Type of publication

Culhane, Dennis; Treglia, Dan; Steif, Kenneth

Estimated Emergency and Observational/Quarantine Capacity Need for the US Homeless Population Related to COVID-19 Exposure by County; Projected Hospitalizations, Intensive Care Units and Mortality

This report estimates the potential hospitalization, ICU use and mortality rates associated with COVID-19 infection among the homeless population in the United States, as well as unmet need for emergency and observational/quarantine beds/units. Results project that homeless individuals infected by COVID-19 would be twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times as likely to die than the general population. The analysis suggests that 400,000 new beds are needed to meet the emergency accommodation and social distancing needs of the single adult homeless population on a given day, and that the total estimated cost to meet the nation’s emergency shelter and observational/quarantine units need is approximately $11.5 billion for one year. The second edition explores alternatives for emergency accommodation including private accommodations, congregate shelters, sheltering in place, and emergency coordination of care

https://escholarship.org/uc/item/9g0992bm

Baggett, Travis ; Lewis, Elizabeth ; Gaeta, Jessie.

Epidemiology of COVID-19 among people experiencing homelessness: Early evidence from Boston

People experiencing homelessness are at high risk for coronavirus disease (COVID-19). We estimated population frequencies of confirmed COVID-19 cases among adults experiencing homelessness in Boston relative to the Massachusetts adult population. Over a 15-day period, 182 homeless adults in Boston were diagnosed with COVID-19 for an estimated cumulative frequency of 46.3 cases per 1000 persons, as compared to 1.9 cases per 1000 among Massachusetts adults on the same date. The trajectory and burden of COVID-19 cases among homeless adults suggests that cities should prepare urgently for the possibility of a COVID-19 surge in this population.

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/154734/Baggett%20Deep%20Blue%20article.pdf?sequence=1

Baggett, Travis; Sporn, Nora; Gaeta, Jessie M.

COVID-19 outbreak at a large homeless shelter in Boston: Implications for universal testing

The circumstances of homelessness create the potential for rapid transmission of SARS-CoV-2 in this vulnerable population. Upon observing a cluster of COVID-19 cases from a single large homeless shelter in Boston, Boston Health Care for the Homeless Program conducted symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2 among all guests residing at the shelter over a 2-day period. Of 408 participants, 147 (36.0%) were PCR-positive for SARS-CoV-2. COVID-positive individuals were more likely to be male (p<0.001) but did not differ significantly from COVID-negative individuals with respect to other demographic and clinical characteristics. Cough (7.5%), shortness of breath (1.4%), and fever (0.7%) were all uncommon among COVID-positive individuals. Our findings illustrate the rapidity with which COVID-19 can be widely transmitted in a homeless shelter setting and suggest that universal PCR testing, rather than a symptom triggered approach, may be a better strategy for identifying and mitigating COVID-19 among people experiencing homelessness.Competing Interest StatementDr. Baggett receives royalties from UpToDate for authorship of a topic review on homeless health care.Funding StatementNo external funding supported this study.Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesThe study data are not available to share due to the highly vulnerable nature of the patient population.

http://medrxiv.org/content/early/2020/04/15/2020.04.12.20059618.abstract

Neto, MLRdS, Ricardo Inácio; Quezado, Rosa Magda Martins; Mendonça, Elayne Cristina Santos; de Araújo, Tallys Iury; Luz, Dayse Christina Rodrigues Pereira; de Santana, Willma José; Sampaio, Juliana Ribeiro Francelino; Carvalho, Poliana Moreira de Medeiros; Arrais, Tereza Maria Siqueira Nascimento; Landim, José Marcondes Macedo; da Silva, Claúdio Gleideston Lima

WHEN BASIC SUPPLIES ARE MISSING, WHAT TO DO? SPECIFIC DEMANDS OF THE LOCAL STREET POPULATION IN TIMES OF CORONAVIRUS – A CONCERN OF SOCIAL PSYCHIATRY

Background : Homeless experts and some federal housing officials are sounding the alarm that the patchwork of government efforts to address the coronavirus outbreak risks leaving out one group of acutely vulnerable people: the homeless. In terms of isolation, it is too unclear what that looks like if you normally sleep on the streets. In this tough moment, when people should be turned away, not only it feels inhumane, but it is also a big public health risk, because where are they going to go? Method : The studies were identified using large-sized newspapers with international circulation. Results : With more cities suspecting community transmission of the novel coronavirus, people who sleep in shelters or hunker down outside already have a lower life expectancy and often have underlying health conditions that put them at greater risk if they develop COVID-19 (Global News, 2020). These people face lack of sleep, malnutrition, and “extreme stress levels just to meet their daily needs”, all of which weakens the immune system. Along with mental illness or substance abuse disorders, they are “incredibly vulnerable to this virus”. Conclusions : Health organizations are well aware of the risks involved in mental health. A large population of homeless people experience their pain and psychological distress intermittently. For low-income patients, the various borderline situations related to health/illness involve growing expectations regarding the basic needs. This is a serious concern when linked to the pandemic.

