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. 2020 Oct 12;7(11):ofaa477.
doi: 10.1093/ofid/ofaa477. eCollection 2020 Nov.

Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Homeless Shelters in Chicago, Illinois-March-May, 2020

Isaac Ghinai  1   2 , Elizabeth S Davis  3 , Stockton Mayer  4 , Karrie-Ann Toews  1   2 , Thomas D Huggett  5 , Nyssa Snow-Hill  4 , Omar Perez  4 , Mary K Hayden  3 , Seena Tehrani  3 , A Justine Landi  3 , Stephanie Crane  3 , Elizabeth Bell  3 , Joy-Marie Hermes  3 , Kush Desai  3 , Michelle Godbee  3 , Naman Jhaveri  4 , Brian Borah  4 , Tracy Cable  4 , Sofia Sami  4 , Laura Nozicka  4 , Yi-Shin Chang  4 , Aditi Jagadish  1   4 , Mark Chee  1   6 , Brynna Thigpen  1 , Christopher Llerena  1   4 , Minh Tran  1   4 , Divya Meher Surabhi  1   4 , Emilia D Smith  1   4 , Rosemary G Remus  1 , Roweine Staszcuk  1 , Evelyn Figueroa  4 , Paul Leo  4 , Wayne M Detmer  5 , Evan Lyon  7 , Sarah Carreon  8 , Stacey Hoferka  9 , Kathleen A Ritger  1 , Wilnise Jasmin  1 , Prathima Nagireddy  1 , Jennifer Y Seo  1 , Marielle J Fricchione  1 , Janna L Kerins  1 , Stephanie R Black  1 , Lisa Morrison Butler  10 , Kimberly Howard  10 , Maura McCauley  10 , Todd Fraley  1 , M Allison Arwady  1 , Stephanie Gretsch  1 , Megan Cunningham  1 , Massimo Pacilli  1 , Peter S Ruestow  1 , Emily Mosites  2 , Elizabeth Avery  3 , Joshua Longcoy  3 , Elizabeth B Lynch  3 , Jennifer E Layden  1
Affiliations

Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Homeless Shelters in Chicago, Illinois-March-May, 2020

Isaac Ghinai et al. Open Forum Infect Dis. .

Abstract

Background: People experiencing homelessness are at increased risk of coronavirus disease 2019 (COVID-19), but little is known about specific risk factors for infection within homeless shelters.

Methods: We performed widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction testing and collected risk factor information at all homeless shelters in Chicago with at least 1 reported case of COVID-19 (n = 21). Multivariable, mixed-effects log-binomial models were built to estimate adjusted prevalence ratios (aPRs) for SARS-CoV-2 infection for both individual- and facility-level risk factors.

Results: During March 1 to May 1, 2020, 1717 shelter residents and staff were tested for SARS-CoV-2; 472 (27%) persons tested positive. Prevalence of infection was higher for residents (431 of 1435, 30%) than for staff (41 of 282, 15%) (prevalence ratio = 2.52; 95% confidence interval [CI], 1.78-3.58). The majority of residents with SARS-CoV-2 infection (293 of 406 with available information about symptoms, 72%) reported no symptoms at the time of specimen collection or within the following 2 weeks. Among residents, sharing a room with a large number of people was associated with increased likelihood of infection (aPR for sharing with >20 people compared with single rooms = 1.76; 95% CI, 1.11-2.80), and current smoking was associated with reduced likelihood of infection (aPR = 0.71; 95% CI, 0.60-0.85). At the facility level, a higher proportion of residents leaving and returning each day was associated with increased prevalence (aPR = 1.08; 95% CI, 1.01-1.16), whereas an increase in the number of private bathrooms was associated with reduced prevalence (aPR for 1 additional private bathroom per 100 people = 0.92; 95% CI, 0.87-0.98).

Conclusions: We identified a high prevalence of SARS-CoV-2 infections in homeless shelters. Reducing the number of residents sharing dormitories might reduce the likelihood of SARS-CoV-2 infection. When community transmission is high, limiting movement of persons experiencing homelessness into and out of shelters might also be beneficial.

Keywords: COVID-19; SARS-CoV-2; congregate settings; homeless; transmission.

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Figures

Figure 1.
Figure 1.
Number of daily cases of coronavirus disease 2019 across Chicago, with a timeline of interventions relevant to homeless shelters—Chicago, Illinois, March–May 2020.
See this image and copyright information in PMC

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