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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; 139:532-548. [PMID: 38379269 PMCID: PMC11344984 DOI: 10.1177/00333549241228525] [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] [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.
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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
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Maria DMS, Padhye N, Ostrosky-Zeichner L, Grimes CZ, Nyamathi A, Lightfoot M, Quadri Y, Paul ME, Jones JT. COVID-19 Vaccination Uptake, Infection Rates, and Seropositivity Among Youth Experiencing Homelessness in the United States. Nurs Res 2024; 73:373-380. [PMID: 38809559 PMCID: PMC11344680 DOI: 10.1097/nnr.0000000000000747] [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] [Indexed: 05/30/2024]
Abstract
BACKGROUND People experiencing homelessness are at greater risk of exposure and poor health outcomes from COVID-19. However, little data exist on the prevalence and correlates of COVID-19 among homeless populations. To mitigate the spread and severity, uptake of the COVID-19 vaccine is needed. This can be challenging among youth experiencing homelessness who are more likely to be unvaccinated when compared to stably housed youth. OBJECTIVE We conducted this study to determine the prevalence and correlates of COVID-19 among youth experiencing homelessness. METHODS We examined experiences of COVID-19 symptoms, self-report of infection, and rates of COVID-19 antibodies and distinguished between natural and vaccinated immunity among youth experiencing homelessness ( N = 265) recruited in one large metropolitan area in the south. RESULTS Based on self-report, very few participants experienced any symptoms, and 80% had never been diagnosed with COVID-19. Of those with COVID-19 antibodies (68%), the proportion with antibodies resulting from natural infection was 44%. The vaccination rate was 42%. Younger and vaccinated participants and those in shelters were likelier to have COVID-19 antibodies. Black and Hispanic youth were more likely than White youth to have had COVID-19. Those who adopted only one or two prevention behaviors were more likely to acquire a natural infection than those who adopted three or more prevention behaviors. DISCUSSION Youth experiencing homelessness report low vaccination rates, disrupted access to healthcare and social supports, and underlying chronic conditions, which may explain why they face poorer outcomes when infected with COVID-19. Vaccination and risk mitigation strategies to combat the high prevalence of COVID-19 are especially needed for sheltered youth who are at high risk yet are often asymptomatic.
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Affiliation(s)
- Diane M. Santa Maria
- University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX
| | - Nikhil Padhye
- University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX
| | - Luis Ostrosky-Zeichner
- University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX
| | - Carolyn Z. Grimes
- Laboratory of Mycology Research, Division of Infectious Diseases, University of Texas, Health Science Center at Houston McGovern Medical School
| | - Adeline Nyamathi
- University of California Irvine Sue & Bill Gross School of Nursing, Irvine, CA
| | - Marguerita Lightfoot
- Oregon Health & Science University-Portland State University School of Public Health
| | | | - Mary E. Paul
- Baylor College of Medicine, Houston, TX
- Texas Children’s Hospital, Houston, TX
| | - Jennifer Torres Jones
- University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX
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Ngandu DN, Sclar GD, Ahmed A, Awale SA, Fernandes C, Goldstein J, Hashmi H, Joshi S, Mallipeddi S, Mudasigana ML, Nicoll L, Parker DE, Price G, Tucker A, Vinton EA, Volkers A, Jacobs EA, Fairfield KM. Reaching Structurally Vulnerable Populations Using Low-Barrier COVID-19 Testing Clinics Co-Created with Community-Based Organizations. J Gen Intern Med 2024:10.1007/s11606-024-08889-2. [PMID: 39020226 DOI: 10.1007/s11606-024-08889-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 06/12/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND The COVID-19 pandemic disproportionately affected people from structurally vulnerable communities. There was a need to improve COVID-19 testing in these communities to reduce viral spread and connect to treatment. OBJECTIVE We created a partnership between an academic medical center and three community-based organizations (CBOs) to offer low-barrier COVID-19 walk-up testing clinics in Portland, Maine. Our objective was to examine whether the co-created testing clinics reached structurally vulnerable populations. DESIGN The clinics offered COVID-19 rapid antigen tests three times a week outside CBO sites from January 2022 to May 2023. Clinic staff administered a brief survey on reason for testing and then instructed participants on how to self-swab. While staff processed the test, participants were invited to complete an additional survey about their demographics and testing perceptions. PARTICIPANTS Adults seeking COVID-19 testing with specific outreach to people who are unhoused, immigrants, and low-income and/or uninsured. MAIN MEASURES Number of tests conducted and result, reasons for testing, and testing perceptions. KEY RESULTS Of 246 completed tests, 18 were positive for COVID-19 (7%). Participants sought testing for a variety of reasons, including symptoms (60%), close contact exposure (29%), and/or need for a negative test result to access services or an activity (33%). Overall, people primarily tested due to symptoms with only 7% testing due to close contact exposure alone. The clinics reached vulnerable populations. Among the 130 people completing the participant survey, 39% were unhoused, 22% spoke a language other than English at home, 23% were uninsured, and 46% earned less than $20,000 in 2019. Qualitative field notes captured key elements of clinics that influenced reach, and how this collaboration with CBOs helped build trust with our target populations. CONCLUSIONS Providing low-barrier walk-up clinics partnering with trusted CBOs was observed to be helpful in reaching structurally vulnerable populations for COVID-19 testing.
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Affiliation(s)
- David N Ngandu
- MaineHealth Institute for Research, Scarborough, ME, USA
| | - Gloria D Sclar
- MaineHealth Institute for Research, Scarborough, ME, USA
| | - Ambia Ahmed
- MaineHealth Institute for Research, Scarborough, ME, USA
| | - Sumayo A Awale
- MaineHealth Institute for Research, Scarborough, ME, USA
| | | | - Joshua Goldstein
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | - Hina Hashmi
- MaineHealth Institute for Research, Scarborough, ME, USA
| | | | | | | | - Leslie Nicoll
- Friends of the Portland Community Free Clinic, Portland, ME, USA
| | | | - Grace Price
- MaineHealth Institute for Research, Scarborough, ME, USA
- Department of Medicine, Maine Medical Center, Portland, ME, USA
| | - Ann Tucker
- Greater Portland Health, Portland, ME, USA
| | - Elizabeth A Vinton
- Department of Public Health and Community Medicine, School of Medicine, Tufts University, Boston, MA, USA
| | | | | | - Kathleen M Fairfield
- MaineHealth Institute for Research, Scarborough, ME, USA.
- Department of Medicine, Maine Medical Center, Portland, ME, USA.
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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.
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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
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Huang W, Gao CX, Luo D, Wang Y, Zheng X, Liu C, Wang Y, Li Y, Qian H. Risk evaluation of venue types and human behaviors of COVID-19 outbreaks in public indoor environments: A systematic review and meta-analysis. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 341:122970. [PMID: 37979645 DOI: 10.1016/j.envpol.2023.122970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/03/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023]
Abstract
Despite increasing vaccination rates, the incidence of breakthrough infections with COVID-19 has increased due to the continued emergence of new variants of the SARS-CoV-2 coronavirus. Therefore, Non-pharmaceutical interventions remain the most effective measures for coping with the ever-changing pandemic. The lifting of compulsory interventions has made individuals primary responsibility for their own health, which highlights the importance of increasing awareness of the infection risk from the environment in which they live and their individual behaviors. We systematically searched PubMed, Web of Science, ScienceDirect, and Scopus on April 17, 2023, for all studies reporting COVID-19 outbreaks in public indoor venues. The study outcome was the attack rate. A total of 42 studies, which included cross-sectional studies, cohort studies, and case studies, reporting data on 1951 confirmed cases in 64 COVID-19 outbreaks satisfied the meta-analysis and were included in the review. A random-effect model was used in the meta-analysis, and subgroup analyses were conducted to investigate factors affecting attack rates. We found a strong level of evidence (p < 0.01) supporting a higher pooled attack rate in recreation-related venues (0.44, 95% CI: 0.30 to 0.60) than in work-related venues (0.21, 95% CI: 0.16 to 0.27). Compared to those outbreaks without that, outbreaks with high-intensity exercise, vocalization, contact behavior, or close body proximity had a higher attack rate of 0.51, 0.55, 0.33, and 0.39, respectively. Further studies suggest that different attack rates across different types of settings may be the result of heterogeneity in exposed people's behaviors. There were significant heterogeneities that may limit the interpretation of connections between influencing factors and outbreak outcomes. The identification of key behaviors that may contribute to transmission risk, and their correlation with venue type, has important implications for the development of future public health interventions and individual prevention strategies for respiratory infectious diseases such as COVID-19.
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Affiliation(s)
- Weiwei Huang
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Caroline X Gao
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia; Orygen, Parkville, VIC 3052, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Danting Luo
- School of Energy and Environment, Southeast University, Nanjing, China; Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Yong Wang
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Xiaohong Zheng
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Cong Liu
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Ying Wang
- Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China; Department of Infection Management, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam Road, Hong Kong, China; School of Public Health, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China; Hubei Engineering Center for Infectious Disease Prevention, Control and Treatment, Wuhan, China.
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Gin JL, Balut MD, Dobalian A. COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation. BMC PRIMARY CARE 2024; 25:24. [PMID: 38216894 PMCID: PMC10785369 DOI: 10.1186/s12875-023-02251-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/18/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care. METHODS This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic). RESULTS Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources. CONCLUSIONS These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.
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Affiliation(s)
- June L Gin
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA.
| | - Michelle D Balut
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
| | - Aram Dobalian
- Veterans Emergency Management Evaluation Center, Department of Veterans Affairs, 16111 Plummer St. MS-152, North Hills, CA, 91343, USA
- Division of Health Services Management and Policy, The Ohio State University College of Public Health, 202 Cunz Hall, 1841 Neil Ave, Columbus, OH, 43210, USA
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Schwartz GL, Leifheit KM, Arcaya MC, Keene D. Eviction as a community health exposure. Soc Sci Med 2024; 340:116496. [PMID: 38091853 PMCID: PMC11249083 DOI: 10.1016/j.socscimed.2023.116496] [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: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/23/2024]
Abstract
Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.
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Affiliation(s)
- Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Urban Health Collaborative & Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Kathryn M Leifheit
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariana C Arcaya
- Department of Urban Studies & Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Danya Keene
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Haworth S, Cranshaw O, Xerri M, Stannard J, Clark R, Pacey E, Leng G, Campos-Matos I. A systematic review of the international evidence on the effectiveness of COVID-19 mitigation measures in communal rough sleeping accommodation. J Public Health (Oxf) 2023; 45:804-815. [PMID: 37477219 PMCID: PMC10788840 DOI: 10.1093/pubmed/fdad114] [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: 01/28/2023] [Revised: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Accommodations with shared washing facilities increase the risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for people experiencing rough sleeping and evidence on what interventions are effective in reducing these risks needs to be understood. METHODS Systematic review, search date 6 December 2022 with methods published a priori. Electronic searches were conducted in MEDLINE, PubMed, Cochrane Library, CINAHL and the World Health Organization (WHO) COVID-19 Database and supplemented with grey literature searches, hand searches of reference lists and publication lists of known experts. Observational, interventional and modelling studies were included; screening, data extraction and risk of bias assessment were done in duplicate and narrative analyses were conducted. RESULTS Fourteen studies from five countries (USA, England, France, Singapore and Canada) were included. Ten studies were surveillance reports, one was an uncontrolled pilot intervention, and three were modelling studies. Only two studies were longitudinal. All studies described the effectiveness of different individual or packages of mitigation measures. CONCLUSIONS Despite a weak evidence base, the research suggests that combined mitigation measures can help to reduce SARS-CoV-2 transmission but are unlikely to prevent outbreaks entirely. Evidence suggests that community prevalence may modify the effectiveness of mitigation measures. More longitudinal research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021292803.
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Affiliation(s)
- Steven Haworth
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
- Institute for Social and Economic Research, University of Essex, Essex CO4 3SQ, UK
| | - Owen Cranshaw
- Institute for Social and Economic Research, University of Essex, Essex CO4 3SQ, UK
| | - Mark Xerri
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Jez Stannard
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Rachel Clark
- Policy, Systems and Innovations Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Emma Pacey
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Gill Leng
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
| | - Ines Campos-Matos
- Addictions and Inclusion Directorate, Office for Health Improvement and Disparities, London SW1H 0EU, UK
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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: 1] [Impact Index Per Article: 1.0] [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.
