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Pandemic Planning in Homeless Shelters: A pilot study of a COVID-19 testing and support program to mitigate the risk of COVID-19 outbreaks in congregate settings

Our take —

This pilot study in eight homeless shelters in Canada demonstrated the apparent effectiveness of aggressive testing and control measures in preventing a large-scale outbreak. Several of the measures may be applicable in a variety of congregate settings: reducing bed density, redesigning shelters to allow isolation of suspected cases, rapid testing and tracing of potential cases, and providing protection for at-risk workers.

Study design

Other

Study population and setting

The authors described measures taken to enable physical distancing in homeless shelters and reported results from a pilot COVID-19 screening program for staff and residents across eight shelters in Hamilton, Canada between March 19 and April 30, 2020. Staff and residents who reported COVID-19 symptoms or who had recently been in contact with a case (n=245; 141 staff and 104 residents) were tested once using a nasopharyngeal swab (NPS). Shelters encouraged physical distancing by increasing the distance between beds and decreasing the density of beds in each shelter. Overall, the number of beds increased, as other venues were repurposed into shelters. On April 18, individuals were required to wear masks in common areas in shelters. COVID-19 positive cases were isolated at a separate center for two weeks. Those waiting for test results were temporarily isolated in single rooms within shelters. Drivers transporting residents were provided with personal protective equipment.

Summary of Main Findings

Out of 104 residents, one tested positive for COVID-19. This resident was not linked to any onward transmission to other residents. Out of 141 staff, seven tested positive for COVID-19. During the study period at a local hospital, one additional resident tested positive for COVID-19 upon presentation. These preliminary results indicated successful prevention of COVID-19 outbreaks in a shelter setting. During the same time period, there were 422 COVID-19 cases in Hamilton, Ontario overall, 10% of which were in congregate settings (e.g., nursing homes).

Study Strengths

The authors documented physical distancing measures taken in detail over the time period. All those that were symptomatic or in contact with a COVID-19 case were tested.

Limitations

The number of people participating in this study was small, as it was a pilot. Demographic information on staff or residents was also not provided. Similarly, bed occupancy was not recorded, and it was unclear if all beds were occupied throughout the study. Thus, it is not possible to know whether the lack of cases was due to having few residents or the prevention measures taken. Also, only symptomatic individuals or those with recent contact with a case were tested, which means the study may have missed some residents or staff who were infected with SARS-CoV-2 but did not develop symptoms or had not been near a case. Furthermore, multiple tests were not administered to each individual tested, which may have resulted in false negatives (i.e., a person tests negative for SARS-CoV-2 but is actually infected). The authors also acknowledged that study participants could have sought testing at health facilities outside of the study, which would not have been captured in these findings. Preventive measures from this study may not be easily applied in other congregate settings (e.g. nursing facilities), where there are greater care requirements for residents.

Value added

The study provided a detailed description of control measures in homeless shelters that may be applicable in similar high-density residential facilities.

This review was posted on: 4 July 2020