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. 2023 Jul 10:151:e129.
doi: 10.1017/S0950268823001036.

Incidence of SARS-CoV-2 infection and associated risk factors among staff and residents at homeless shelters in King County, Washington: an active surveillance study

Julia H Rogers  1   2 , Sarah N Cox  1   2 , Amy C Link  1 , Gift Nwanne  3   4 , Peter D Han  5 , Brian Pfau  5 , Eric J Chow  1 , Caitlin R Wolf  1 , Michael Boeckh  1   3 , James P Hughes  3   6 , M Elizabeth Halloran  3   6 , Timothy M Uyeki  7 , M Mia Shim  8   9 , Jeffrey Duchin  1   8 , Janet A Englund  10 , Emily Mosites  11 , Melissa A Rolfes  7 , Lea A Starita  3   12 , Helen Y Chu  1
Affiliations

Incidence of SARS-CoV-2 infection and associated risk factors among staff and residents at homeless shelters in King County, Washington: an active surveillance study

Julia H Rogers et al. Epidemiol Infect. .

Abstract

Homeless shelter residents and staff may be at higher risk of SARS-CoV-2 infection. However, SARS-CoV-2 infection estimates in this population have been reliant on cross-sectional or outbreak investigation data. We conducted routine surveillance and outbreak testing in 23 homeless shelters in King County, Washington, to estimate the occurrence of laboratory-confirmed SARS-CoV-2 infection and risk factors during 1 January 2020-31 May 2021. Symptom surveys and nasal swabs were collected for SARS-CoV-2 testing by RT-PCR for residents aged ≥3 months and staff. We collected 12,915 specimens from 2,930 unique participants. We identified 4.74 (95% CI 4.00-5.58) SARS-CoV-2 infections per 100 individuals (residents: 4.96, 95% CI 4.12-5.91; staff: 3.86, 95% CI 2.43-5.79). Most infections were asymptomatic at the time of detection (74%) and detected during routine surveillance (73%). Outbreak testing yielded higher test positivity than routine surveillance (2.7% versus 0.9%). Among those infected, residents were less likely to report symptoms than staff. Participants who were vaccinated against seasonal influenza and were current smokers had lower odds of having an infection detected. Active surveillance that includes SARS-CoV-2 testing of all persons is essential in ascertaining the true burden of SARS-CoV-2 infections among residents and staff of congregate settings.

Keywords: SARS-CoV-2 incidence; Surveillance; cross-sectional study; homeless shelter; infection risk factors; molecular testing.

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Conflict of interest statement

Dr. Chu reported consulting with Ellume, Pfizer, the Bill & Melinda Gates Foundation, Glaxo Smith Kline, and Merck. She has received research funding from Gates Ventures and Sanofi Pasteur, and support and reagents from Ellume and Cepheid outside of the submitted work. Dr. Englund reported research support from Merck, AstraZeneca, Pfizer, and GlaxoSmithKline. She is a consultant for Meissa Vaccines, Sanofi Pasteur, and Astra Zeneca.

Figures

Figure 1.
Figure 1.
Crude incidence estimates among all unique participants, plus stratifications: (a) resident versus staff; (b) children versus adults; (c) shelter type (adult, family, youth); (d) asymptomatic versus symptomatic (≥1 symptom).
Figure 2. (
Figure 2. (
a)–(c) Epidemic curves of SARS-CoV-2 case count (a; N = 139); test positivity (b; N = 139/12,915); and COVID-19 vaccine uptake (≥1 dose) (c; N = 597/12,915) by epidemiological week.
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