population level study of SARS-CoV-2 prevalence amongst people experiencing homelessness in Wales, UK

Abstract

IntroductionPrior research into the prevalence of SARS-CoV-2 infection amongst people experiencing homelessness (PEH) largely relates to people in communal forms of temporary accommodation in contexts where this type of accommodation remained a major part of the response to homelessness during the COVID-19 pandemic. Little is known about the prevalence of SARS-CoV-2 amongst PEH more broadly, and in a policy and practice context that favoured self-contained accommodation, such as Wales, UK. ObjectiveDescribe the prevalence of SARS-CoV-2 amongst PEH in Wales, UK, using routinely collected administrative data from the Secure Anonymised Information Linkage Databank. MethodsRoutinely collected data were used to identify PEH in Wales between 1st March 2020 and 1st March 2021. Using SARS-CoV-2 pathology testing data, prevalence rates were generated for PEH and three comparator groups: (1) the not-homeless population; (2) a cohort `exact matched' for age, sex, local authority and area deprivation; and (3) a matched comparison group created using these same variables and Propensity Score Matching (PSM). Three logistic regressions were run on samples containing each of the comparator groups to explore the effect of experiencing homelessness on testing positive for SARS-CoV-2. ResultsThe prevalence of SARS-CoV-2 infection amongst PEH was 5.0%, compared to the not-homeless population at 5.6%. For the exact matched and PSM match comparator groups, prevalence was 6.9% and 6.7%, respectively. Logistic regression found that SARS-CoV-2 infection was 0.9 times less likely amongst PEH compared to people not experiencing homelessness from the general population. The odds of SARS-CoV-2 infection for PEH was 0.75 and 0.73 where the `not-homeless' comparators were from the exact match and PSM samples, respectively. ConclusionOur analysis revealed that a year into the COVID-19 pandemic, the prevalence of SARS-CoV-2 amongst PEH in Wales was lower than the general population. A policy response to homelessness that moved away from communal accommodation may be partly responsible for the reduced SAR-CoV-2 infection amongst PEH.

Low prevalence of current and past SARS-CoV-2 infections among visitors and staff members of homelessness services in Amsterdam at the end of the second wave of infections in the Netherlands

“…Our results are in line with a population level study from Wales, UK showing lower PCR positivity among PEH as compared to the general population (9). The authors explain this nding by a proactive policy response directing local authorities on sourcing additional temporary accommodation for PEH, including, for instance, hotels and bed and breakfasts accommodation and adapted night-shelters, a situation comparable to the Netherlands.…”

“…A study conducted across nine Dutch cities during the rst wave reported a SARS-CoV-2 PCR positivity rate of 17% among PEH with COVID-related symptoms or who had a close contact with individuals with COVID-19 and visited the 'street doctors' (7), which was higher than the rate found among the general population during that period (8). In contrast, a population-based study from Wales, United Kingdom (UK) using routinely collected administrative data found that the SARS-CoV-2 PCR positivity rate among PEH was comparable to that of the general population (5.0% versus 5.6% between March 2020 and March 2021) (9). The authors suggest that this low percentage may have been due to the policy pandemic response for PEH, moving away from communal accommodation to offering PEH private rooms to reduce the risk of SARS-CoV-2 transmission(9).…”

“…In the Netherlands, no major outbreaks among visitors attending homelessness services had been identi ed since the start of the pandemic until December 2021, contrary to the situation in the US. It might be that the extra strategies set in place to control COVID-19 among PEH during the lockdown periods, such as those implemented in the UK (9), resulted in limited transmission. Dutch municipalities provided emergency accommodations with more space for all PEH, irrespective of insurance and legal status, to be able to accommodate people who were unable to follow the "stay-home" measure (10).…”

Ku-gaa-gii pimitizi-win, the COVID-19 cohort study of people experiencing homelessness in Toronto, Canada: a study protocol

“…Specific settings, including emergency shelters and those with overcrowding or communal sleeping arrangements, are associated with increased risk of infection, presumably due to greater exposure during outbreaks compared with PEH living outdoors or in private and/or well distanced accommodations 15–18 24–27. In Wales, where PEH were comprehensively housed in private settings during the pandemic, COVID-19 prevalence was lower than in the general population 30. Similarly, shelters implementing physical distancing practices have been shown to have lower infection rates 15.…”

“… 15–18 24–27 In Wales, where PEH were comprehensively housed in private settings during the pandemic, COVID-19 prevalence was lower than in the general population. 30 Similarly, shelters implementing physical distancing practices have been shown to have lower infection rates. 15 Evidence for other individual-level or shelter-level factors associated with COVID-19 infection remains to be established, and effectiveness of most interventions remain to be evaluated.…”