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Affiliation(s)
| | | | | | | | - Shixing Tang
- Guangdong Provincial Key Laboratory of Tropical Disease Research, Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, China
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Loubiere S, Hafrad I, Monfardini E, Mosnier M, Bosetti T, Auquier P, Mosnier E, Tinland A. Morbidity and mortality in a prospective cohort of people who were homeless during the COVID-19 pandemic. Front Public Health 2023; 11:1233020. [PMID: 37780443 PMCID: PMC10536263 DOI: 10.3389/fpubh.2023.1233020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/30/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction Certain living conditions, such as homelessness, increase health risks in epidemic situations. We conducted a prospective observational cohort study to investigate the impact of the COVID-19 pandemic on morbidity and mortality in adult people who were homeless. Methods The study population comprised around 40% of the entire population experiencing homelessness in Marseille. They were enrolled at 48 different locations during the first pandemic wave (June to August 2020) and were followed up 3 and 6 months later. Rapid serological screening for SARS-CoV-2 was performed by community outreach teams at each follow-up, who also conducted interviews. Death registers and hospital administrative databases were consulted. Results A total of 1,332 participants [mean age 40.1 years [SD 14.2], women 339 (29.9%)] were enrolled in the cohort. Of these, 192 (14.4%) participants were found positive for COVID-19 and were propensity score matched (1:3) and compared with 553 non-COVID-19 cases. Living in emergency shelters was associated with COVID-19 infection. While 56.3% of the COVID-19-infected cohort reported no symptoms, 25.0% were hospitalized due to the severity of the disease. Presence of three or more pre-existing comorbidities was associated with all-cause hospitalization. Among COVID-19 cases, only older age was associated with COVID-19 hospitalization. Three deaths occurred in the cohort, two of which were among the COVID-19 cases. Conclusion The study provides new evidence that the population experiencing homelessness faces higher risks of infection and hospitalization due to COVID-19 than the general population. Despite the efforts of public authorities, the health inequities experienced by people who are homeless remained major. More intensive and appropriate integrated care and earlier re-housing are needed.
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Affiliation(s)
- Sandrine Loubiere
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France
- CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France
| | - Ikrame Hafrad
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Elisabetta Monfardini
- Department of Psychiatry, Assistance Publique – Hôpitaux de Marseille, Marseille, France
| | - Marine Mosnier
- Médecins du Monde – Doctors of the World, Marseille, France
| | - Thomas Bosetti
- Médecins du Monde – Doctors of the World, Marseille, France
| | - Pascal Auquier
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique – Hôpitaux de Marseille, Marseille, France
- CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France
| | - Emilie Mosnier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille University, Marseille, France
| | - Aurélie Tinland
- CEReSS – Health Service Research and Quality of Life Center, EA 3279: CEReSS – Health Service Research and Quality of Life Center, School of medicine – La Timone Medical Campus, Aix-Marseille University, Marseille, France
- Department of Psychiatry, Assistance Publique – Hôpitaux de Marseille, Marseille, France
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11
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Generaal E, van Santen DKD, Campman SL, Booij MJ, Price D, Buster M, van Dijk C, Boyd A, Bruisten SM, van Dam AP, van der Lubben M, van Duijnhoven YTHP, Prins M. Low prevalence of current and past SARS-CoV-2 infections among visitors and staff members of homelessness services in Amsterdam at the end of the second wave of infections in the Netherlands. PLoS One 2023; 18:e0288610. [PMID: 37490469 PMCID: PMC10368265 DOI: 10.1371/journal.pone.0288610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 07/02/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) may be at increased risk of SARS-CoV-2 infection and severe COVID-19. The Dutch government established emergency shelters and introduced preventive measures for homelessness services. There were no major SARS-CoV-2 outbreaks noticed among PEH during the first two waves of infections. This study aimed to assess the prevalence of current and past infections among PEH and staff by conducting an on-site COVID-19 screening project at homelessness services in Amsterdam, the Netherlands. METHODS We assessed the proportion of visitors and staff members of four homelessness services at two locations in Amsterdam with positive SARS-CoV-2 qPCR and antibody results (IgG/IgM Rapid Test/Biozek) in May 2021. We also assessed sociodemographic, clinical and lifestyle characteristics, compliance with basic prevention measures and intention to vaccinate against COVID-19 among PEH and staff. RESULTS A total of 138 visitors and 53 staff members filled out a questionnaire and were tested. Among PEH, the SARS-CoV-2 positivity rate was 0% (0/133;95%CI = 0-1.9) and the antibody positivity rate was 1.6% (2/131;95%CI = 0.8-7.5) among those without prior COVID-19 vaccination. Among staff, these percentages were 3% (1/32;95%CI = 0.1-16.2) and 11% (5/53;95%CI = 3.6-23.6), respectively. Most participants were often compliant with the basic preventive measures 'not shaking hands', 'wearing a face mask' and 'washing hands', but not with 'physical distancing'. High vaccination intent was more common among staff members (55%) than among visitors (42%), while high trust in the governmental COVID-19 policies was more common among visitors (41%) than among staff (30%). CONCLUSIONS We observed a low prevalence of past and current SARS-CoV-2 infections among PEH, which may be explained by instated shelter policies, limited daily activities of PEH and compliance with prevention measures. Vaccine hesitancy and mistrust among visitors and staff could hinder vaccination uptake, suggesting that interventions towards homelessness services are needed.
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Affiliation(s)
- Ellen Generaal
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control (Cib), Bilthoven, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - D K Daniela van Santen
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sophie L Campman
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Marjolein J Booij
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Dylan Price
- Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Marcel Buster
- Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | | | - Anders Boyd
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Stichting HIV Monitoring, Amsterdam, the Netherlands
| | - Sylvia M Bruisten
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | - Alje P van Dam
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
- Public Health Service of Amsterdam, Amsterdam, the Netherlands
| | | | - Yvonne T H P van Duijnhoven
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Public Health Service of Rotterdam, Rotterdam, the Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Amsterdam, the Netherlands
- Amsterdam UMC Location University of Amsterdam, Infectious Diseases, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
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12
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Sohn W, Kotval-Karamchandani Z. Risk perception of compound emergencies: A household survey on flood evacuation and sheltering behavior during the COVID-19 pandemic. SUSTAINABLE CITIES AND SOCIETY 2023; 94:104553. [PMID: 36992858 PMCID: PMC10035798 DOI: 10.1016/j.scs.2023.104553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 06/19/2023]
Abstract
Compound hazards are derived from independent disasters that occur simultaneously. Since the outbreak of COVID-19, the coupling of low-probability high-impact climate events has introduced a novel form of conflicting stressors that inhibits the operation of traditional logistics developed for single-hazard emergencies. The competing goals of hindering virus contagion and expediting massive evacuation have posed unique challenges for community safety. Yet, how a community perceives associated risks has been debated. This research utilized a web-based survey to explore the relationship between residents' perceptions of conflicting risks and emergency choices made during a historic compound event, the flooding in 2020 in Michigan, US that coincided with the pandemic. After the event, postal mail was randomly sent to 5,000 households living in the flooded area, collecting 556 responses. We developed two choice models for predicting survivors' evacuation options and sheltering length. The impact of sociodemographic factors on perceptions of COVID-19 risks was also examined. The results revealed greater levels of concern among females, democrats, and the economically inactive population. The relationship between evacuation choice and concern about virus exposure was dependent upon the number of seniors in the household. Concern about a lack of mask enforcement particularly discouraged evacuees from extended sheltering.
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Affiliation(s)
- Wonmin Sohn
- School of Planning, Design & Construction, Michigan State University, 552W Circle Drive, East Lansing, MI 48824, United States
| | - Zeenat Kotval-Karamchandani
- School of Planning, Design & Construction, Michigan State University, 552W Circle Drive, East Lansing, MI 48824, United States
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13
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Cox SN, Scott EM, Rogers JH, Chow EJ, Wasse JK, Carone M, Hughes JP, Chu HY. Burden of long COVID among adults experiencing sheltered homelessness: a longitudinal cohort study in King County, WA between September 2020-April 2022. BMC Public Health 2023; 23:1079. [PMID: 37277786 PMCID: PMC10241609 DOI: 10.1186/s12889-023-16026-7] [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: 02/09/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) are at increased risk for acquiring SARS-CoV-2, but the burden of long COVID in this population is unknown. METHODS We conducted a matched prospective cohort study to assess the prevalence, characteristics, and impact of long COVID among sheltered PEH in Seattle, WA between September 2020-April 2022. Adults ≥ 18 years, residing across nine homeless shelters with active respiratory virus surveillance, were eligible to complete in-person baseline surveys and interval follow-up phone surveys. We included a subset of 22 COVID-19-positive cases who tested positive or inconclusive for SARS-CoV-2 and 44 COVID-19-negative controls who tested negative for SARS-CoV-2, frequency matched on age and sex. Among controls, 22 were positive and 22 were negative for one of 27 other respiratory virus pathogens. To assess the impact of COVID-19 on the risk of symptom presence at follow-up (day 30-225 post-enrollment test), we performed log-linear regression with robust standard errors, adjusting for confounding by shelter site and demographic variables determined a priori. RESULTS Of 53 eligible COVID-19 cases, 22 (42%) completed ≥ 1 follow-up survey. While five (23%) cases reported ≥ 1 symptom at baseline, this increased to 77% (10/13) between day 30-59 and 33% (4/12) day 90 + . The most commonly reported symptoms day 30 + were fatigue (27%) and rhinorrhea (27%), with 8 (36%) reporting symptoms that interfered with or prevented daily activities. Four (33%) symptomatic cases reported receiving medical care outside of a medical provider at an isolation facility. Of 44 controls, 12 (27%) reported any symptoms day 90 + . Risk of any symptoms at follow-up was 5.4 times higher among COVID-19 cases compared to controls (95% CI: 2.7-10.5). CONCLUSIONS Shelter residents reported a high prevalence of symptoms 30 + days after their SARS-CoV-2 detection, though few accessed medical care for persistent illness. The impact of COVID-19 extends beyond acute illness and may exacerbate existing challenges that marginalized populations face in maintaining their health and wellbeing.
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Affiliation(s)
- Sarah N Cox
- Department of Epidemiology, University of Washington, WA, Seattle, USA.
- Department of Medicine, University of Washington, Seattle, USA.
| | - Emily M Scott
- Department of Medicine, University of Colorado, Denver, USA
| | - Julia H Rogers
- Department of Epidemiology, University of Washington, WA, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
| | - Eric J Chow
- Department of Medicine, University of Washington, Seattle, USA
- Public Health - Seattle & King County, Seattle, USA
| | | | - Marco Carone
- Fred Hutchinson Cancer Center, Vaccine and Infectious Disease Division, Seattle, USA
- Department of Biostatistics, University of Washington, Seattle, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, USA
| | - Helen Y Chu
- Department of Epidemiology, University of Washington, WA, Seattle, USA
- Department of Medicine, University of Washington, Seattle, USA
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14
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Groenewold MR, Billock R, Free H, Burrer SL, Sweeney MH, Wong J, Lavender A, Argueta G, Crawford HL, Erukunuakpor K, Karlsson ND, Armenti K, Thomas H, Gaetz K, Dang G, Harduar-Morano L, Modji K, Luckhaupt SE. Excess risk of SARS-CoV-2 infection among in-person nonhealthcare workers in six states, September 2020-June 2021. Am J Ind Med 2023. [PMID: 37153939 DOI: 10.1002/ajim.23487] [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: 11/08/2022] [Revised: 04/19/2023] [Accepted: 04/24/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND While the occupational risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection for healthcare personnel in the United States has been relatively well characterized, less information is available on the occupational risk for workers employed in other settings. Even fewer studies have attempted to compare risks across occupations and industries. Using differential proportionate distribution as an approximation, we evaluated excess risk of SARS-CoV-2 infection by occupation and industry among non-healthcare workers in six states. METHODS We analyzed data on occupation and industry of employment from a six-state callback survey of adult non-healthcare workers with confirmed SARS-CoV-2 infection and population-based reference data on employment patterns, adjusted for the effect of telework, from the U.S. Bureau of Labor Statistics. We estimated the differential proportionate distribution of SARS-CoV-2 infection by occupation and industry using the proportionate morbidity ratio (PMR). RESULTS Among a sample of 1111 workers with confirmed SARS-CoV-2 infection, significantly higher-than-expected proportions of workers were employed in service occupations (PMR 1.3, 99% confidence interval [CI] 1.1-1.5) and in the transportation and utilities (PMR 1.4, 99% CI 1.1-1.8) and leisure and hospitality industries (PMR 1.5, 99% CI 1.2-1.9). CONCLUSIONS We found evidence of significant differences in the proportionate distribution of SARS-CoV-2 infection by occupation and industry among respondents in a multistate, population-based survey, highlighting the excess risk of SARS-CoV-2 infection borne by some worker populations, particularly those whose jobs require frequent or prolonged close contact with other people.
