services, Phoenix, AZ, United States
| | - Jessica White
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| | - Brenna Garrett
- Arizona Department of Health Services, Phoenix, AZ, United States
| | | | - Rebecca Sunenshine
- Maricopa County Department of Public Health, Phoenix, AZ, United States
- CDC COVID-19 Response, Atlanta, Georgia, United States
| | | | - Sarah E Scott
- Maricopa County Department of Public Health, Phoenix, AZ, United States
| |
Collapse
|
22
|
Chronic diseases and multi-morbidity in persons experiencing homelessness: results from a cross-sectional study conducted at three humanitarian clinics in Germany in 2020. BMC Public Health 2022; 22:1597. [PMID: 35996145 PMCID: PMC9395771 DOI: 10.1186/s12889-022-14023-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany. Methods Study participants were adults who sought medical care at clinics of the humanitarian organisation “Ärzte der Welt” in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group. Results Of the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35–49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68–3.24; AOR = 3.57, 95% CI = 2.55–5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive. Conclusions Housing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.
Collapse
|
23
|
COVID-19 Vaccine Coverage and Sociodemographic, Behavioural and Housing Factors Associated with Vaccination among People Experiencing Homelessness in Toronto, Canada: A Cross-Sectional Study. Vaccines (Basel) 2022; 10:vaccines10081245. [PMID: 36016133 PMCID: PMC9412474 DOI: 10.3390/vaccines10081245] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/25/2022] Open
Abstract
People experiencing homelessness were prioritized for COVID-19 vaccination in Toronto, Canada, due to the high risk of infection and associated complications relative to the general population. We aimed to ascertain COVID-19 vaccine coverage in this population and explore factors associated with the receipt of at least one dose. We collected survey and blood sample data from individuals ages 16+ recruited by random selection at 62 shelters, hotels and encampment sites between 16 June 2021 and 9 September 2021. We report vaccine coverage by dose number and explored sociodemographic, behavioral, health and housing factors associated with vaccination using multivariable modified Poisson regression. In total, 80.4% (95% CI 77.3–83.1%) received at least one vaccine dose, and 63.6% (CI 60.0–67.0%) received two or more doses. Vaccination was positively associated with age (every 10 years adjusted rate ratio (aRR) 1.05 [95% CI 1.03–1.08]), and receipt of influenza vaccination (aRR 1.19 [95% CI 1.11–1.27]). Factors negatively associated with vaccination included female gender (aRR 0.92 [95% CI 0.85–1.0]), Black racial self-identification (aRR 0.89 [95% CI 0.80–0.99]) and low frequencies of masking in public places (aRR 0.83 [95% CI 0.72–0.95]). COVID-19 vaccine coverage is very high among people experiencing homelessness in Toronto, suggesting advocacy and outreach efforts may have been effective.
Collapse
|
24
|
Meehan AA, Thomas I, Horter L, Schoonveld M, Carmichael AE, Kashani M, Valencia D, Mosites E. Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021. JAMA Netw Open 2022; 5:e2227248. [PMID: 35980638 PMCID: PMC9389352 DOI: 10.1001/jamanetworkopen.2022.27248] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
IMPORTANCE A lack of timely and high-quality data is an ongoing challenge for public health responses to COVID-19 among people experiencing homelessness (PEH). Little is known about the total number of cases of COVID-19 among PEH. OBJECTIVE To estimate the number of COVID-19 cases among PEH and compare the incidence rate among PEH with that in the general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from a survey distributed by the Centers for Disease Control and Prevention to all US state, district, and territorial health departments that requested aggregated COVID-19 data among PEH from January 1, 2020, to September 30, 2021. Jurisdictions were encouraged to share the survey with local health departments. MAIN OUTCOMES AND MEASURES The primary study outcome was the number of cases of COVID-19 identified among PEH. COVID-19 cases and incidence rates among PEH were compared with those in the general population in the same geographic areas. RESULTS Participants included a population-based sample of all 64 US jurisdictional health departments. Overall, 25 states, districts, and territories completed the survey, among which 18 states (72.0%) and 27 localities reported COVID-19 data among PEH. A total of 26 349 cases of COVID-19 among PEH were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 among PEH at the state level was 567.9 per 10 000 person-years (95% CI, 560.5-575.4 per 10 000 person-years) compared with 715.0 per 10 000 person-years (95% CI, 714.5-715.5 per 10 000 person-years) in the general population. At the local level, the incidence rate of COVID-19 among PEH was 799.2 per 10 000 person-years (95% CI, 765.5-834.0 per 10 000 person-years) vs 812.5 per 10 000 person-years (95% CI, 810.7-814.3 per 10 000 person-years) in the general population. CONCLUSIONS AND RELEVANCE These results provide an estimate of COVID-19 incidence rates among PEH in multiple US jurisdictions; however, a national estimate and the extent of under- or overestimation remain unknown. The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making.
