Coronavirus Disease 2019 (COVID-19) Prevalences Among People Experiencing Homelessness and Homelessness Service Staff During Early Community Transmission in Atlanta, Georgia, April-May 2020

Jane C Yoon; Martha P Montgomery; Ann M Buff; Andrew T Boyd; Calla Jamison; Alfonso Hernandez; Kristine Schmit; Sarita Shah; Sophia Ajoku; David P Holland; Juliana Prieto; Sasha Smith; Mark A Swancutt; Kim Turner; Tom Andrews; Kevin Flowers; Alyssa Wells; Cathryn Marchman; Emaline Laney; Danae Bixler; Sean Cavanaugh; Nicole Flowers; Nicholas Gaffga; Jean Y Ko; Heather N Paulin; Mark K Weng; Emily Mosites; Sapna Bamrah Morris

doi:10.1093/cid/ciaa1340

Coronavirus Disease 2019 (COVID-19) Prevalences Among People Experiencing Homelessness and Homelessness Service Staff During Early Community Transmission in Atlanta, Georgia, April-May 2020

Clin Infect Dis. 2021 Nov 2;73(9):e2978-e2984. doi: 10.1093/cid/ciaa1340.

Authors

Jane C Yoon¹, Martha P Montgomery², Ann M Buff², Andrew T Boyd², Calla Jamison², Alfonso Hernandez¹, Kristine Schmit², Sarita Shah³, Sophia Ajoku⁴, David P Holland^{1

4}, Juliana Prieto⁴, Sasha Smith⁴, Mark A Swancutt⁴, Kim Turner⁴, Tom Andrews⁵, Kevin Flowers⁵, Alyssa Wells⁵, Cathryn Marchman⁶, Emaline Laney⁷, Danae Bixler², Sean Cavanaugh², Nicole Flowers², Nicholas Gaffga², Jean Y Ko², Heather N Paulin², Mark K Weng², Emily Mosites², Sapna Bamrah Morris²

Affiliations

¹ Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
² Coronavirus Disease 2019 (COVID-19) Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
⁴ Fulton County Board of Health, Atlanta, Georgia, USA.
⁵ Mercy Care, Atlanta, Georgia, USA.
⁶ Partners for HOME, Atlanta, Georgia, USA.
⁷ Emory University School of Medicine, Atlanta, Georgia, USA.

Abstract

Background: In response to reported coronavirus disease 2019 (COVID-19) outbreaks among people experiencing homelessness (PEH) in other US cities, we conducted multiple, proactive, facility-wide testing events for PEH living sheltered and unsheltered and homelessness service staff in Atlanta, Georgia. We describe the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) prevalence and associated symptoms, and review shelter infection prevention and control (IPC) policies.

Methods: PEH and staff were tested for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR) during 7 April-6 May 2020. A subset of PEH and staff was screened for symptoms. Shelter assessments were conducted concurrently at a convenience sample of shelters using a standardized questionnaire.

Results: Overall, 2875 individuals at 24 shelters and 9 unsheltered outreach events underwent SARS-CoV-2 testing, and 2860 (99.5%) had conclusive test results. The SARS-CoV-2 prevalences were 2.1% (36/1684) among PEH living sheltered, 0.5% (3/628) among PEH living unsheltered, and 1.3% (7/548) among staff. Reporting fever, cough, or shortness of breath in the last week during symptom screening was 14% sensitive and 89% specific for identifying COVID-19 cases, compared with RT-PCR. Prevalences by shelter ranged 0-27.6%. Repeat testing 3-4 weeks later at 4 shelters documented decreased SARS-CoV-2 prevalences (0-3.9%). Of 24 shelters, 9 completed shelter assessments and implemented IPC measures as part of the COVID-19 response.

Conclusions: PEH living in shelters experienced a higher SARS-CoV-2 prevalence compared with PEH living unsheltered. Facility-wide testing in congregate settings allowed for the identification and isolation of COVID-19 cases, and is an important strategy to interrupt SARS-CoV-2 transmission.

Keywords: COVID-19; SARS-CoV-2; homeless persons; prevalence; universal testing.

MeSH terms

COVID-19 Testing
COVID-19*
Georgia / epidemiology
Humans
Ill-Housed Persons*
Prevalence
SARS-CoV-2