A recent report from the Centers for Disease Control and Prevention (CDC) confirms homelessness is a significant contributor to virus spread.

As the global pandemic persists across the country, the CDC continues to analyze the demographics of those most vulnerable to contracting the virus. A recent report from the agency, published in Morbidity and Mortality Weekly Report, furthers the argument that social determinants of health (SDoH) are drivers in the disease spread.

Researchers evaluated the connection between the vulnerable population and the virus as homeless shelters across the country have been hit especially hard by coronavirus. The findings confirm that homelessness is a key SDoH that increases the risk of COVID-19 contraction and mortality, something long feared by the health care industry, reports Sara Heath in an article for PatientEngagementHIT.

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The agency studied clusters (two or more cases in the preceding two weeks) of COVID-19 in residents and staff members from five homeless shelters in Boston (one shelter), San Francisco (one shelter), and Seattle (three shelters). The report also included data from 12 additional homeless shelters in Seattle where each location identified only a single case and two shelters in Atlanta that had no known cases.

Within each city, all shelter residents and staff members from the assessed facilities were tested for the virus, regardless of symptoms. Individuals who tested positive were then either sent to the hospital or predesignated community isolation areas. Overall, 1,192 residents and 313 staff members were tested in the 19 homeless shelters evaluated.

The virus spread across all studied shelters and was most aggressive in the five that had previously experienced clusters:

  • In Seattle, 17 percent of residents and staff members each tested positive for the virus across the three shelters studied
  • In Boston, those who tested positive included 36 percent residents and 30 percent staff
  • As for the San Francisco shelter, 66 percent residents and 16 percent staff tested positive for the virus

The other studied shelters without previous cluster occurrences showed low prevalence of infection, with five percent residents and one percent staff testing positive across the remaining Seattle shelters and four percent and two percent in Atlanta, respectively.

Community spread in the four cities didn’t appear to be tied to virus spread throughout the shelters. The average number of cases in Boston per 100,000 persons per day was 14.4, the highest of any of the cities studied. But only one-third of residents or staff members in the Boston shelter tested positive. San Francisco, however, had the lowest community spread in the study with 5.7, yet had 66 percent of residents test positive.

Other factors put the vulnerable population at heightened risk, according to the CDC. Homeless shelters are commonly crowded and unable to practice social distancing, and many of the residents are older or have underlying health conditions, putting them at a higher risk for COVID-19.

The agency recommends homeless service providers continue to implement infection control practices, place resident beds at least six feet apart, and promote the use of cloth face coverings among all residents.

The agency also recommends testing residents and staff members when possible. “Given the high proportion of positive tests in the shelters with identified clusters and evidence for presymptomatic and asymptomatic transmission of SARS-CoV-2, testing of all residents and staff members regardless of symptoms at shelters where clusters have been detected should be considered,” study authors write. “If testing is easily accessible, regular testing in shelters before identifying clusters should also be considered. Testing all persons can facilitate isolation of those who are infected to minimize ongoing transmission in these settings.”