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Affiliation(s)
- Matthew R Groenewold
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Rachael Billock
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Hannah Free
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Sherry L Burrer
- Emergency Preparedness and Response Office, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marie Haring Sweeney
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
| | - Jessie Wong
- California Department of Public Health, Sacramento, California, USA
| | | | | | | | | | - Nicole D Karlsson
- New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Karla Armenti
- University of New Hampshire, Durham, New Hampshire, USA
| | - Hannah Thomas
- New Hampshire Department of Health and Human Services, Concord, New Hampshire, USA
| | - Kim Gaetz
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Gialana Dang
- North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
- Western States Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Denver, Colorado, USA
| | - Laurel Harduar-Morano
- Pennsylvania Department of Health, Harrisburg, Pennsylvania, USA
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Komi Modji
- Wisconsin Department of Health Services, Division of Public Health, Madison, Wisconsin, USA
| | - Sara E Luckhaupt
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, Ohio, USA
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15
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Loitz CC, Johansen S, Johnston JC, Strain KL, Patterson K, Chambers P, Devolin M. Exploring the Alberta Health Services COVID-19 provincial public health integrated outbreak prevention, preparedness, management, and response interventions to support congregate and communal living sites in Alberta. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:218-228. [PMID: 36787032 PMCID: PMC9927052 DOI: 10.17269/s41997-023-00749-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
SETTING On March 17, 2020, a state of public health emergency was declared in Alberta under the Public Health Act in response to the COVID-19 pandemic. Congregate and communal living sites were environments with a high risk of exposure to and transmission of COVID-19. Consequently, provincial efforts to prevent and manage COVID-19 were required and prioritized. INTERVENTION During the first 9 months of the pandemic, vaccines were unavailable and alternate strategies were used to prevent and manage COVID-19 (e.g., physical distancing, masking, symptom screening, testing, isolating cases). Alberta Health Services worked with local, provincial, and First Nations and Inuit Health Branch stakeholders to deliver interventions to support congregate and communal living sites. Interventions included resources and site visits to support prevention and preparedness, and the creation of a coordinated response line to serve as a single point of contact to access information and services in the event of an outbreak (e.g., guidance, testing, personal protective equipment, reporting). OUTCOMES Data from an internal monitoring dashboard informed intervention uptake and use. Online survey results found high levels of awareness, acceptability, appropriateness, and use of the interventions among congregate and communal living site administrators (n = 550). Recommendations were developed from reported experiences, challenges, and facilitators, and processes were improved. IMPLICATIONS Provincially coordinated prevention, preparedness, and outbreak management interventions supported congregate and communal living sites. Efforts to further develop adaptive system-level approaches for prevention and preparedness, in addition to communication and information sharing in complex rapidly changing contexts, could benefit future public health emergencies.
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Affiliation(s)
- Christina C Loitz
- Population and Public Health, Alberta Health Services, Edmonton, AB, Canada.
| | - Sandra Johansen
- Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - J Cyne Johnston
- Population and Public Health, Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Keri-Lynn Strain
- Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Kara Patterson
- Population and Public Health, Alberta Health Services, Calgary, AB, Canada
| | - Patricia Chambers
- Provincial Clinical Programs and Virtual Health, Alberta Health Services, Calgary, AB, Canada
| | - Maureen Devolin
- Population and Public Health, Alberta Health Services, Calgary, AB, Canada
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16
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Dauria EF, Clemenzi-Allen A, Nowotny K, Brinkley-Rubinstein L, Williams B, Wurcel A. Increasing availability of COVID-19 vaccine to older adults under community supervision. Int J Prison Health 2023; 19:88-94. [PMID: 36367307 PMCID: PMC10114607 DOI: 10.1108/ijph-06-2022-0035] [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] [Indexed: 11/13/2022]
Abstract
PURPOSE Vaccinating adults who are involved with the carceral system, particularly those aged 55 or older, is crucial to containing the COVID-19 pandemic in the USA, particularly as variants continue to emerge and spread. In this Viewpoint, the authors discuss the reasons why improving access to COVID-19 vaccine and boosters among community supervised adults, especially the aging population, is critical to mitigating the public health consequences of the COVID-19 pandemic. This study concludes by providing recommendations to enhance vaccine and booster uptake in this population, as the pandemic continues. DESIGN/METHODOLOGY/APPROACH This is a Viewpoint paper regarding mitigating the spread of COVID-19 by improving access to vaccine and boosters among community supervised adults, especially the aging population. FINDINGS A key population that has been overlooked in vaccination efforts are older adults involved in the carceral system who are living in the community (i.e. "community supervised" or people on probation or parole). Older adults on probation and parole are at high risk for SARS-CoV-2 transmission and severe disease due to numerous factors at the individual, community, social and structural levels. ORIGINALITY/VALUE Implementation of recommendations presented in this Viewpoint will mitigate COVID-19 risk among a population that has been marginalized and overlooked, yet has been the epicenter of the COVID-19 pandemic.
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Affiliation(s)
- Emily F. Dauria
- University of Pittsburgh, Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA, USA
| | - Angelo Clemenzi-Allen
- Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Kathryn Nowotny
- Department of Sociology, University of Miami, Coral Gables, Florida, USA
| | - Lauren Brinkley-Rubinstein
- University of North Carolina, Chapel Hill, Department of Social Medicine, Center for Health Equity Research, Chapel Hill, NC, USA
| | - Brie Williams
- Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Alysse Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
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17
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Ahillan T, Emmerson M, Swift B, Golamgouse H, Song K, Roxas A, Mendha SB, Avramović E, Rastogi J, Sultan B. COVID-19 in the homeless population: a scoping review and meta-analysis examining differences in prevalence, presentation, vaccine hesitancy and government response in the first year of the pandemic. BMC Infect Dis 2023; 23:155. [PMID: 36918758 PMCID: PMC10012317 DOI: 10.1186/s12879-023-08037-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 01/30/2023] [Indexed: 03/16/2023] Open
Abstract
AIMS People experiencing homelessness (PEH) have been identified as being increasingly susceptible to Coronavirus disease (COVID-19), with policies enacted to test, isolate, increase hygiene practices and prioritise vaccines among this population. Here, we conduct a scoping review of the current evidence-base pertaining to the prevalence and presentation of COVID-19 in PEH, COVID-vaccine hesitancy rates and government interventions enacted within the first year of the pandemic for PEH. MATERIALS AND METHODS A systematic search was conducted on Pubmed, Cochrane, Embase and MedRxiv databases for studies reporting primary data on COVID-19 prevalence and clinical characteristics in PEH, vaccine uptake for PEH and policies enacted targeting PEH. Study qualities were assessed with The National Heart, Lung and Blood Institute's set of Study Quality. RESULTS Eighty-three studies were included in our final analysis. The overall prevalence of symptomatic COVID-19 infection in PEH is estimated at 35%. The most common symptoms found were cough and shortness of breath, followed by fever. Concerns regarding vaccine hesitancy amongst PEH related to thoroughness of COVID-19 vaccine clinical trials, side effects and mistrust of the government. The main strategies implemented by governments were mass testing, adaption of healthcare service provision, provision of alternative housing, encouraging personal hygiene (hand sanitation and mask wearing), and inter-organisational communication. DISCUSSION In our meta-analysis, 35% of PEH with a COVID-19 infection presented symptomatically; the low prevalence of symptomatic COVID-19 infection suggests widespread testing following outbreaks would be beneficial for this group of individuals. Temporary recuperation units and measures for housing stability in the pandemic, namely provision of alternative housing and stopping evictions, were found to be highly effective. High rates of vaccine hesitancy means that education and encouragement towards vaccination would be beneficial for this vulnerable population, where comorbidities are common. Finally increased focus in research should be placed on the mental health burden of COVID-19 and the pandemic on PEH moving forwards.
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Affiliation(s)
| | | | - Bethan Swift
- Wellcome Centre for Human Genetics, Oxford, UK.,Nuffield Department of Women's and Reproductive Health, Oxford, UK
| | | | | | | | | | | | | | - Binta Sultan
- Institute of Global Health, University College London, London, UK
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18
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Hoover CM, Skaff NK, Blumberg S, Fukunaga R. Aligning staff schedules, testing, and isolation reduces the risk of COVID-19 outbreaks in carceral and other congregate settings: A simulation study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001302. [PMID: 36962883 PMCID: PMC10022395 DOI: 10.1371/journal.pgph.0001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023]
Abstract
COVID-19 outbreaks in congregate settings remain a serious threat to the health of disproportionately affected populations such as people experiencing incarceration or homelessness, the elderly, and essential workers. An individual-based model accounting for individual infectiousness over time, staff work schedules, and testing and isolation schedules was developed to simulate community transmission of SARS-CoV-2 to staff in a congregate facility and subsequent transmission within the facility that could cause an outbreak. Systematic testing strategies in which staff are tested on the first day of their workweek were found to prevent up to 16% more infections than testing strategies unrelated to staff schedules. Testing staff at the beginning of their workweek, implementing timely isolation following testing, limiting test turnaround time, and increasing test frequency in high transmission scenarios can supplement additional mitigation measures to aid outbreak prevention in congregate settings.
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Affiliation(s)
- Christopher M. Hoover
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
| | - Nicholas K. Skaff
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Seth Blumberg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, California, United States of America
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Rena Fukunaga
- Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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19
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Zhu A, Bruketa E, Svoboda T, Patel J, Elmi N, El-Khechen Richandi G, Baral S, Orkin AM. Respiratory infectious disease outbreaks among people experiencing homelessness: a systematic review of prevention and mitigation strategies. Ann Epidemiol 2023; 77:127-135. [PMID: 35342013 DOI: 10.1016/j.annepidem.2022.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 02/16/2022] [Accepted: 03/05/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE People experiencing homelessness (PEH) are at increased risk of respiratory infections and associated morbidity and mortality. To characterize optimal intervention strategies, we completed a systematic review of mitigation strategies for PEH to minimize the spread and impact of respiratory infectious disease outbreaks, including COVID-19. METHODS The study protocol was registered in PROSPERO (#2020 CRD42020208964) and was consistent with the preferred reporting in systematic reviews and meta-analyses guidelines. A search algorithm containing keywords that were synonymous to the terms "Homeless" and "Respiratory Illness" was applied to the six databases. The search concluded on September 22, 2020. Quality assessment was performed at the study level. Steps were conducted by two independent team members. RESULTS A total of 4468 unique titles were retrieved with 21 meeting criteria for inclusion. Interventions included testing, tracking, screening, infection prevention and control, isolation support, and education. Historically, there has been limited study of intervention strategies specifically for PEH across the world. CONCLUSIONS Staff and organizations providing services for people experiencing homelessness face specific challenges in adhering to public health guidelines such as physical distancing, isolation, and routine hygiene practices. There is a discrepancy between the burden of infectious diseases among PEH and specific research characterizing optimal intervention strategies to mitigate transmission in the context of shelters. Improving health for people experiencing homelessness necessitates investment in programs scaling existing interventions and research to study new approaches.
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Affiliation(s)
- Alice Zhu
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada; Department of General Surgery, University of Toronto, Toronto, ON, Canada
| | - Eva Bruketa
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Queen's University, School of Medicine, Kingston, ON, Canada
| | - Tomislav Svoboda
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada
| | - Jamie Patel
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Ryerson University, Daphne Cockwell School of Nursing, Toronto, ON, Canada
| | - Nika Elmi
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | - Stefan Baral
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Aaron M Orkin
- Population Health Service, Inner City Health Associates. Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, ON, Canada.
