Background People experiencing homelessness are at increased risk of COVID-19, but little is known about specific risk factors for infection within homeless shelters. Methods We performed widespread SARS-CoV-2 PCR testing and collected risk factor information at all homeless shelters in Chicago with at least one 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 (431/1435, 30%) than for staff (41/282, 15%) (prevalence ratio [PR] =2.52, 95% CI 1.78–3.58). The majority of residents with SARS-CoV-2 infection (293/406 with available information about symptoms, 72%) reported no symptoms at the time of specimen collection or within the following two 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 to 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), while an increase in the number of private bathrooms was associated with reduced prevalence (aPR for one 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.

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Chronic liver disease is the 11th leading cause of mortality in the United States. 1 Portal hypertension is a common endpoint for progressive liver disease, and can clinically manifest as refractory ascites, splenomegaly, and life-threatening esophageal and gastric variceal bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) is an endovascular procedure that treats portal hypertension by making a connection between the portal and systemic venous systems. By creating a low-resistance outflow tract for portal venous drainage, TIPS decreases portal hypertension and its dangerous sequelae in patients not responding to medical therapy.Creation of transjugular intrahepatic portosystemic shunt (TIPS) dates to the 1960s, when Josef Rosch, a successful

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