Collapse
Affiliation(s)
- Ashley A. Meehan
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
| | - Isabel Thomas
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Libby Horter
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Goldbelt C6, LLC, Chesapeake, Virginia
| | - Megan Schoonveld
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Andrea E. Carmichael
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Mitra Kashani
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
- Oak Ridge Institute for Science and Education Fellowship, Oak Ridge Associated Universities, Oak Ridge, Tennessee
| | - Diana Valencia
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
| | - Emily Mosites
- Centers for Disease Control and Prevention, COVID-19 Emergency Response, Atlanta, Georgia
| |
Collapse
|
25
|
Liu M, Richard L, Campitelli MA, Nisenbaum R, Dhalla IA, Wadhera RK, Shariff SZ, Hwang SW. Hospitalizations During the COVID-19 Pandemic Among Recently Homeless Individuals: a Retrospective Population-Based Matched Cohort Study. J Gen Intern Med 2022; 37:2016-2025. [PMID: 35396658 PMCID: PMC8992790 DOI: 10.1007/s11606-022-07506-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hospitalizations fell precipitously among the general population during the COVID-19 pandemic. It remains unclear whether individuals experiencing homelessness experienced similar reductions. OBJECTIVE To examine how overall and cause-specific hospitalizations changed among individuals with a recent history of homelessness (IRHH) and their housed counterparts during the first wave of the COVID-19 pandemic, using corresponding weeks in 2019 as a historical control. DESIGN Population-based cohort study conducted in Ontario, Canada, between September 30, 2018, and September 26, 2020. PARTICIPANTS In total, 38,617 IRHH, 15,022,368 housed individuals, and 186,858 low-income housed individuals matched on age, sex, rurality, and comorbidity burden. MAIN MEASURES Primary outcomes included medical-surgical, non-elective (overall and cause-specific), elective surgical, and psychiatric hospital admissions. KEY RESULTS Average rates of medical-surgical (rate ratio: 3.8, 95% CI: 3.7-3.8), non-elective (10.3, 95% CI: 10.1-10.4), and psychiatric admissions (128.1, 95% CI: 126.1-130.1) between January and September 2020 were substantially higher among IRHH compared to housed individuals. During the peak period (March 17 to June 16, 2020), rates of medical-surgical (0.47, 95% CI: 0.47-0.47), non-elective (0.80, 95% CI: 0.79-0.80), and psychiatric admissions (0.86, 95% CI: 0.84-0.88) were significantly lower among housed individuals relative to equivalent weeks in 2019. No significant changes were observed among IRHH. During the re-opening period (June 17-September 26, 2020), rates of non-elective hospitalizations for liver disease (1.41, 95% CI: 1.23-1.69), kidney disease (1.29, 95% CI: 1.14-1.47), and trauma (1.19, 95% CI: 1.07-1.32) increased substantially among IRHH but not housed individuals. Distinct hospitalization patterns were observed among IRHH even in comparison with more medically and socially vulnerable matched housed individuals. CONCLUSIONS Persistence in overall hospital admissions and increases in non-elective hospitalizations for liver disease, kidney disease, and trauma indicate that the COVID-19 pandemic presented unique challenges for recently homeless individuals. Health systems must better address the needs of this population during public health crises.