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20
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Marshall A, Dugan JA. Addressing hygiene needs of housing insecure populations: A qualitative analysis of Seattle and King County's mobile hygiene station intervention. PUBLIC HEALTH IN PRACTICE 2022; 4:100332. [PMID: 36324636 PMCID: PMC9612873 DOI: 10.1016/j.puhip.2022.100332] [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: 05/18/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 11/06/2022] Open
Abstract
Objective To evaluate the Seattle Public Utility mobile hygiene station program, a program deployed using public funds in response to the large-scale closures of public hygiene facilities due to COVID-19. Study design We conduct a qualitative analysis using semi-structured interviews. Methods We interviewed four Seattle Public Utility (SPU) and Public Health Seattle & King County (PHSKC) employees involved in the design, deployment, and management of the hygiene station intervention. Data were also collected from communications and reports released through SPU/PHSKC web sources. Results Our analysis revealed factors affecting the implementation of the hygiene program included the rental of hygiene trailers, community partnership to mediate between housed and housing insecure populations, funding source and cost-effectiveness, geographic location of the units, and maintenance of the units to continue population hygiene support. Conclusion The SPU/PHSKC hygiene station was designed to support the housing insecure and homeless by compensating for the large-scale closures of public restrooms and showers. Several logistical and financing challenges need to be addressed to ensure the continuity of the program.
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Affiliation(s)
- Arisa Marshall
- University of Washington School of Public Health Hans Rosling Center for Population Health, 3980 15th Avenue NE Box 351616, Seattle, WA, 98195-1616, USA
| | - Jerome A. Dugan
- University of Washington School of Public Health Hans Rosling Center for Population Health, 3980 15th Avenue NE Box 351616, Seattle, WA, 98195-1616, USA,Evans School of Public Policy & Governance, University of Washington, Seattle, Box 353055, Seattle, WA, 98195-3055, USA,Corresponding author. University of Washington School of Public Health Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351616, Seattle, WA, 98195-1616, USA
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21
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Mejia-Lancheros C, Lachaud J, Gogosis E, Thulien N, Stergiopoulos V, Da Silva G, Nisenbaum R, O’Campo P, Hwang S. Providing Housing First services for an underserved population during the early wave of the COVID-19 pandemic: A qualitative study. PLoS One 2022; 17:e0278459. [PMID: 36454981 PMCID: PMC9714853 DOI: 10.1371/journal.pone.0278459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We assessed the critical role of Housing First (HF) programs and frontline workers in responding to challenges faced during the first wave of the COVID-19 pandemic. METHOD Semi-structured interviews were conducted with nine HF frontline workers from three HF programs between May 2020 and July 2020, in Toronto, Canada. Information was collected on challenges and adjustments needed to provide services to HF clients (people experiencing homelessness and mental disorders). We applied the Analytical Framework method and thematic analysis to our data. RESULTS Inability to provide in-person support and socializing activities, barriers to appropriate mental health assessments, and limited virtual communication due to clients' lack of access to digital devices were among the most salient challenges that HF frontline workers reported during the COVID-19 pandemic. Implementing virtual support services, provision of urgent in-office or in-field support, distributing food aid, connecting clients with online healthcare services, increasing harm reduction education and referral, and meeting urgent housing needs were some of the strategies implemented by HF frontline workers to support the complex needs of their clients during the pandemic. HF frontline workers experienced workload burden, job insecurity and mental health problems (e.g. distress, worry, anxiety) as a consequence of their services during the first wave of the COVID-19 pandemic. CONCLUSION Despite the several work-, programming- and structural-related challenges experienced by HF frontline workers when responding to the needs of their clients during the first wave of the COVID-19 pandemic, they played a critical role in meeting the communication, food, housing and health needs of their clients during the pandemic, even when it negatively affected their well-being. A more coordinated, integrated, innovative, sustainable, effective and well-funded support response is required to meet the intersecting and complex social, housing, health and financial needs of underserved and socio-economically excluded groups during and beyond health emergencies.
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Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Research Group in Nursing Care and Practice, Family Health Nursing and Health Measures; Nursing Faculty, Universidad Nacional de Colombia, Bogotá, Colombia
- * E-mail:
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Evie Gogosis
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Naomi Thulien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - George Da Silva
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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22
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Chang AH, Kwon JJ, Shover CL, Greenwell L, Gomih A, Blake J, Del Rosario A, Jones PS, Fisher R, Balter S, Brosnan HK. COVID-19 Mortality Rates in Los Angeles County Among People Experiencing Homelessness, March 2020-February 2021. Public Health Rep 2022; 137:1170-1177. [PMID: 35989598 PMCID: PMC9548447 DOI: 10.1177/00333549221115658] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Understanding COVID-19-related mortality among the large population of people experiencing homelessness (PEH) in Los Angeles County (LA County) may inform public health policies to protect this vulnerable group. We investigated the impact of COVID-19 on PEH compared with the general population in LA County. METHODS We calculated crude COVID-19 mortality rates per 100 000 population and mortality rates adjusted for age, race, and sex/gender among PEH and compared them with the general population in LA County from March 1, 2020, through February 28, 2021. RESULTS Among adults aged ≥18 years, the crude mortality rate per 100 000 population among PEH was 20% higher than among the general LA County population (348.7 vs 287.6). After adjusting for age, the mortality rate among PEH was 570.7 per 100 000 population. PEH had nearly twice the risk of dying from COVID-19 as people in the general LA County population; PEH aged 18-29 years had almost 8 times the risk of dying compared with their peers in the general LA County population. PEH had a higher risk of mortality than the general population after adjusting for race (standardized mortality ratio [SMR] = 1.4; 95% CI, 1.2-1.6) and sex/gender (SMR = 1.3; 95% CI, 1.1-1.5). CONCLUSIONS A higher risk of COVID-19-related death among PEH compared with the general population indicates the need for public health policies and interventions to protect this vulnerable group.
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Affiliation(s)
- Alicia H. Chang
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jennifer J. Kwon
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Chelsea L. Shover
- UCLA David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lisa Greenwell
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Ayodele Gomih
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Jerome Blake
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Aubrey Del Rosario
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Padma S. Jones
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Rebecca Fisher
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Sharon Balter
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
| | - Hannah K. Brosnan
- People Experiencing Homelessness COVID-19 Response Team, Acute Communicable Disease Control Program, Los Angeles County Department of Public Health, Los Angeles, CA, USA
- Hannah K. Brosnan, MPH, Los Angeles County Department of Public Health, Acute Communicable Disease Control Program, People Experiencing Homelessness COVID-19 Response Team, 313 N Figueroa St, Los Angeles, CA 90012, USA.
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23
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Chow EJ, Casto AM, Rogers JH, Roychoudhury P, Han PD, Xie H, Mills MG, Nguyen TV, Pfau B, Cox SN, Wolf CR, Hughes JP, Uyeki TM, Rolfes MA, Mosites E, Shim MM, Duchin JS, Sugg N, Starita LA, Englund JA, Chu HY. The clinical and genomic epidemiology of seasonal human coronaviruses in congregate homeless shelter settings: A repeated cross-sectional study. LANCET REGIONAL HEALTH. AMERICAS 2022; 15:100348. [PMID: 35996440 PMCID: PMC9387177 DOI: 10.1016/j.lana.2022.100348] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background The circulation of respiratory viruses poses a significant health risk among those residing in congregate settings. Data are limited on seasonal human coronavirus (HCoV) infections in homeless shelter settings. Methods We analysed data from a clinical trial and SARS-CoV-2 surveillance study at 23 homeless shelter sites in King County, Washington between October 2019-May 2021. Eligible participants were shelter residents aged ≥3 months with acute respiratory illness. We collected enrolment data and nasal samples for respiratory virus testing using multiplex RT-PCR platform including HCoV. Beginning April 1, 2020, eligibility expanded to shelter residents and staff regardless of symptoms. HCoV species was determined by RT-PCR with species-specific primers, OpenArray assay or genomic sequencing for samples with an OpenArray relative cycle threshold <22. Findings Of the 14,464 samples from 3281 participants between October 2019-May 2021, 107 were positive for HCoV from 90 participants (median age 40 years, range: 0·9-81 years, 38% female). HCoV-HKU1 was the most common species identified before and after community-wide mitigation. No HCoV-positive samples were identified between May 2020-December 2020. Adults aged ≥50 years had the highest detection of HCoV (11%) among virus-positive samples among all age-groups. Species and sequence data showed diversity between and within HCoV species over the study period. Interpretation HCoV infections occurred in all congregate homeless shelter site age-groups with the greatest proportion among those aged ≥50 years. Species and sequencing data highlight the complexity of HCoV epidemiology within and between shelters sites. Funding Gates Ventures, Centers for Disease Control and Prevention, National Institute of Health.
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Affiliation(s)
- Eric J. Chow
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Amanda M. Casto
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Julia H. Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Pavitra Roychoudhury
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Peter D. Han
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Hong Xie
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Margaret G. Mills
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Tien V. Nguyen
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Brian Pfau
- Brotman Baty Institute for Precision Medicine, Seattle, Washington, USA
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA
| | - Sarah N. Cox
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Caitlin R. Wolf
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - James P. Hughes
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Timothy M. Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Melissa A. Rolfes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily Mosites
- Office of the Deputy Director for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M. Mia Shim
- Public Health – Seattle & King County, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jeffrey S. Duchin
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
- Public Health – Seattle & King County, Seattle, Washington, USA
| | - Nancy Sugg
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Lea A. Starita
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Virology Division, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Janet A. Englund
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
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24
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Bhatia R, Sledge I, Baral S. Missing science: A scoping study of COVID-19 epidemiological data in the United States. PLoS One 2022; 17:e0248793. [PMID: 36223335 PMCID: PMC9555641 DOI: 10.1371/journal.pone.0248793] [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: 03/09/2021] [Accepted: 09/12/2022] [Indexed: 11/06/2022] Open
Abstract
Systematic approaches to epidemiologic data collection are critical for informing pandemic responses, providing information for the targeting and timing of mitigations, for judging the efficacy and efficiency of alternative response strategies, and for conducting real-world impact assessments. Here, we report on a scoping study to assess the completeness of epidemiological data available for COVID-19 pandemic management in the United States, enumerating authoritative US government estimates of parameters of infectious transmission, infection severity, and disease burden and characterizing the extent and scope of US public health affiliated epidemiological investigations published through November 2021. While we found authoritative estimates for most expected transmission and disease severity parameters, some were lacking, and others had significant uncertainties. Moreover, most transmission parameters were not validated domestically or re-assessed over the course of the pandemic. Publicly available disease surveillance measures did grow appreciably in scope and resolution over time; however, their resolution with regards to specific populations and exposure settings remained limited. We identified 283 published epidemiological reports authored by investigators affiliated with U.S. governmental public health entities. Most reported on descriptive studies. Published analytic studies did not appear to fully respond to knowledge gaps or to provide systematic evidence to support, evaluate or tailor community mitigation strategies. The existence of epidemiological data gaps 18 months after the declaration of the COVID-19 pandemic underscores the need for more timely standardization of data collection practices and for anticipatory research priorities and protocols for emerging infectious disease epidemics.
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Affiliation(s)
- Rajiv Bhatia
- Primary Care and Population Health, Stanford University, Stanford, CA, United States of America
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, United States of America
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25
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Jones PS, Yeh KW, Brosnan HK, Regos-Stewart D, Ngo C, Kwon J, Chang AH. Evaluation of the Homeless Management Information System for COVID-19 Surveillance Among People Experiencing Homelessness. J Infect Dis 2022; 226:S327-S334. [PMID: 36208169 DOI: 10.1093/infdis/jiac335] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Variable and incomplete reporting of housing status creates challenges in the surveillance of coronavirus disease 2019 (COVID-19) among the homeless population in Los Angeles County (LA County) and nationwide. METHODS We developed standard investigation procedures to assess the housing status of LA County COVID-19 patients. Using data sharing procedures, we matched COVID-19 patients to Homeless Management Information System (HMIS) client profiles and supplemented with additional data sources for contributory data points and to further housing status ascertainment. RESULTS We identified 10 586 COVID-19 patients among people experiencing homelessness (PEH) between 30 March 2020 and 30 December 2021; 2801 (26.5%) patients were first identified from HMIS profile matches, 1877 (17.7%) from quarantine/isolation housing intake rosters, 573 (5.4%) from hospital records, 749 (7.1%) from case and contact interviews, 3659 (34.6%) directly from PEH medical and service providers, and 927 (8.8%) had unknown sources. Among COVID-19 patients matched to HMIS profiles, 5351 (42.5%) were confirmed to be PEH at the time of COVID-19 diagnosis. CONCLUSIONS Interoperability between public health data, HMIS, and external partners have been critical components in evaluating the impact of COVID-19 among the LA County homeless population. No one data source was complete for COVID-19 surveillance in this population.
