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. 2021 Mar 1;4(3):e210490.
doi: 10.1001/jamanetworkopen.2021.0490.

Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

Jonathan D Fuchs  1   2 , Henry Clay Carter  2 , Jennifer Evans  2   3 , Dave Graham-Squire  2   3 , Elizabeth Imbert  2   4 , Jessica Bloome  2   4 , Charles Fann  1 , Tobi Skotnes  1 , Jonathan Sears  1 , Rebecca Pfeifer-Rosenblum  1 , Alice Moughamian  1 , Joanna Eveland  1 , Amber Reed  1 , Deborah Borne  1 , Michele Lee  1 , Molly Rosenthal  2 , Vivek Jain  2   4 , Naveena Bobba  1 , Margot Kushel  2   3 , Hemal K Kanzaria  3   5
Affiliations

Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

Jonathan D Fuchs et al. JAMA Netw Open. .

Abstract

Importance: Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting.

Objective: To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity.

Design, setting, and participants: This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness.

Exposure: A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder.

Main outcomes and measures: Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay.

Results: Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 (P = .11).

Conclusions and relevance: To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Fuchs reported receiving grants from the Centers for Disease Control and Prevention outside the submitted work. Dr Jain reported receiving grants from the Centers for Disease Control and Prevention and President’s Emergency Plan for AIDS Relief outside the submitted work. Dr Kanzaria reported serving as an unpaid clinical advisory board member for Collective Medical and has received reimbursement for travel and accommodation-related expenses outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Isolation and Quarantine (I/Q) Hotel System of Care
COVID-19 indicates coronavirus disease 2019.
Figure 2.
Figure 2.. Flow Diagram of Referrals From Zuckerberg San Francisco General (ZSFG) Hospital Campus to Isolation and Quarantine (I/Q) Hotels, March 19 to May 31, 2020
The number of referrals (n = 346) exceeded the number of individuals transferred (n = 327) as individuals could be referred more than once. COVID-19 indicates coronavirus disease 2019; PUI, persons under investigation; and SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 3.
Figure 3.. Total Isolation and Quarantine (I/Q) Hotel Transfers From Zuckerberg San Francisco General (ZSFG) Hospital by Hospital Referral Location, March 19 to May 31, 2020 (N = 346)
A, Total number of patient transfers per week to I/Q hotels from ZSFG between March 19 and May 31, 2020. B, Percentage of transfers over time by hospital campus location (ie, emergency department [ED], urgent care, ambulatory care clinic, and inpatient unit). Overall, the proportion of referrals from inpatient units decreased over time, while referrals from other locations increased.
See this image and copyright information in PMC

Comment in

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