Collapse
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, MA, USA. .,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. .,ICES Central, Toronto, Ontario, Canada.
| | | | | | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irfan A Dhalla
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
26
|
Rosen AD, Beltran J, Thomas E, Miller J, Robie B, Walseth S, Backes S, Leachman N, Chang AH, Bratcher A, Frederes A, Romero R, Beas I, Alvarado J, Cruz B, Tabajonda M, Shover CL. COVID-19 Vaccine Acceptability and Financial Incentives among Unhoused People in Los Angeles County: a Three-Stage Field Survey. J Urban Health 2022; 99:594-602. [PMID: 35639229 PMCID: PMC9153868 DOI: 10.1007/s11524-022-00659-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/08/2022]
Abstract
Unhoused people have higher COVID-19 mortality and lower vaccine uptake than housed community members. Understanding vaccine hesitancy among unhoused people is key for developing programs that address their unique needs. A three-round, rapid, field-based survey was conducted to describe attitudes toward COVID-19 vaccination. Round 1 assessed vaccine brand preference, round 2 assessed intention to accept a financial incentive for vaccination, and round 3 measured vaccine uptake and assessed reasons for vaccine readiness during implementation of a financial incentive program. A total of 5177 individuals were approached at COVID-19 vaccination events for unhoused people in Los Angeles County from May through November 2021. Analyses included 4949 individuals: 3636 (73.5%) unsheltered and 1313 (26.5%) sheltered. Per self-report, 2008 (40.6%) were already vaccinated, 1732 (35%) wanted to get vaccinated, 359 (7.3%) were not yet ready, and 850 (17.2%) did not want to get vaccinated. Brand preference was evenly split among participants (Moderna 31.0%, J&J 35.5%, either 33.5%, p = 0.74). Interest in a financial incentive differed between those who were not yet ready and those who did not want to get vaccinated (43.2% vs. 16.2%, p < 0.01). After implementing a financial incentive program, 97.4% of participants who indicated interest in vaccination were vaccinated that day; the financial incentive was the most cited reason for vaccine readiness (n = 731, 56%). This study demonstrated the utility of an iterative, field-based assessment for program implementation during the rapidly evolving pandemic. Personal engagement, a variety of brand choices, and financial incentives could be important for improving vaccine uptake among unhoused people.
Collapse
Affiliation(s)
- Allison D Rosen
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Jacqueline Beltran
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Emily Thomas
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Jonni Miller
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Brooke Robie
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Savanah Walseth
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Shea Backes
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Nicolas Leachman
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Alicia H Chang
- Community Field Services, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Anna Bratcher
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA.,Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Ashley Frederes
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ivan Beas
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Julissa Alvarado
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.,Department of Environmental Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Brenda Cruz
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Michelle Tabajonda
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| |
Collapse
|
27
|
Mosites E, Harrison B, Montgomery MP, Meehan AA, Leopold J, Barranco L, Schwerzler L, Carmichael AE, Clarke KEN, Butler JC. Public Health Lessons Learned in Responding to COVID-19 Among People Experiencing Homelessness in the United States. Public Health Rep 2022; 137:625-629. [PMID: 35485305 PMCID: PMC9066269 DOI: 10.1177/00333549221083643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Martha P Montgomery
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ashley A Meehan
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Lindsey Barranco
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Andrea E Carmichael
- Oak Ridge Associated Universities, Division of Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristie E N Clarke
- Office of the Director, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jay C Butler
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
28
|
