Coronavirus Spreads Among Homeless Shelter Residents in US, CDC Study Finds

Coronavirus has been spreading through homeless shelters in the United States, according to a set of studies and local figures that point to a particularly vulnerable population. The source reports that an estimated two million people experience homelessness each year in the US, and about 500,000 individuals sleep in homeless shelters each night. Shelter life, with its congregate living and hygiene challenges, creates the potential for rapid transmission of SARS-CoV-2, and the source notes that the number of positive cases in shelters has grown as testing capacity has expanded in many states.

A study by the Centers for Disease Control and Prevention (CDC) examined 19 shelters in Boston, Seattle, San Francisco and Atlanta. Of 1,912 shelter residents tested, 293, or 25%, tested positive. The study had limitations, including that it represented a single point in time and that some residents declined to be tested. The source reports that the findings nonetheless raised concern about the vulnerability of this group.

According to the CDC, several measures should be put in place to protect shelter residents and staff, including infection control practices, maintaining social distance, and promoting the use of cloth face coverings. The agency said: “Homeless shelters are often crowded, making social distancing difficult. Many persons experiencing homelessness are older or have underlying medical conditions, placing them at higher risk for severe COVID-19–associated illness.”

A separate study by a group of researchers, published in JAMA Network, tested 408 residents of a shelter in Boston over two days. Up to 147 of them, or 36%, tested positive. The average age of participants was 52, and almost three quarters were men. Only 1% had a fever, 8% reported a cough, less than 1% reported shortness of breath, and 6% reported other symptoms. Overall, 361 individuals, or 88.5%, reported no symptoms. The researchers concluded that most people with newly identified infections had no symptoms or fever at diagnosis, suggesting that symptom screening may not fully capture transmission in this setting.

Since the focused testing in Boston, a few hundred more people who are homeless in the city have been tested, bringing the total to 946. The city reports that 26% have tested positive. One person experiencing homelessness is known to have died from COVID-19, and a handful have been hospitalized. Officials expect that by the following week more than half of the city’s adult shelter population will have been tested. That population ranges from about 1,500 to 1,800 people on any given night, according to the public health commission, and more than 900 isolation beds have been set up locally for people who are homeless.

Dr. Jim O’Connell, president of Boston Health Care for the Homeless Program, which provides medical care at the city’s shelters, described the situation: “It was like a double knockout punch. The number of positives was shocking, but the fact that the positives had no symptoms was equally shocking.”

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