Interventions to Mitigate the Impact of COVID-19 Among People Experiencing Sheltered Homelessness: Chicago, Illinois, March 1, 2020-May 11, 2023

Abstract

Objectives. To compare the incidence, case-hospitalization rates, and vaccination rates of COVID-19 between people experiencing sheltered homelessness (PESH) and the broader community in Chicago, Illinois, and describe the impact of a whole community approach to disease mitigation during the public health emergency. Methods. Incidence of COVID-19 among PESH was compared with community-wide incidence using case-based surveillance data from March 1, 2020, to May 11, 2023. Seven-day rolling means of COVID-19 incidence were assessed for the overall study period and for each of 6 distinct waves of COVID-19 transmission. Results. A total of 774 009 cases of COVID-19 were detected: 2579 among PESH and 771 430 in the broader community. Incidence and hospitalization rates per 100 000 in PESH were more than 5 times higher (99.84 vs 13.94 and 16.88 vs 2.14) than the community at large in wave 1 (March 1, 2020-October 3, 2020). This difference decreased through wave 3 (March 7, 2021-June 26, 2021), with PESH having a lower incidence rate per 100 000 than the wider community (8.02 vs 13.03). Incidence and hospitalization of PESH rose again to rates higher than the broader community in waves 4 through 6 but never returned to wave 1 levels. Throughout the study period, COVID-19 incidence among PESH was 2.88 times higher than that of the community (70.90 vs 24.65), and hospitalization was 4.56 times higher among PESH (7.51 vs 1.65). Conclusions. Our findings suggest that whole-community approaches can minimize disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission between vulnerable populations and the broader community, and reinforce the benefits of a shared approach that include multiple partners when addressing public health emergencies in special populations. (Am J Public Health. 2024;114(S7):S590-S598. https://doi.org/10.2105/AJPH.2024.307801).

FIGURE 1—

Seven-Day Rolling Means of COVID-19 Incidence Among People Experiencing Sheltered Homelessness (PESH) and the Community: Chicago, IL, March 1, 2020–May 11, 2023 ^aThe community comprised the 2019 citywide population estimate of 2 693 959 according to the American Communities Survey. ^bPESH comprised 2579 total cases according to the Illinois National Electronic Disease Surveillance System Address Match.

FIGURE 2—

Percent of Population That Had Received at Least 1 Dose of a COVID-19 Vaccine or Were Fully Vaccinated Among People Experiencing Sheltered Homelessness (PESH) and the Community: Chicago, IL, March 1, 2020–May 11, 2023 ^aPESH comprised a mean population estimate of 2433 sheltered individuals aged 18 years and older, averaged from the 2020–2023 point-in-time count. ^bThe community comprised the 2019 citywide aged 18 years and older population estimate of 2 138 535 according to the American Communities Survey.