First Identification of Reinfection by a Genetically Different Variant of SARS-CoV-2 in a Homeless Person from the Metropolitan Area of Santiago, Chile. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:3859071. [PMID: 35528635 PMCID: PMC9068328 DOI: 10.1155/2022/3859071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/05/2022] [Accepted: 04/01/2022] [Indexed: 02/06/2023]
Abstract
The identification and tracking of SARS-CoV-2 infected patients in the general population are essential components of the global strategy to limit the COVID-19 viral spread, specifically for maintaining traceability and suppressing the resurgence of local outbreaks. Public health programs that include continuous RT-qPCR testing for COVID-19 in the general population, viral sequencing, and genomic surveillance for highly contagious forms of the virus have allowed for the identification of SARS-CoV-2 infections and reinfections. This work identified SARS-CoV-2 reinfection in a homeless person, which occurred 58 days after the first COVID-19 diagnosis. Genomic sequencing identified a different Nextstrain classification clade (20A and 20B) and PANGO lineage, with a divergence of 4 single nucleotide variants (SNVs) in S and ORF1ab genes, suggesting reinfection by different viral variants. This study is the first from the great metropolitan area of Santiago, Chile, one of the top ten countries in the world to live during the COVID-19 pandemic. We support the importance of performing intensive genomic surveillance programs in the whole population and high-risk groups, such as homeless people, nearly 20 thousand people in Chile, and have limited access to health care services and poor viral traceability.
Collapse
|
29
|
Lorvick J, Hemberg JL, Browne EN, Alter H, Comfort ML. Decreased Homelessness among Women Involved in the Criminal Legal System after a COVID-19 Housing Intervention. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2022; 32:377-380. [PMID: 38144398 PMCID: PMC10746145 DOI: 10.1080/10530789.2022.2060460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/25/2022] [Indexed: 12/26/2023]
Abstract
The COVID-19 outbreak fueled unprecedented public health efforts to mitigate the spread of infection, including rapid provision of non-congregate housing to people experiencing homelessness. People on community supervision (criminal probation or parole) have high levels of homelessness due to housing discrimination, poverty and racism, and are among the groups most vulnerable to COVID-19. We examined housing status in a cohort of women with probation histories in Alameda County, CA before and after the COVID-19 outbreak (N=204). Before March 2020, 38% of women in the cohort reporting being homeless (95% CI: 34-43%), a level that was consistent over 2 years. As of August 2020, 15% of the cohort was homeless (95% CI: 10-20%; relative risk [RR] 0.40, 95% CI: 0.28, 0.55; p<0.001). During a period of assertive public health efforts to reduce COVID-19 risk through provision of housing, we found meaningful reductions in homelessness in this sample of vulnerable women.
Collapse
Affiliation(s)
- Jennifer Lorvick
- Community Health and Implementation Research Program, RTI International
| | - Jordana L Hemberg
- Community Health and Implementation Research Program, RTI International
| | | | | | | |
Collapse
|
30
|
Sharma R, Anand A. The effect of pandemic prevalence on the reported efficacy of SARS-CoV-2 vaccines. PLoS One 2022; 17:e0266271. [PMID: 35381023 PMCID: PMC8982900 DOI: 10.1371/journal.pone.0266271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/17/2022] [Indexed: 12/02/2022] Open
Abstract
The efficacy of SARS-CoV-2 vaccines reported in Phase 3 trials varies from ~45% to ~95%. This study tests the hypothesis that the observed variation in efficacy of SARS-CoV-2 vaccine candidates can be explained by the prevalence of the COVID-19 pandemic at trial sites. To test the proposed hypothesis, we conducted a systematic search following PRISMA guidelines. Our search resulted in 8 vaccine candidates that had reported efficacy data from a total of 20 Phase 3 trials, representing a total of 221,968 subjects, 453 infections across the vaccinated groups and 1,554 infections across the placebo groups. We use meta-regression models to analyse the potential associations between prevalence of COVID-19 pandemic at trial sites and efficacy of the reported SARS-CoV2 vaccines. The overall estimate of the risk-ratio is 0.24 (95% CI, 0.17–0.34, p ≤ 0.01), with a high degree of heterogeneity (τ2 = 0.50, I2 = 88.73%). Our meta-regression analysis with pandemic prevalence as the predictor explains almost half the variance in risk ratios across trials (R2 = 49.06%, p ≤ 0.01). This study finds that efficacy of SARS-CoV-2 vaccines reported in Phase 3 trial declines as pandemic prevalence at trial sites increases. Trials conducted in locations with low pandemic prevalence reported higher efficacies as compared to trials conducted in high pandemic prevalence locations.