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Affiliation(s)
- Padma S Jones
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Karen W Yeh
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Hannah K Brosnan
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Dalia Regos-Stewart
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Cathy Ngo
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Jennifer Kwon
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Alicia H Chang
- Los Angeles County Department of Public Health, Los Angeles, California, USA
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26
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Dost K, Heinrich F, Graf W, Brennecke A, Kowalski V, Leider A, Kraus A, van Rüth V, Ondruschka B, Püschel K, König HH, Bertram F, Hajek A. Predictors of Loneliness among Homeless Individuals in Germany during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12718. [PMID: 36232018 PMCID: PMC9566392 DOI: 10.3390/ijerph191912718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/28/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The aim of the study was to identify the frequency of loneliness and to examine the factors associated with loneliness among homeless individuals in Germany during the COVID-19 pandemic. METHODS Data were taken from the 'national survey on the psychiatric and somatic health of homeless individuals during the COVID-19 pandemic'. The data collection took place from 26th July to 17th September 2021 (the analytical sample included n = 491 observations). The well-established UCLA-3 tool was used to quantify loneliness. Independent variables included sex, age, marital status, the existence of children and pets, level of education, country of origin, duration of homelessness, alcohol and drug consumption, mental health concerns and concerns regarding COVID-19 illness. Multiple logistic regressions were used to examine the predictors of loneliness. RESULTS The frequency of loneliness was 41.7% for the total sample. Multiple logistic regression analysis stratified by gender showed that a higher likelihood of loneliness was associated with being born in Germany, being middle aged (40 to 49 years compared to 18 to 29 years), having mental health problems and a short period of homelessness (1 month compared to longer periods) among women. In men, a higher likelihood of loneliness was associated with a higher fear of COVID-19 and a short period of homelessness. CONCLUSIONS Our study revealed a high frequency rate of loneliness among homeless individuals. The study results highlight the associations between some explanatory variables (i.e., the duration of homelessness and mental health problems). Identifying the factors associated with loneliness may help to adequately address the problems of homeless individuals at risk of loneliness. Longitudinal studies are required to confirm our findings.
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Affiliation(s)
- Katharina Dost
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Fabian Heinrich
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Wiebke Graf
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Anna Brennecke
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Veronika Kowalski
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Anna Leider
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Anika Kraus
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Victoria van Rüth
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Franziska Bertram
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, 22529 Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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27
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Rowell-Cunsolo TL, Bellerose M, Haile R. Hazards of Anti-Blackness in the United States. INTERNATIONAL JOURNAL OF SOCIAL WELFARE 2022; 31:520-528. [PMID: 36337765 PMCID: PMC9632408 DOI: 10.1111/ijsw.12547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 06/14/2022] [Indexed: 06/16/2023]
Abstract
On February 26, 2012, a Black child, Trayvon Martin, was executed in Sanford, Florida. Seventeen months later his killer was found not guilty. This is but one example of the state's brazen disregard for Black life, rooted in the kidnapping and enslavement of Africans more than 400 years ago, and the ways in which they and their descendants were systematically tortured. Trayvon Martin's murder catalyzed the Black Lives Matter (BLM) movement, which names and resists deeply entrenched state violence and inequities against Black people in the U.S. In this manuscript we: (1) summarize examples of structural disregard for Black lives in the U.S.; (2) describe how this disregard is reflected in differential patterns of social inequities, morbidity, and mortality; and (3) discuss how we can better employ the BLM perspective to frame a more historicized understanding of patterns in population health and to envision ways to resist health inequities.
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Affiliation(s)
| | - Meghan Bellerose
- Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032
| | - Rahwa Haile
- State University of New York- College at Old Westbury, Department of Public Health, Natural Sciences Building, Old Westbury, NY 11568
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28
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Aykanian A. The effects of COVID-19 on the mental health and job stress of frontline homelessness services workers in Texas (U.S.). HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2793-e2804. [PMID: 35037348 DOI: 10.1111/hsc.13723] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 12/03/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
As the COVID-19 pandemic persists in the U.S. and elsewhere, there is a growing need to understand the impacts of the pandemic on essential and frontline workers. Given the dearth of research on the experiences of homelessness services workers during the COVID-19 pandemic, this study aimed to understand the impact of COVID-related stressors in the workplace on the wellbeing of the homelessness services workers in the state of Texas (U.S.). Using a cross-sectional survey design, the analysis focusses on examining the relationship between COVID stressors with mental health symptoms and job stress indictors. Data were collected from a sample of 132 frontline homelessness services workers across the state during April, May and June of 2021. Primary outcomes of interest were measured with the Depression, Anxiety and Stress Scale (DASS-42) and the Professional Quality of Life Scale (ProQOL). Multiple linear regression models were specified to explore associations between the outcomes of interest and predictor variables (i.e. demographics, work experiences and COVID-19 stressors). Results showed that perceiving a decline in job satisfaction because of the COVID-19 pandemic was associated with higher stress (β = ++0.18), 95% CI [.13, 6.68], higher burnout (β = 0.32), 95% CI [2.54, 7.30] and lower compassion satisfaction (β = 0.42), 95% CI [-8.14, -3.69]. Additionally, being worried about contracting COVID-19 at work was associated with an increase in burnout (β = 0.19), 95% CI [.40, 4.79]. Also notable is that older age and Black/African American race were associated with lower stress, lower burnout and higher compassion satisfaction. Implications for supporting the homelessness sector through high-quality supervision, useful training, adequate benefits and routine check-ins are discussed.
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Affiliation(s)
- Amanda Aykanian
- School of Social Work, The University of Texas at Arlington, Arlington, Texas, USA
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29
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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: 5] [Impact Index Per Article: 2.5] [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.
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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
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Eriksen ARR, Fogh K, Hasselbalch RB, Bundgaard H, Nielsen SD, Jørgensen CS, Scharff BFSS, Erikstrup C, Sækmose SG, Holm DK, Aagaard B, Kristensen JH, Bødker CA, Norsk JB, Nielsen PB, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, K Fischer T, Folke F, Lippert F, Ostrowski SR, Ethelberg S, Koch A, Vangsted AM, Krause T, Fomsgaard A, Nielsen C, Ullum H, Skov R, Iversen K. SARS-CoV-2 antibody prevalence among homeless people and shelter workers in Denmark: a nationwide cross-sectional study. BMC Public Health 2022; 22:1261. [PMID: 35761270 PMCID: PMC9238223 DOI: 10.1186/s12889-022-13642-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People experiencing homelessness (PEH) and associated shelter workers may be at higher risk of infection with "Severe acute respiratory syndrome coronavirus 2" (SARS-CoV-2). The aim of this study was to determine the prevalence of SARS-CoV-2 among PEH and shelter workers in Denmark. DESIGN AND METHODS In November 2020, we conducted a nationwide cross-sectional seroprevalence study among PEH and shelter workers at 21 recruitment sites in Denmark. The assessment included a point-of-care test for antibodies against SARS-CoV-2, followed by a questionnaire. The seroprevalence was compared to that of geographically matched blood donors considered as a proxy for the background population, tested using a total Ig ELISA assay. RESULTS We included 827 participants in the study, of whom 819 provided their SARS-CoV-2 antibody results. Of those, 628 were PEH (median age 50.8 (IQR 40.9-59.1) years, 35.5% female) and 191 were shelter workers (median age 46.6 (IQR 36.1-55.0) years and 74.5% female). The overall seroprevalence was 6.7% and was similar among PEH and shelter workers (6.8% vs 6.3%, p = 0.87); and 12.2% among all participants who engaged in sex work. The overall participant seroprevalence was significantly higher than that of the background population (2.9%, p < 0.001). When combining all participants who reported sex work or were recruited at designated safe havens, we found a significantly increased risk of seropositivity compared to other participants (OR 2.23, 95%CI 1.06-4.43, p = 0.02). Seropositive and seronegative participants reported a similar presence of at least one SARS-CoV-2 associated symptom (49% and 54%, respectively). INTERPRETATIONS The prevalence of SARS-CoV-2 antibodies was more than twice as high among PEH and associated shelter workers, compared to the background population. These results could be taken into consideration when deciding in which phase PEH are eligible for a vaccine, as part of the Danish national SARS-CoV-2 vaccination program rollout. FUNDING TrygFonden and HelseFonden.
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Affiliation(s)
- Alexandra R Röthlin Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Bibi F S S Scharff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne G Sækmose
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
- Department of Research Medicine, University of Southern Denmark, Odense, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Cecilie A Bødker
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Jakob B Norsk
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Pernille B Nielsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S Johansen
- Department of Research Medicine, University of Southern Denmark, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, University of Roskilde, Roskilde, Denmark
| | - Thea K Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
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Choi K, Romero R, Guha P, Sixx G, Rosen AD, Frederes A, Beltran J, Alvarado J, Robie B, Richard L, Coleman A, Rice A, Rosales M, Baez A, Thomas E, Shover CL. Community Health Worker Perspectives on Engaging Unhoused Peer Ambassadors for COVID-19 Vaccine Outreach in Homeless Encampments and Shelters. J Gen Intern Med 2022; 37:2026-2032. [PMID: 35411533 PMCID: PMC8999995 DOI: 10.1007/s11606-022-07563-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND COVID-19 vaccination is a priority for people experiencing homelessness. However, there are barriers to vaccine access driven in part by mistrust towards clinicians and healthcare. Community health workers (CHWs) and Peer Ambassadors (PAs) may be able to overcome mistrust in COVID-19 vaccine outreach. An unhoused PA program for COVID-19 vaccine outreach by CHWs was implemented in Los Angeles using a participatory academic-community partnership. OBJECTIVE The purpose of this study was to evaluate CHW perspectives on an unhoused PA COVID-19 vaccine outreach program in Los Angeles. DESIGN This study used a participatory community conference and qualitative focus groups to understand CHW perspectives on the PA program. The one-day conference was held in November 2021. PARTICIPANTS Of the 42 conference participants, 19 CHWs participated in focus groups for two-way knowledge exchange between CHWs and researchers. APPROACH Four focus groups were held during the conference, with 4-6 CHWs per group. Each group had a facilitator and two notetakers. Focus group notes were then analyzed using content analysis to derive categories of findings. CHWs reviewed the qualitative analysis to ensure that findings represented their experiences with the PA program. KEY RESULTS The five categories of findings from focus groups were as follows: (1) PAs were effective liaisons to their peers to promote COVID-19 vaccines; (2) CHWs recognized the importance of establishing genuine trust and equitable working relationships within CHW/PA teams; (3) there were tradeoffs of integrating unhoused PAs into the existing CHW workflow; (4) CHWs had initial misgivings about the research process; and (5) there were lingering questions about the ethics of "exploiting" the invaluable trust unhoused PAs have with unhoused communities. CONCLUSIONS CHWs were in a unique position to empower unhoused PAs to take a leadership role in reaching their peers with COVID-19 vaccines and advocate for long-term employment and housing needs.
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Affiliation(s)
- Kristen Choi
- UCLA School of Nursing, Los Angeles, CA, USA.
