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About 1.4 million people in the United States use emergency shelter or transitional housing each year, and such settings can spread infectious disease. In spring 2020, public health teams tested every resident and staff member they could at homeless shelters in four cities — regardless of symptoms — to see how far COVID-19 had reached.
What the teams did
| Situation | Where | What happened |
|---|---|---|
| Clusters — two or more cases in the previous 2 weeks | 5 shelters: Boston (1), San Francisco (1), Seattle (3) | responded in late March and early April, testing residents and staff over about 1–2 weeks |
| A single known case | 12 shelters in Seattle | tested in the same period |
| No known cases in the previous 2 weeks | 2 shelters in Atlanta | tested proactively |
Testing was by reverse transcription–polymerase chain reaction for SARS-CoV-2, at commercial and public health laboratories, working with academic partners, health care providers and homeless service providers. Anyone who tested positive was taken to a hospital or a community isolation site set up in advance.
Results
In all, 1,192 residents and 313 staff were tested in 19 shelters.
| City | Shelters | Testing dates | Residents positive | Staff positive |
|---|---|---|---|---|
| Shelters with clusters | ||||
| Seattle | 3 | Mar 30–Apr 8 | 31 of 179 (17%) | 6 of 35 (17%) |
| Boston | 1 | Apr 2–3 | 147 of 408 (36%) | 15 of 50 (30%) |
| San Francisco | 1 | Apr 4–15 | 95 of 143 (66%) | 10 of 63 (16%) |
| Shelters with one known case | ||||
| Seattle | 12 | Mar 27–Apr 15 | 10 of 213 (5%) | 1 of 106 (1%) |
| Shelters with no known cases | ||||
| Atlanta | 2 | Apr 8–9 | 10 of 249 (4%) | 1 of 59 (2%) |
| All | 19 | Mar 27–Apr 15 | 293 of 1,192 | 33 of 313 |
- Where a cluster had been found, large shares of residents and staff were infected.
- Where there had been one case, or none, prevalence was low.
- Community spread also differed: average daily reported cases per 100,000 people in each county during testing were highest in Boston (14.4) and lowest in San Francisco (5.7).
Why shelters are vulnerable
Homelessness brings several problems that can worsen and amplify the spread of COVID-19:
- shelters are often crowded, which makes distancing hard;
- many people experiencing homelessness are older or have underlying medical conditions, raising their risk of severe illness.
What CDC recommends
- Infection control practices in every shelter.
- Social distancing, including keeping residents' heads at least 6 feet (2 meters) apart while they sleep.
- Cloth face coverings for all residents.
These matter most once COVID-19 is spreading in the surrounding community. Because so many tested positive where clusters were found, and because the virus spreads from people before symptoms or without them:
- where a cluster is found, consider testing all residents and staff, whatever their symptoms;
- where testing is easy to get, consider regular testing even before clusters appear.
Testing everyone makes it possible to isolate those who are infected and limit further spread.
Limits
- Each shelter was tested once.
- Not everyone was available or agreed to be tested — in San Francisco, 143 of an estimated 255 residents at risk were tested.
- Symptoms weren't recorded consistently, so they aren't reported here (Boston's are published separately).
CDC's guidance for shelters: plan, prepare and respond.
Sources
Based on Mosites E, Parker EM, Clarke KEN, et al., "Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020," MMWR volume 69, number 17, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licens: CC0 1.0 (offentligt eje) · Bearbejdet efter www.cdc.gov
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