Collapse
Affiliation(s)
- Rajeev Sharma
- Waikato Management School, University of Waikato, Hamilton, Waikato, New Zealand
- * E-mail:
| | - Abhijith Anand
- Department of Information Systems, Walton College of Business, University of Arkansas, Fayetteville, Arkansas, United States of America
| |
Collapse
|
31
|
Loutfy M, Kennedy VL, Riazi S, Lena S, Kazemi M, Bawden J, Wright V, Richardson L, Mills S, Belsito L, Mukerji G, Bhatia S, Gupta M, Barrett C, Martin D. Development and assessment of a hospital-led, community-partnering COVID-19 testing and prevention program for homeless and congregate living services in Toronto, Canada: a descriptive feasibility study. CMAJ Open 2022; 10:E483-E490. [PMID: 35672043 PMCID: PMC9177196 DOI: 10.9778/cmajo.20210105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Outbreaks of SARS-CoV-2 in shelters and congregate living settings are a major concern because of overcrowding and because resident populations are often at high risk for infection. The objective of this study was to describe the development, implementation and assessment of the COVID-19 Community Response Team, a program that enabled Women's College Hospital in Toronto, Ontario, to work in partnership with shelters and congregate living settings to prevent outbreaks. METHODS The Community Response Team, associated with Women's College Hospital, an academic ambulatory hospital, carried out mobile testing for SARS-CoV-2, supported outbreak management and prevention through ongoing onsite partnership with medical staff, and conducted infection prevention and control (IPC) training to shelter staff. We conducted a descriptive analysis of the sites supported by the program between Apr. 20, 2020, and Aug. 15, 2020. We also assessed the program's feasibility (number of completed needs assessments, mobile testing events and IPC training events, and median time from referral to service delivery), adoption (number of nasopharyngeal swabs, number of pre- and post-program outbreaks and IPC uptake) and acceptability or satisfaction. RESULTS The Community Response Team supported 32 sites. Of those, 30 completed an intake needs assessment, 24 completed mobile testing for SARS-CoV-2 and 15 received IPC support. Mobile testing resulted in the collection of 1566 nasopharyngeal swabs, of which 64 were positive for SARS-CoV-2 infection. Three sites had confirmed outbreaks. The median time from referral to needs assessment was 4 days (interquartile range [IQR] 1-13 days), and the median time to the testing day was 9 days (IQR 1-49 days). The median time from referral to IPC staff training was 14 days (IQR 4-79 days), and 100% of respondents reported being pleased or very pleased with the training. During the follow-up period, the 3 facilities with outbreaks overcame those outbreaks. Three sites supported by the Community Response Team had further single cases, but no site reported subsequent or secondary outbreaks. INTERPRETATION The Community Response Team program led to the transfer of IPC knowledge, allowed for the management and prevention of SARS-CoV-2 outbreaks, and demonstrated feasibility. Collaborative supports between hospitals and the community housing sector may serve as models for ongoing system integration beyond the COVID-19 pandemic.