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Ruby Romero
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Priyanka Guha
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Gunner Sixx
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Allison D Rosen
- Department of Health Policy and Management, UCLA Fielding School of Public Health, 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
| | - Jacqueline Beltran
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Julissa Alvarado
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Brooke Robie
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Lindsey Richard
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Anthony Coleman
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Adam Rice
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
- Los Angeles Community Action Network, Los Angeles, CA, USA
| | - Marisol Rosales
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Angel Baez
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Emily Thomas
- Housing for Health, Los Angeles County Department of Health Services, Los Angeles, CA, USA
| | - Chelsea L Shover
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
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Behavioral Health Providers' Experience with Changes in Services for People Experiencing Homelessness During COVID-19, USA, August-October 2020. J Behav Health Serv Res 2022; 49:470-486. [PMID: 35618881 PMCID: PMC9135314 DOI: 10.1007/s11414-022-09800-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2022] [Indexed: 11/07/2022]
Abstract
The COVID-19 pandemic caused disruptions in behavioral health services (BHS), essential for people experiencing homelessness (PEH). BHS changes created barriers to care and opportunities for innovative strategies for reaching PEH. The authors conducted 50 qualitative interviews with behavioral health providers in the USA during August–October 2020 to explore their observations of BHS changes for PEH. Interviews were transcribed and entered into MAXQDA for analysis and to identify salient themes. The largest impact from COVID-19 was the closure or limited hours for BHS and homeless shelters due to mandated “stay-at-home” orders or staff working remotely leading to a disconnection in services and housing linkages. Most providers initiated telehealth services for clients, yielding positive outcomes. Implications for BHS are the need for long-term strategies, such as advances in communication technology to support BHS and homeless services and to ensure the needs of underserved populations are met during public health emergencies.
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McCosker LK, El-Heneidy A, Seale H, Ware RS, Downes MJ. Strategies to improve vaccination rates in people who are homeless: A systematic review. Vaccine 2022; 40:3109-3126. [PMID: 35484042 PMCID: PMC9040475 DOI: 10.1016/j.vaccine.2022.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/14/2022] [Accepted: 04/04/2022] [Indexed: 10/28/2022]
Abstract
People who are homeless experience higher rates of vaccine-preventable disease, including COVID-19, than the general population, and poorer associated health outcomes. However, delivering vaccinations to people who are homeless is complex, and there is a lack of evidence to inform practice in this area. The aim of this systematic review is to: (a) identify, (b) analyse the characteristics of, and (c) evaluate the outcomes of, strategies to improve vaccination rates in people who are homeless. Literature was retrieved from eight electronic databases. Studies undertaken in high-income countries, published in English, in a peer-reviewed journal, and in full-text were considered. No limits were placed on study design or date. A total of 1,508 articles were retrieved and, after the removal of duplicates, 637 were screened. Twenty-three articles, reporting on nineteen separate vaccination strategies for hepatitis A/B, influenza, herpes zoster, invasive pneumococcal disease, and diphtheria in people who are homeless, were selected for inclusion. All the strategies were effective at improving vaccination rates in, people who are homeless. Most strategies involved vaccination clinics and most were delivered, at least in part, by nurses. Other characteristics of successful strategies included: delivering vaccinations at convenient locations; using accelerated vaccination schedules (if available); vaccinating at the first appointment, regardless of whether a person's vaccination history or serological status were known (if clinically safe); operating for a longer duration; offering training to staff about working with people who are homeless; widely promoting clinics; considering education, reminders, incentives, and co-interventions; ensuring no out-of-pocket costs; and working collaboratively with stakeholders, including people who are homeless themselves. These findings will inform evidence-based vaccination strategies, including for COVID-19, in people who are homeless, and improve associated health outcomes in this at-risk, hard-to-reach group.
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Affiliation(s)
- Laura K McCosker
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia; School of Population Health, University of New South Wales, Australia.
| | - Asmaa El-Heneidy
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Holly Seale
- School of Population Health, University of New South Wales, Australia
| | - Robert S Ware
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Martin J Downes
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, The Circuit, Nathan, QLD 4111, Australia; Menzies Health Institute Queensland, Griffith University, Australia
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Nouri M, Ostadtaghizadeh A, Sari AA. COVID-19 in Homelessness: A Worldwide Scoping Review on Vulnerabilities, Risks, and Risk Management. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:303-318. [PMID: 34963409 DOI: 10.1080/19371918.2021.2011525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Homeless individuals are at greater risk of death due to social inequalities during Covid-19 pandemic. Strategies taken for general population to prevent the spread of Covid-19, such as social distance, staying at home, and observing personal hygiene are not possible for this group of people. This is a scoping review on articles published and other credible resources published analyze studies done on homeless people during the COVID-19 pandemic. In this scoping review, for the first time, we studied published articles on the situation of the homeless during the Covid-19 epidemic and by extracting and categorizing vulnerabilities, risks, as well as risk management plans, Finally we presented, useful guidance for organizations providing health and social services during the spread of diseases.
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Affiliation(s)
- Mohsen Nouri
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - Abbas Ostadtaghizadeh
- Department of Health in Emergencies and Disasters, School of Public Health, Tehran University of Medical Sciences(TUMS), Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and EconomicsSchool of Public Health, Tehran University of Medical Sciences (Tums), Tehran, Iran
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Pixley CL, Henry FA, DeYoung SE, Settembrino MR. The role of homelessness community based organizations during COVID-19. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1816-1830. [PMID: 34033680 PMCID: PMC8242750 DOI: 10.1002/jcop.22609] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 05/12/2023]
Abstract
People experiencing homelessness are vulnerable to disasters and hazards and are at risk for contracting COVID-19. In this study, we gathered data from 10 community-based organizations (CBO's) in the United States that work to provide services for people experiencing homelessness. The combined CBO's span across rural, urban, and a mixture of both settings. We identified three needs that the CBO's indicated to be urgent: (1) the increased need for basic services among guests/clients, (2) new organizational challenges for the CBO's, and (3) issues related to emergency management and disasters. Among these urgent needs, respondents also indicated the need for emotional support for staff and volunteers experiencing burnout during the COVID-19 response. They also expressed some unique aspects of new care delivery systems, such as clients' willingness to engage in rehabilitation programs because of noncongregate sheltering options corresponding with those support services.
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Affiliation(s)
- Cotina Lane Pixley
- Disaster Science & Management ProgramUniversity of DelawareNewarkDelawareUSA
| | - Felicia A. Henry
- Department of Sociology & Criminal JusticeUniversity of DelawareNewarkDelawareUSA
| | - Sarah E. DeYoung
- Department of Sociology & Criminal JusticeUniversity of DelawareNewarkDelawareUSA
| | - Marc R. Settembrino
- Department of Sociology & Criminal JusticeSoutheastern Louisiana UniversityHammondLouisianaUSA
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Wang Q, Lung DC, Chan PT, Jia W, Dung CH, Miao T, Huang J, Chen W, Wang Z, Leung KM, Xu P, Lin Z, Wong D, Tse H, Ying Wong SC, Choi GKY, To KKW, Cheng VCC, Yuen KY, Li Y. High attack rate in a Tong Lau house outbreak of COVID-19 with subdivided units in Hong Kong. Interface Focus 2022; 12:20210063. [PMID: 35261729 PMCID: PMC8831081 DOI: 10.1098/rsfs.2021.0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/08/2021] [Indexed: 12/11/2022] Open
Abstract
Poor housing conditions are known to be associated with infectious diseases such as high Coronavirus disease 2019 (COVID-19) incidences. Transmission causes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in poor housing conditions can be complex. An understanding of the exact mechanism of transmission can help to pinpoint contributing environmental issues. Here, we investigated a Hong Kong COVID-19 outbreak in early 2021 in four traditional Tong Lau houses with subdivided units. There are more than 80 subdivided units of less than 20 m2 floor area each on average. With a total of 34 confirmed COVID-19 cases, the outbreak had an attack rate of 25.4%, being one of the highest attack rates observed in Hong Kong, and ranked among the highest attack rates in reported outbreaks internationally. Tracer gas leakage and decay measurements were performed in the drainage system and in the subdivided units to determine the transport of infectious aerosols by the owner-modified sophisticated wastewater drainage pipe networks and the poor ventilation conditions in some subdivided units. The results show that the outbreak was probably due to multiple transmission routes, i.e. by the drainage pipe spread of stack aerosols, which is enhanced by poor ventilation in the subdivided units.
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Affiliation(s)
- Qun Wang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - David Christopher Lung
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong SAR, People's Republic of China
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Pak-To Chan
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Wei Jia
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Chung-Hin Dung
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Te Miao
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Jianxiang Huang
- Department of Urban Planning and Design, Faculty of Architecture, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Wenzhao Chen
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Zixuan Wang
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Kai-Ming Leung
- Environmental Protection Department, Hong Kong SAR, People's Republic of China
| | - Pengcheng Xu
- Institute of Applied Mathematics, Academy of Mathematics and Systems Sciences, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Zhang Lin
- Division of Building Science and Technology, City University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Daniel Wong
- Estates office, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Herman Tse
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong SAR, People's Republic of China
| | - Sally Cheuk Ying Wong
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong SAR, People's Republic of China
| | - Garnet Kwan-Yue Choi
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong SAR, People's Republic of China
| | - Kelvin Kai-Wang To
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | | | - Kwok-Yung Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong SAR, People's Republic of China
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Campbell JR, Dion C, Uppal A, Yansouni CP, Menzies D. Systematic on-site testing for SARS-CoV-2 infection among asymptomatic essential workers in Montréal, Canada: a prospective observational and cost-assessment study. CMAJ Open 2022; 10:E409-E419. [PMID: 35537749 PMCID: PMC9259431 DOI: 10.9778/cmajo.20210290] [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 Essential workers are at increased risk for SARS-CoV-2 infection. We aimed to estimate the yield, acceptability and cost of systematic workplace-based testing of asymptomatic essential workers for SARS-CoV-2 infection. METHODS From Jan. 27 to Mar. 12, 2021, we prospectively recruited non-health care essential businesses in Montréal, Canada, through email or telephone contact. Two trained mobile teams, each composed of 2 non-health care professionals, visited businesses. Consenting asymptomatic employees provided saline gargle samples under supervision. Samples were analyzed by means of reverse transcription polymerase chain reaction (RT-PCR). At businesses with outbreaks (≥ 2 participants with a positive result), we retested all participants with a negative result on initial testing. Our primary outcomes were yield (proportion of test results that were positive), acceptability (proportion of participants estimated to be present at the business who agreed to participate) and costs (including training, sample collection and analysis, and communicating results). Our secondary outcome was identification of factors associated with a positive test result on multivariable logistic regression. RESULTS Of the 366 businesses contacted, 69 (18.8%) agreed to participate. Nineteen businesses (28%) were manufacturers or suppliers, 12 (17%) were in auto sales or repair, and 11 (16%) were in childcare; the corresponding number of employees was 1225, 242 and 113. The median number of participants per business was 13 (interquartile range [IQR] 8-22). Of an estimated 2348 employees on site, 2128 (90.6%) participated (808 [38.0%] female, median age 48 [IQR 37-57] yr). Of the 2626 tests performed, 53 (2.0%) gave a positive result. Self-reported nonwhite ethnicity (adjusted odds ratio [OR] 3.7, 95% confidence interval [CI] 1.4-9.9) and a negative SARS-CoV-2 test result before the study (adjusted OR 0.4, 95% CI 0.2-0.8) were associated with a positive test result. Five businesses were experiencing an outbreak; at these businesses, 40/917 participants (4.4%) had a positive result on the initial test. We repeated testing for employees with initially negative results at 3 of these businesses over 2-3 weeks: 8/350 participants (2.3%) had a positive result on the second test, and none had a positive result on the third and fourth tests; no employer reported new positive results after our final visit (up to Mar. 26, 2021). At the remaining 64 businesses, 1211 participants were tested once, of whom 5 (0.4%) had a positive result. The per-person RT-PCR cost was $34, and all other costs, $8.67. INTERPRETATION On-site saline gargle sampling of essential workers for SARS-CoV-2 testing was acceptable and of modest cost, and appears most useful in the context of outbreaks. This sampling strategy should be evaluated further as a component of efforts to prevent SARS-CoV-2 transmission. PREPRINT: medRxiv - doi:10.1101/2021.05.12.21256956.