http://www.sciencedirect.com/science/article/pii/S0165178120306119

Lima, NNRdS, Ricardo Inácio; Feitosa, Pedro Walisson Gomes; Moreira, Jorge Lucas de Sousa; da Silva, Claudio Gleidiston Lima; Neto, Modesto Leite Rolim

PEOPLE EXPERIENCING HOMELESSNESS: THEIR POTENTIAL EXPOSURE TO COVID-19

Background : Insufficient housing quality is associated with stress and mental health impacts. Crowding, pollution, noise, inadequate lighting, lack of access to green spaces, and other environmental factors associated with slums can exacerbate mental health disorders, including depression, anxiety, violence, and other forms of social dysfunction. Method : The studies were identified using large-sized newspapers with international circulation. Results : Experts say that people who sleep in shelters or on the streets already have lower life expectancy, suffer from addiction, and have underlying health conditions that put them at greater risk should they develop the virus. There are just so many competing and unmet needs, which makes it much harder for homeless to contend with all of this. If exposed, people experiencing homelessness might be more susceptible to illness or death due to the prevalence of underlying physical and mental medical conditions and a lack of reliable and affordable health care. Nevertheless, without an urgent solution, people experiencing homelessness will remain in limbo. Conclusions : Many people living on the streets already have a diminished health condition, higher rates of chronic illnesses or compromised immune systems, all of which are risk factors for developing a more serious manifestation of the coronavirus infection. Those suffering from mental illness may have difficulty in recognizing and responding to the threat of infection. Homeless people have less access to health care providers who could otherwise order diagnostic testing and, if confirmed, isolate them from others in coordination with local health departments.

http://www.sciencedirect.com/science/article/pii/S0165178120306491

Kar, SKYA, S. M.; Marthoenis, Marthoenis; Kabir, Russell

Homeless mentally ill people and COVID-19 pandemic: The two-way sword for LMICs

http://www.sciencedirect.com/science/article/pii/S1876201820301787

Rosenthal, DMU, Marcella; Heys, Michelle; Hayward, Andrew; Lakhanpaul, Monica

Impacts of COVID-19 on vulnerable children in temporary accommodation in the UK

https://doi.org/10.1016/S2468-2667(20)30080-3

Wood, LJD, A. P.; Khan, Z.

COVID-19 precautions: easier said than done when patients are homeless

https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50571

Centers for Disease Control and Prevention

Screening clients for respiratory infection symptoms at entry to homeless shelters

https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/screening-clients-respiratory-infection-symptoms.html

Efforts escalate to protect homeless people from COVID-19 in UK

http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medp&AN=32222165; http://sfx.library.cdc.gov/cdc?sid=OVID:medline&id=pmid:32222165&id=10.1016%2FS2213-2600%2820%2930160-0&issn=2213-2600&isbn=&volume=&issue=&spage=&pages=&date=2020&title=The+Lancet+Respiratory+Medicine&atitle=Efforts+escalate+to+protect+homeless+people+from+COVID-19+in+UK.&aulast=Kirby&pid=%3Cauthor%3EKirby+T%3C%2Fauthor%3E&%3CAN%3E32222165%3C%2FAN%3E&%3CDT%3EJournal+Article%3C%2FDT%3E

Advocates for the homeless seeking funding for COVID-19

Now that the federal $8.3 billion appropriations bill has passed and been signed into law this month to stem the spread of the new coronavirus (COVID-19), advocates are hoping some of that funding reaches one of this country's most vulnerable populations: the homeless.

https://doi.org/10.1002/mhw.32276

COVID-19: a potential public health problem for homeless populations

http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medp&AN=32171054; http://sfx.library.cdc.gov/cdc?sid=OVID:medline&id=pmid:32171054&id=10.1016%2FS2468-2667%2820%2930053-0&issn=2468-2667&isbn=&volume=&issue=&spage=&pages=&date=2020&title=The+lancet.+Public+Health&atitle=COVID-19%3A+a+potential+public+health+problem+for+homeless+populations.&aulast=Tsai&pid=%3Cauthor%3ETsai+J%2CWilson+M%3C%2Fauthor%3E&%3CAN%3E32171054%3C%2FAN%3E&%3CDT%3EJournal+Article%3C%2FDT%3E

Office of Homelessness Prevention and Intervention

Infectious Disease Homeless System Response Plan

https://www.hsdl.org/?abstract&did=835168; http://bereadylexington.com/wp-content/uploads/2020/03/System-Plan-_-FINAL_-3_13_2020.pdf

New York City Department of Health

Interim COVID-19 Guidance for Homeless Shelters

https://www.hsdl.org/?abstract&did=834965; ; https://www1.nyc.gov/assets/doh/downloads/pdf/imm/guidance-for-homeless-shelters-covid19.pdf

Centers for Disease Control and Prevention

https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/plan-prepare-respond.html