Collapse
Affiliation(s)
- Mona Loutfy
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont.
| | - V Logan Kennedy
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Sheila Riazi
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Suvendrini Lena
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Mina Kazemi
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Jessica Bawden
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Vanessa Wright
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Lisa Richardson
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Selena Mills
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Laura Belsito
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Geetha Mukerji
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Sacha Bhatia
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Meenakshi Gupta
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Cristina Barrett
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| | - Danielle Martin
- Department of Medicine (Loutfy, Lena, Mukerji, Bhatia, Barrett), Women's College Hospital; Temerty Faculty of Medicine (Loutfy, Richardson, Bhatia, Martin), University of Toronto; Women's College Research Institute (Kennedy, Kazemi, Gupta), Women's College Hospital; Women's College Institute of Health Systems Solutions and Virtual Care (Mukerji, Bhatia); Department of Anesthesia and Pain Medicine (Riazi), Women's College Hospital, University of Toronto; Centre for Addiction & Mental Health (Lena); Department of Family and Community Medicine (Bawden, Wright, Belsito, Mukerji, Martin), Women's College Hospital; Department of Medicine (Gupta), Mount Sinai Hospital; Department of Medicine (Richardson), University Health Network; Centre for Wise Practices in Indigenous Health (Richardson, Mills), Women's College Hospital, Toronto, Ont
| |
Collapse
|
32
|
Shariff SZ, Richard L, Hwang SW, Kwong JC, Forchuk C, Dosani N, Booth R. COVID-19 vaccine coverage and factors associated with vaccine uptake among 23 247 adults with a recent history of homelessness in Ontario, Canada: a population-based cohort study. Lancet Public Health 2022; 7:e366-e377. [PMID: 35278362 PMCID: PMC8906815 DOI: 10.1016/s2468-2667(22)00037-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND People experiencing homelessness face a high risk of SARS-CoV-2 infection and transmission, as well as health complications and death due to COVID-19. Despite being prioritised for receiving the COVID-19 vaccine in many regions, little data are available on vaccine uptake in this vulnerable population. Using population-based health-care administrative data from Ontario, Canada-a region with a universal, publicly funded health system-we aimed to describe COVID-19 vaccine coverage (ie, the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent history of homelessness. METHODS We conducted a retrospective, population-based cohort study of adults (aged ≥18 years) with a recent experience of homelessness, inadequate housing, or shelter use as recorded in routinely collected health-care databases between June 14, 2020, and June 14, 2021 (a period within 6 months of Dec 14, 2020, when COVID-19 vaccine administration was initiated in Ontario). Participants were followed up from Dec 14, 2020, to Sept 30, 2021, for the receipt of one or two doses of a COVID-19 vaccine using the province's real-time centralised vaccine information system. We described COVID-19 vaccine coverage overall and within predefined subgroups. Using modified Poisson regression, we further identified sociodemographic factors, health-care usage, and clinical factors associated with receipt of at least one dose of a COVID-19 vaccine. FINDINGS 23 247 individuals with a recent history of homelessness were included in this study. Participants were predominantly male (14 752 [63·5%] of 23 247); nearly half were younger than 40 years (11 521 [49·6%]) and lived in large metropolitan regions (12 123 [52·2%]); and the majority (18 226 [78·4%]) visited a general practitioner for an in-person consultation during the observation period. By Sept 30, 2021, 14 271 (61·4%; 95% CI 60·8-62·0) individuals with a recent history of homelessness had received at least one dose of a COVID-19 vaccine and 11 082 (47·7%; 47·0-48·3) had received two doses; in comparison, over the same period, 86·6% of adults in the total Ontario population had received a first dose and 81·6% had received a second dose. In multivariable analysis, factors positively associated with COVID-19 uptake were one or more outpatient visits to a general practitioner (adjusted risk ratio [aRR] 1·37 [95% CI 1·31-1·42]), older age (50-59 years vs 18-29 years: 1·18 [1·14-1·22], ≥60 years vs 18-29 years: 1·27 [1·22-1·31]), receipt of an influenza vaccine in either of the two previous influenza seasons (1·25 [1·23-1·28]), being identified as homeless via a visit to a community health centre versus exclusively a hospital-based encounter (1·13 [1·10-1·15]), receipt of one or more SARS-CoV-2 tests between March 1, 2020, and Sept 30, 2021 (1·23 [1·20-1·26]), and the presence of chronic health conditions (one condition: 1·05 [1·03-1·08]; two or more conditions: 1·11 [1·08-1·14]). By contrast, living in a smaller metropolitan region (aRR 0·92 [95% CI 0·90-0·94]) or rural location (0·93 [0·90-0·97]) versus large metropolitan regions were associated with lower uptake. INTERPRETATION In Ontario, COVID-19 vaccine coverage among adults with a recent history of homelessness has lagged and, as of Sept 30, 2021, was 25 percentage points lower than that of the general adult population in Ontario for a first dose and 34 percentage points lower for a second dose. With high usage of outpatient health services among individuals with a recent history of homelessness, better utilisation of outpatient primary care structures might offer an opportunity to increase vaccine coverage in this population. Our findings underscore the importance of leveraging existing health and service organisations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery. FUNDING The Public Health Agency of Canada. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
- Salimah Z Shariff
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada; Lawson Health Research Institute, London, ON, Canada; Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.