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Affiliation(s)
- Jonathon R Campbell
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que.
| | - Cynthia Dion
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
| | - Aashna Uppal
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
| | - Cedric P Yansouni
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
| | - Dick Menzies
- Research Institute of the McGill University Health Centre (Campbell, Menzies, Dion, Yansouni, Uppal); Faculty of Medicine (Campbell, Menzies, Yansouni), McGill University; McGill International TB Centre (Campbell, Menzies); J.D. MacLean Centre for Tropical Diseases (Yansouni), Montréal, Que
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Downes H, Phillips DC, Sullivan JX. The Effect of Emergency Financial Assistance on Healthcare Use. JOURNAL OF PUBLIC ECONOMICS 2022; 208:104626. [PMID: 35422535 PMCID: PMC9004658 DOI: 10.1016/j.jpubeco.2022.104626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Does providing financial assistance to people who have just experienced an income shock affect their healthcare use? To address this question, we examine healthcare outcomes in a setting where people at risk of homelessness due to an income shock were offered or denied referral to financial assistance quasi-randomly. Among callers who have been screened as eligible for assistance at Chicago's Homelessness Prevention Call Center (HPCC), some are denied assistance because the availability of funding varies. Conditional on some observable characteristics, funding availability is as-good-as-randomly assigned to callers. We link callers to healthcare utilization records and observe their inpatient hospital stays and emergency department visits. We find that referral to financial assistance has little effect on overall healthcare use-we can reject increases in total utilization greater than 7% of the base rate and decreases of more than 4%. This null effect can be explained, in part, by the fact that the income shock does not significantly change overall healthcare use among those not receiving assistance, suggesting that these individuals can insure health and healthcare demand against these shocks in other ways.
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Farnish KA, Schoenfeld EA. Implications of the COVID-19 Pandemic for Youth Housing and Homelessness Services. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2022; 41:1-20. [PMID: 35345536 PMCID: PMC8943111 DOI: 10.1007/s10560-022-00830-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 06/14/2023]
Abstract
Youth homelessness is a growing crisis in the United States that is associated with a range of adverse outcomes. A variety of social service programs exist to address youth homelessness and its consequences, such as street outreach and diversion services, emergency shelters, transitional housing programs, and rapid rehousing services, among others. The coronavirus disease 2019 (COVID-19) pandemic reached the United States in early 2020, altering nearly every facet of daily life, including the way social service organizations structure and deliver their programming. To understand the implications of the pandemic on housing and homelessness services for youth, the current study examines data from interviews conducted with staff from a large non-profit in Austin, Texas, serving vulnerable transition-age youth. Through these interviews, programmatic changes that occurred as a result of COVID-19-as well as challenges and facilitators to service delivery-were identified. This article provides an overview of these key learnings, as well as recommendations derived from these key learnings, for other organizations adapting their housing and homelessness services in response to the COVID-19 pandemic.
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Affiliation(s)
| | - Elizabeth A. Schoenfeld
- LifeWorks, 835 N. Pleasant Valley Road, Austin, TX 78702 USA
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, USA
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Aranda-Díaz A, Imbert E, Strieff S, Graham-Squire D, Evans JL, Moore J, McFarland W, Fuchs J, Handley MA, Kushel M. Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters. PLoS One 2022; 17:e0264929. [PMID: 35271622 PMCID: PMC8912252 DOI: 10.1371/journal.pone.0264929] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses. Methods We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation. Results Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study. Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters. Adoption: We offered testing to all eligible participants within weeks of the project’s initiation. Implementation: Adaptations made to increase reach and improve consistency were promptly implemented. Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot. Conclusion Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.
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Affiliation(s)
- Andrés Aranda-Díaz
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Elizabeth Imbert
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
| | - Sarah Strieff
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Dave Graham-Squire
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jennifer L. Evans
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jamie Moore
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Jonathan Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Margaret A. Handley
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- UCSF PRISE Center: Partnerships for Research in Implementation Science for Equity, San Francisco, California, United States of America
| | - Margot Kushel
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
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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; 19:3219. [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] [Grants] [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.
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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.)
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Parolin Z, Lee EK. The Role of Poverty and Racial Discrimination in Exacerbating the Health Consequences of COVID-19. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100178. [PMID: 35018358 PMCID: PMC8739518 DOI: 10.1016/j.lana.2021.100178] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There were more than 800,000 confirmed coronavirus disease 2019 (COVID-19) deaths in the United States (U.S) by the end of 2021. The health consequences of COVID-19, however, have not affected all residents equally. In this review, we synthesize recent evidence suggesting that high levels of poverty in the U.S. compared to other high-income countries, as well as historic and ongoing racial/ethnic discrimination, have exacerbated the health consequences of COVID-19, particularly for racial/ethnic minorities. We discuss four mechanisms through which poverty and discrimination affect COVID-19-related health consequences: greater pre-existing health challenges, reduced access to healthcare, lower-quality neighbourhood and housing conditions, and unequal exposure to high-risk occupations. Evidence suggests that economic and policy institutions that contributed to higher pre-pandemic poverty rates in the U.S., particularly among racial/ethnic minorities, have been central determinants of unequal health outcomes during the COVID-19 pandemic.
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Affiliation(s)
- Zachary Parolin
- Department of Social and Political Sciences, Bocconi University, Milan, Italy
| | - Emma K. Lee
- Columbia University Center on Poverty and Social Policy, New York, NY, USA
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43
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Casto AM, Rogers JH, Link AC, Boeckh M, Jackson ML, Uyeki TM, Englund JA, Starita LM, Chu HY. Phylogenomics of SARS-CoV-2 in Emergency Shelters for People Experiencing Homelessness. J Infect Dis 2022; 226:217-224. [PMID: 35091746 PMCID: PMC8807325 DOI: 10.1093/infdis/jiac021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/25/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Residents and staff of emergency shelters for people experiencing homelessness (PEH) are at high risk of infection with SARS-CoV-2. The importance of shelter-related transmission of SARS-CoV-2 in this population remains unclear. It is also unknown whether there is significant spread of shelter-related viruses into surrounding communities. We analyzed genome sequence data for 28 SARS-CoV-2-positive specimens collected from 8 shelters in King County, Washington between March and October, 2020. We identified at least 12 separate SARS-CoV-2 introduction events into these 8 shelters and estimated that 57% (16 out of 28) of the examined cases of SARS-CoV-2 infection were the result of intra-shelter transmission. However, we identified just a few SARS-CoV-2 specimens from Washington that were possible descendants of shelter viruses. Our data suggest that SARS-CoV-2 spread in shelters is common, but we did not observe evidence of wide-spread transmission of shelter-related viruses into the general population.
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Affiliation(s)
- Amanda M Casto
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Julia H Rogers
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Amy C Link
- 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 Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Michael L Jackson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Timothy M Uyeki
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet A Englund
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
- Seattle Children’s Research Institute, Seattle, WA, USA
| | - Lea M Starita
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Helen Y Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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44
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Rowan SE, McCormick DW, Wendel KA, Scott T, Chavez-van de Hey J, Wilcox K, Stella SA, Kamis K, Burman WJ, Marx GE. Lower Prevalence of SARS-CoV-2 Infection Among People Experiencing Homelessness Tested in Outdoor Encampments Compared with Overnight Shelters - Denver, Colorado, June - July 2020. Clin Infect Dis 2022; 75:e157-e164. [PMID: 35040947 PMCID: PMC8807271 DOI: 10.1093/cid/ciac039] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A better understanding of the risk for COVID-19 that people experiencing homelessness (PEH) face in congregate shelters versus unsheltered encampments is critical for an effective pandemic response. METHODS We analyzed factors associated with current and past SARS-CoV-2 infection among PEH in day and overnight shelters and encampments in Denver, Colorado, during June 2-July 28, 2020, and constructed multivariable logistic regression models to examine risk factors for SARS-CoV-2 RNA and seropositivity with age, race/ethnicity, testing location, testing month, and symptom status as predictor variables. RESULTS A total of 823 participants were tested for SARS-CoV-2 RNA, and 276 individuals were tested for SARS-CoV-2 antibodies. A greater percentage of PEH at overnight shelters tested positive for SARS-CoV-2 RNA (8.6% vs 2.5%, p<0.01) and antibodies (21.5% vs 8.7%, p=0.03) compared to encampments. In regression models, testing at an overnight shelter compared to testing at encampments (OR=3.03, 95% CI 1.16-9.02) had increased odds of a positive SARS-CoV-2 RNA result. Age >60 years compared to age <40 years (OR=5.92, 95% CI 1.83-20.3), Hispanic ethnicity (OR=3.43, 95% CI 1.36-8.95) and non-Hispanic Black race compared to non-Hispanic White race (OR=3.07, 95% CI 1.16-8.26), and testing at an overnight shelter compared to testing at encampments (OR=2.45, 95% CI 1.04-6.17) had increased odds of a positive antibody result. CONCLUSIONS Our findings support the need for continuing assessment of mitigation strategies in shelters, increasing access to individual rooms and linkage to housing options for PEH, and supporting people to remain in encampments when these options are not available.
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Affiliation(s)
- Sarah E Rowan
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - David W McCormick
- Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
| | - Karen A Wendel
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Tracy Scott
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | | | - Kay Wilcox
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Public Health Associate Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sarah A Stella
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Kevin Kamis
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - William J Burman
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA
| | - Grace E Marx
- Denver Public Health, Denver Health and Hospital Authority, Denver, Colorado, USA.,Division of Infectious Diseases, University of Colorado Denver, Aurora, Colorado, USA.,National Center for Emerging and Zoonotic Infectious Diseases, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, USA
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Brown C, Wilkins K, Craig-Neil A, Upshaw T, Pinto AD. Reducing Inequities During the COVID-19 Pandemic: A Rapid Review and Synthesis of Public Health Recommendations. Public Health Rev 2022; 42:1604031. [PMID: 35140994 PMCID: PMC8802804 DOI: 10.3389/phrs.2021.1604031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 11/04/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives: Efforts to contain the COVID-19 pandemic should take into account worsening health inequities. While many public health experts have commented on inequities, no analysis has yet synthesized recommendations into a guideline for practitioners. The objective of this rapid review was to identify the areas of greatest concern and synthesize recommendations. Methods: We conducted a rapid systematic review (PROSPERO: CRD42020178131). We searched Ovid MEDLINE, Embase, PsycINFO, CINAHL and Cochrane Central Register of Controlled Trials databases from December 1, 2019 to April 27, 2020. We included English language peer-reviewed commentaries, editorials, and opinion pieces that addressed the social determinants of health in the context of COVID-19. Results: 338 articles met our criteria. Authors represented 81 countries. Income, housing, mental health, age and occupation were the most discussed social determinants of health. We categorized recommendations into primordial, primary, secondary and tertiary prevention that spoke to the social determinants of COVID-19 and equity. Conclusion: These recommendations can assist efforts to contain COVID-19 and reduce health inequities during the pandemic. Using these recommendations, public health practitioners could support a more equitable pandemic response. Systematic Review Registration: PROSPERO, CRD42020178131.
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Affiliation(s)
- Chloe Brown
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katie Wilkins
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy Craig-Neil
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Tara Upshaw
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Andrew David Pinto
- Upstream Lab, MAP/Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Babando J, Quesnel DA, Woodmass K, Lomness A, Graham JR. Responding to pandemics and other disease outbreaks in homeless populations: A review of the literature and content analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:11-26. [PMID: 33825271 PMCID: PMC8251050 DOI: 10.1111/hsc.13380] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/15/2021] [Accepted: 03/17/2021] [Indexed: 05/06/2023]
Abstract
Considering the recent COVID-19 pandemic, we recognised a lack of synthesis amongst the available literature pertaining to the intersections of homelessness and pandemic response and planning. Therefore, the purpose of this review was to identify relevant peer-reviewed literature in this area to thematically produce evidence-based recommendations that would inform community planning and response amongst homeless populations. Although this review is inspired by the COVID-19 pandemic, our intention was to produce relevant recommendations to for all current and future outbreaks and pandemics more generally. Our search criteria focused on pandemics and rapid-spread illnesses such as contagious respiratory diseases with contact spread and with an emphasis on individuals experiencing homelessness. Content analysis methods were followed to extract and thematically synthesise key information amongst the 223 articles that matched our search criteria between the years of 1984 and 2020. Two reviewers were assigned to the screening process and used Covidence and undertook two rounds of discussion to identify and finalise themes for extraction. This review illustrates that the current breadth of academic literature on homeless populations has thus far focused on tuberculosis (TB) rather than diseases that are more recent and closely related to COVID-19-such as Severe Acute Respiratory Syndrome (SARS) or H1N1. Our thematic content analysis revealed six themes that offer tangible and scalable recommendations which include (1) education and outreach, (2) adapting structure of services, (3) screening and contract tracing, (4) transmission and prevention strategies, (5) shelter protocols and (6) treatment, adherence and vaccination. The breadth and depth of reviews such as these are dependent on the quantity and quality of the available literature. Therefore, the limited existing literature outside of tuberculosis specific to homelessness in this review illustrates a need for more academic research into the intersections of pandemics and homelessness-particularly for evaluations of response and planning. Nonetheless, this review offers timely considerations for pandemic response and planning amongst homeless populations during the current COVID-19 pandemic and can facilitate future research in this area.
