Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study
May 7, 2021
Chapman LAC, Kushel M, Cox SN, et al.
This study assessed different infection control strategies to slow the spread of COVID-19 among people experiencing homelessness who reside in shelters using a microsimulation model. Health outcomes associated with each strategy were compared using polymerase chain reaction (PCR) survey data from COVID-19 outbreaks in five US homeless shelters across three cities from March 28 to April 10, 2020. The study found that combined strategies such as daily symptom screening, routine PCR testing, and universal masking helped reduce outbreak risk in scenarios with low reproduction numbers and low community incidence. However, outbreak risk increased with increasing community incidence and transmission rate, and no combination of infection control strategies was found likely to prevent outbreaks in shelters with high transmission rates that were unable to maintain basic infection control practices (e.g., social distancing, reduced living density), as well as in cities with high community incidence. These findings suggest that while combining different infection control strategies may help reduce risk, it is necessary to provide non-congregate housing for people experiencing homelessness to prevent COVID-19 outbreaks.
Chapman LAC, Kushel M, Cox SN, et al. Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study. BMC Med 2021; 19: 116.