| | - Lucie Richard
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jeffrey C Kwong
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Public Health Ontario, Toronto, ON, Canada,University Health Network, Toronto, ON, Canada
| | - Cheryl Forchuk
- Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Naheed Dosani
- Division of Palliative Care, Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Richard Booth
- ICES (formerly the Institute for Clinical Evaluative Sciences), London, ON, Canada,Lawson Health Research Institute, London, ON, Canada,Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| |
Collapse
|
33
|
Corey J, Lyons J, O’Carroll A, Stafford R, Ivers JH. A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063219. [PMID: 35328907 PMCID: PMC8954292 DOI: 10.3390/ijerph19063219] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023]
Abstract
Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.
Collapse
Affiliation(s)
- Julia Corey
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | - James Lyons
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
| | | | - Richie Stafford
- HSE Community Healthcare Organisation Dublin North City & County, D09C8P5 Dublin, Ireland;
| | - Jo-Hanna Ivers
- Department of Public Health & Primary Care, School of Medicine, Trinity College Dublin, D24H74 Dublin, Ireland; (J.C.); (J.L.)
- Correspondence:
| |
Collapse
|
34
|
Lindner AK, Sarma N, Rust LM, Hellmund T, Krasovski-Nikiforovs S, Wintel M, Klaes SM, Hoerig M, Monert S, Schwarzer R, Edelmann A, Martinez GE, Mockenhaupt FP, Kurth T, Seybold J. Monitoring for COVID-19 by universal testing in a homeless shelter in Germany: a prospective feasibility cohort study. BMC Infect Dis 2021; 21:1241. [PMID: 34895157 PMCID: PMC8665323 DOI: 10.1186/s12879-021-06945-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
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.