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Affiliation(s)
- Jordan Babando
- School of Social WorkUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Danika A. Quesnel
- School of Social WorkUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Kyler Woodmass
- School of Social WorkUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - Arielle Lomness
- Okanagan LibraryUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
| | - John R. Graham
- School of Social WorkUniversity of British Columbia‐Okanagan CampusKelownaBritish ColumbiaCanada
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Ou C, Hu S, Luo K, Yang H, Hang J, Cheng P, Hai Z, Xiao S, Qian H, Xiao S, Jing X, Xie Z, Ling H, Liu L, Gao L, Deng Q, Cowling BJ, Li Y. Insufficient ventilation led to a probable long-range airborne transmission of SARS-CoV-2 on two buses. BUILDING AND ENVIRONMENT 2022; 207:108414. [PMID: 34629689 PMCID: PMC8487323 DOI: 10.1016/j.buildenv.2021.108414] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 05/02/2023]
Abstract
Uncertainty remains on the threshold of ventilation rate in airborne transmission of SARS-CoV-2. We analyzed a COVID-19 outbreak in January 2020 in Hunan Province, China, involving an infected 24-year-old man, Mr. X, taking two subsequent buses, B1 and B2, in the same afternoon. We investigated the possibility of airborne transmission and the ventilation conditions for its occurrence. The ventilation rates on the buses were measured using a tracer-concentration decay method with the original driver on the original route. We measured and calculated the spread of the exhaled virus-laden droplet tracer from the suspected index case. Ten additional passengers were found to be infected, with seven of them (including one asymptomatic) on B1 and two on B2 when Mr. X was present, and one passenger infected on the subsequent B1 trip. B1 and B2 had time-averaged ventilation rates of approximately 1.7 and 3.2 L/s per person, respectively. The difference in ventilation rates and exposure time could explain why B1 had a higher attack rate than B2. Airborne transmission due to poor ventilation below 3.2 L/s played a role in this two-bus outbreak of COVID-19.
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Affiliation(s)
- Cuiyun Ou
- School of Atmospheric Sciences, Sun Yat-sen University, and Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai, China
| | - Shixiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Kaiwei Luo
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Hongyu Yang
- School of Atmospheric Sciences, Sun Yat-sen University, and Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai, China
| | - Jian Hang
- School of Atmospheric Sciences, Sun Yat-sen University, and Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai, China
| | - Pan Cheng
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Zheng Hai
- Shaodong County Center for Disease Control and Prevention, Shaodong, China
| | - Shanliang Xiao
- Shaoyang City Center for Disease Control and Prevention, Shaoyang, China
| | - Hua Qian
- School of Energy and Environment, Southeast University, Nanjing, China
| | - Shenglan Xiao
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
| | - Xinping Jing
- Shaodong County Center for Disease Control and Prevention, Shaodong, China
| | - Zhengshen Xie
- Shaodong County Center for Disease Control and Prevention, Shaodong, China
| | - Hong Ling
- School of Atmospheric Sciences, Sun Yat-sen University, and Southern Marine Science and Engineering Guangdong Laboratory (Zhuhai), Zhuhai, China
| | - Li Liu
- School of Architecture, Tsinghua University, Beijing, China
| | - Lidong Gao
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China
| | - Qihong Deng
- XiangYa School of Public Health, Central South University, Changsha, China
| | | | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Hong Kong, China
- School of Public Health, The University of Hong Kong, Hong Kong, China
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48
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Chang YS, Mayer S, Davis ES, Figueroa E, Leo P, Finn PW, Perkins DL. Transmission Dynamics of Large Coronavirus Disease Outbreak in Homeless Shelter, Chicago, Illinois, USA, 2020. Emerg Infect Dis 2022; 28:76-84. [PMID: 34856112 PMCID: PMC8714208 DOI: 10.3201/eid2801.210780] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has the potential for rapid transmission in congregate settings. We describe the multidisciplinary response to an outbreak of coronavirus disease (COVID-19) in a large homeless shelter in Chicago, Illinois, USA. The response to the outbreak included 4 rounds of mass PCR testing of all staff and residents and subsequent isolation of persons who tested positive for SARS-CoV-2. We further describe the dynamics of the shelter outbreak by fitting a modified susceptible-exposed-infectious-recovered compartmental model incorporating the widespread SARS-CoV-2 testing and isolation measures implemented in this shelter. Our model demonstrates that rapid transmission of COVID-19 in the shelter occurred before the outbreak was detected; rates of transmission declined after widespread testing and isolation measures were put in place. Overall, we demonstrate the feasibility of mass PCR testing and isolation in congregate settings and suggest the necessity of prompt response to suspected COVID-19 outbreaks in homeless shelters.
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Affiliation(s)
- Yi-Shin Chang
- University of Illinois at Chicago, Chicago, Illinois, USA (Y.-S. Chang, S. Mayer, E. Figueroa, P. Leo, P.W. Finn, D.L. Perkins)
- Rush University Medical Center, Chicago (E.S. Davis)
| | - Stockton Mayer
- University of Illinois at Chicago, Chicago, Illinois, USA (Y.-S. Chang, S. Mayer, E. Figueroa, P. Leo, P.W. Finn, D.L. Perkins)
- Rush University Medical Center, Chicago (E.S. Davis)
| | - Elizabeth S. Davis
- University of Illinois at Chicago, Chicago, Illinois, USA (Y.-S. Chang, S. Mayer, E. Figueroa, P. Leo, P.W. Finn, D.L. Perkins)
- Rush University Medical Center, Chicago (E.S. Davis)
| | - Evelyn Figueroa
- University of Illinois at Chicago, Chicago, Illinois, USA (Y.-S. Chang, S. Mayer, E. Figueroa, P. Leo, P.W. Finn, D.L. Perkins)
- Rush University Medical Center, Chicago (E.S. Davis)
| | - Paul Leo
- University of Illinois at Chicago, Chicago, Illinois, USA (Y.-S. Chang, S. Mayer, E. Figueroa, P. Leo, P.W. Finn, D.L. Perkins)
- Rush University Medical Center, Chicago (E.S. Davis)
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49
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Luong L, Beder M, Nisenbaum R, Orkin A, Wong J, Damba C, Emond R, Lena S, Wright V, Loutfy M, Bruce-Barrett C, Cheung W, Cheung YK, Williams V, Vanmeurs M, Boozary A, Manning H, Hester J, Hwang SW. Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. Canadian Journal of Public Health 2021; 113:117-125. [PMID: 34919211 PMCID: PMC8678973 DOI: 10.17269/s41997-021-00591-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/25/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. METHODS The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17-April 25; T2: April 26-May 23; T3: May 24-June 25). RESULTS The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06-0.75) during T2 and 0.14 times lower (95% CI: 0.04-0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. CONCLUSION During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks, and/or individual site characteristics.
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Affiliation(s)
- Linh Luong
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Michaela Beder
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Aaron Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Cynthia Damba
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Ryan Emond
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Suvendrini Lena
- Department of Medicine, Women's College Hospital, Toronto, ON, Canada.,The Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vanessa Wright
- Department of Family and Community Medicine, Women's College Hospital, Toronto, ON, Canada
| | - Mona Loutfy
- Women's College Research Institute, Women's College Hospital, University of Toronto & Maple Leaf Medical Clinic, Toronto, ON, Canada
| | | | - Wilfred Cheung
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Yick Kan Cheung
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Victoria Williams
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | - Miriam Vanmeurs
- Central Local Health Integration Network, Ontario Health Toronto, Toronto, ON, Canada
| | | | | | - Joe Hester
- Anishnawbe Health Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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50
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Bahji A, Bach P, Danilewitz M, El-Guebaly N, Doty B, Thompson L, Clarke DE, Ghosh SM, Crockford D. Strategies to aid self-isolation and quarantine for individuals with severe and persistent mental illness during the COVID-19 pandemic: A systematic review. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2021; 3:184-190. [PMID: 34901762 PMCID: PMC8652932 DOI: 10.1176/appi.prcp.20210022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/20/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Individuals with severe and persistent mental illness (SPMI) have a higher risk of contracting COVID‐19 than individuals without SPMI. In combination with physical distancing, hygiene protocols, and vaccines, quarantine and self‐isolation are primary means of viral containment. However, individuals with SPMI may experience more difficulties with mandated quarantine or self‐isolation because of their illness(es), stigma, and marginalization. To date, there is a lack of consensus on strategies that could aid such individuals in completing isolation. Aim This review aimed to synthesize evidence for interventions to support self‐isolation and mandated quarantine for COVID‐19 among individuals with SPMIs. Methods We followed the PRISMA guidelines, searching 19 electronic databases (9 published literature registries and 10 gray literature sources). We looked for relevant randomized controlled trials, quasi‐experimental studies, and program evaluations of the effectiveness of relevant psychosocial, pharmacological, harm reduction, and addiction management strategies to support isolation settings or quarantine requirements for individuals with any SPMI (e.g., any mental disorder, substance use disorder, or their combination). Findings Of 10,298 total records that were located, 5582 were duplicate citations. Upon screening the remaining 4716 unique records by title and abstract, we excluded a further 3562 records. Only one original article met our inclusion criteria after reviewing the full texts of the remaining 1154 citations. To support individuals experiencing homelessness during the COVID‐19 pandemic, San Francisco developed an isolation hotel that reduced COVID‐19 hospital strain for 1009 participants (25% had a mental health disorder and 26% had a substance use disorder). While 81% completed their hotel stay, 48 patients had behavioral health needs that exceeded the hotel's capabilities. No other studies met our review's eligibility criteria. Most articles located by the search simply proposed solutions or discussed the challenges brought by COVID‐19 for people with SPMIs. While some documents went a step further (e.g., shelter guidance documents to support individuals experiencing homelessness), these rarely addressed individuals with SPMIs directly. Conclusions This systematic review evaluated evidence from published and gray literature on interventions to support self‐isolation and mandated COVID‐19 quarantine for individuals with SPMIs. Only one study met our inclusion criteria. This study found a beneficial effect of a dedicated isolation hotel for individuals experiencing homelessness and COVID‐19—where approximately 25%–50% of the study sample had a mental or substance use disorder. While there has been an abundance of COVID‐19 protocols in general, information for SPMIs is lacking. As the pandemic continues and we better prepare for future pandemics, developing protocols for supporting SPMIs in this context is imperative. Individuals with severe and persistent mental illness (SPMI) have a higher risk of contracting COVID‐19 than individuals without SPMI. This review aimed to synthesize evidence for interventions to support self‐isolation and mandated quarantine for COVID‐19 among individuals with SPMIs. Only one study met our inclusion criteria. This study found a beneficial effect of a dedicated isolation hotel for individuals experiencing homelessness and COVID‐19—where approximately 25%–50% of the study sample had a mental or substance use disorder. While there has been an abundance of COVID‐19 protocols in general, information for SPMIs is lacking. As the pandemic continues and we better prepare for future pandemics, developing protocols for supporting SPMIs in this context is imperative.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry University of Calgary Calgary Canada.,British Columbia Center for Substance Use Vancouver Canada
| | - Paxton Bach
- British Columbia Center for Substance Use Vancouver Canada.,Department of Medicine University of British Columbia Vancouver Canada
| | | | - Nady El-Guebaly
- Department of Psychiatry University of Calgary Calgary Canada
| | - Benjamin Doty
- Division of Research American Psychiatric Association Washington District of Columbia USA
| | - Laura Thompson
- Division of Research American Psychiatric Association Washington District of Columbia USA
| | - Diana E Clarke
- Division of Research American Psychiatric Association Washington District of Columbia USA
| | - Sumantra Monty Ghosh
- Department of Psychiatry University of Calgary Calgary Canada.,Department of Medicine University of Alberta Edmonton Canada
| | - David Crockford
- Department of Psychiatry University of Calgary Calgary Canada
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