Collapse
Affiliation(s)
- Andreas K Lindner
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Navina Sarma
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | | | - Mia Wintel
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | | | | | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank P Mockenhaupt
- Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Seybold
- Medical Directorate, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
35
|
Montgomery MP, Meehan AA, Cooper A, Toews KA, Ghinai I, Schroeter MK, Gibbs R, Rehman N, Stylianou KS, Yeh D, Thomas-Campbell N, Washington NC, Brosnan HK, Chang AH, Gomih A, Ngo C, Vickery KD, Harrison B, Winkelman TN, Gerstenfeld A, Zeilinger L, Mosites E. Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness - Six U.S. Jurisdictions, December 2020-August 2021. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1676-1678. [PMID: 34855724 PMCID: PMC8641566 DOI: 10.15585/mmwr.mm7048a4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
36
|
Thomas I, Mackie P. A population level study of SARS-CoV-2 prevalence amongst people experiencing homelessness in Wales, UK. Int J Popul Data Sci 2021; 5:1695. [PMID: 35097224 PMCID: PMC8757314 DOI: 10.23889/ijpds.v5i4.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Introduction Prior research into the prevalence of SARS-CoV-2 infection amongst people experiencing homelessness (PEH) largely relates to people in communal forms of temporary accommodation in contexts where this type of accommodation remained a major part of the response to homelessness during the COVID-19 pandemic. Little is known about the prevalence of SARS-CoV-2 amongst PEH more broadly, and in a policy and practice context that favoured self-contained accommodation, such as Wales, UK. Objective Describe the prevalence of SARS-CoV-2 amongst PEH in Wales, UK, using routinely collected administrative data from the Secure Anonymised Information Linkage Databank. Methods Routinely collected data were used to identify PEH in Wales between 1st March 2020 and 1st March 2021. Using SARS-CoV-2 pathology testing data, prevalence rates were generated for PEH and three comparator groups: (1) the not-homeless population; (2) a cohort 'exact matched' for age, sex, local authority and area deprivation; and (3) a matched comparison group created using these same variables and Propensity Score Matching (PSM). Three logistic regressions were run on samples containing each of the comparator groups to explore the effect of experiencing homelessness on testing positive for SARS-CoV-2. Results The prevalence of SARS-CoV-2 infection amongst PEH was 5.0%, compared to the not-homeless population at 5.6%. For the exact matched and PSM match comparator groups, prevalence was 6.9% and 6.7%, respectively. Logistic regression found that SARS-CoV-2 infection was 0.9 times less likely amongst PEH compared to people not experiencing homelessness from the general population. The odds of SARS-CoV-2 infection for PEH was 0.75 and 0.73 where the 'not-homeless' comparators were from the exact match and PSM samples, respectively. Conclusion Our analysis revealed that a year into the COVID-19 pandemic, the prevalence of SARS-CoV-2 amongst PEH in Wales was lower than the general population. A policy response to homelessness that moved away from communal accommodation may be partly responsible for the reduced SAR-CoV-2 infection amongst PEH.
Collapse
Affiliation(s)
| | - Peter Mackie
- Cardiff University, School of Geography and Planning, Cardiff, CF10 3WA
| |
Collapse
|
37
|
Rao CY, Robinson T, Huster K, Laws RL, Keating R, Tobolowsky FA, McMichael TM, Gonzales E, Mosites E. Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19. PLoS One 2021; 16:e0253108. [PMID: 34723986 PMCID: PMC8559982 DOI: 10.1371/journal.pone.0253108] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the work environment and COVID-19 mitigation measures for homeless shelter workers and assess occupational risk factors for COVID-19. Methods Between June 9-August 10, 2020, we conducted a self-administered survey among homeless shelter workers in Washington, Massachusetts, Utah, Maryland, and Georgia. We calculated frequencies for work environment, personal protective equipment use, and SARS-CoV-2 testing history. We used generalized linear models to produce unadjusted prevalence ratios (PR) to assess risk factors for SARS-CoV-2 infection. Results Of the 106 respondents, 43.4% reported frequent close contact with clients; 75% were worried about work-related SARS-CoV-2 infections; 15% reported testing positive. Close contact with clients was associated with testing positive for SARS-CoV-2 (PR 3.97, 95%CI 1.06, 14.93). Conclusions Homeless shelter workers may be at risk of being exposed to individuals with COVID-19 during the course of their work. Frequent close contact with clients was associated with SARS-CoV-2 infection. Protecting these critical essential workers by implementing mitigation measures and prioritizing for COVID-19 vaccination is imperative during the pandemic.
Collapse
Affiliation(s)
- Carol Y. Rao
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Tashina Robinson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Karin Huster
- Public Health-Seattle & King County, Seattle, Washington, United States of America
| | - Rebecca L. Laws
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ryan Keating
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Farrell A. Tobolowsky
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Temet M. McMichael
- Public Health-Seattle & King County, Seattle, Washington, United States of America
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Elysia Gonzales
- Public Health-Seattle & King County, Seattle, Washington, United States of America
| | - Emily Mosites
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|