Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston

Baggett, Travis P.; Keyes, Heather Anne; Sporn, Nora; Gaeta, Jessie M.

doi:10.1001/jama.2020.6887

Cited by 320 publications

(385 citation statements)

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“…In a homeless shelter in Boston, all residents were offered viral testing following identification of symptomatic cases, and 147 (36%) of 408 were positive. 2 Similar mass screening was done in shelters in Seattle, San Francisco, and Atlanta, 1 , 31 with high prevalence in shelters that reported cases before screening. Many cases were asymptomatic, leading to recommendations for universal testing in homeless settings to inform outbreak control.…”

Section: Discussionmentioning

confidence: 97%

“…Outbreaks of COVID-19 have been documented in shelters in the USA. 1 , 2 Similarly, during historic pandemic influenza seasons, particularly large spikes in hospitalisations have been observed in homeless populations. 3 In addition to risks related to infection, people experiencing homelessness might be at increased risk of severe COVID-19 due to high prevalence of long-term health conditions.…”

Section: Introductionmentioning

confidence: 99%

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COVID-19 among people experiencing homelessness in England: a modelling study

Lewer

Braithwaite

Bullock

et al. 2020

The Lancet Respiratory Medicine

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Background People experiencing homelessness are vulnerable to COVID-19 due to the risk of transmission in shared accommodation and the high prevalence of comorbidities. In England, as in some other countries, preventive policies have been implemented to protect this population. We aimed to estimate the avoided deaths and health-care use among people experiencing homelessness during the so-called first wave of COVID-19 in England—ie, the peak of infections occurring between February and May, 2020—and the potential impact of COVID-19 on this population in the future. Methods We used a discrete-time Markov chain model of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that included compartments for susceptible, exposed, infectious, and removed individuals, to explore the impact of the pandemic on 46 565 individuals experiencing homelessness: 35 817 living in 1065 hostels for homeless people, 3616 sleeping in 143 night shelters, and 7132 sleeping outside. We ran the model under scenarios varying the incidence of infection in the general population and the availability of prevention measures: specialist hotel accommodation, infection control in homeless settings, and mixing with the general population. We divided our scenarios into first wave scenarios (covering Feb 1–May 31, 2020) and future scenarios (covering June 1, 2020–Jan 31, 2021). For each scenario, we ran the model 200 times and reported the median and 95% prediction interval (2·5% and 97·5% quantiles) of the total number of cases, the number of deaths, the number hospital admissions, and the number of intensive care unit (ICU) admissions. Findings Up to May 31, 2020, we calibrated the model to 4% of the homeless population acquiring SARS-CoV-2, and estimated that 24 deaths (95% prediction interval 16–34) occurred. In this first wave of SARS-CoV-2 infections in England, we estimated that the preventive measures imposed might have avoided 21 092 infections (19 777–22 147), 266 deaths (226–301), 1164 hospital admissions (1079–1254), and 338 ICU admissions (305–374) among the homeless population. If preventive measures are continued, we projected a small number of additional cases between June 1, 2020, and Jan 31, 2021, with 1754 infections (1543–1960), 31 deaths (21–45), 122 hospital admissions (100–148), and 35 ICU admissions (23–47) with a second wave in the general population. However, if preventive measures are lifted, outbreaks in homeless settings might lead to larger numbers of infections and deaths, even with low incidence in the general population. In a scenario with no second wave and relaxed measures in homeless settings in England, we projected 12 151 infections (10 718–13 349), 184 deaths (151–217), 733 hospital admissions (635–822), and 213 ICU admissions (178–251) between June 1, 2020, and Jan 31, 2021. Interpretation Outbreaks of SARS-CoV-2 in homeless settings can lead to a high attack rate among people experiencing h...

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

COVID-19 among people experiencing homelessness in England: a modelling study

Lewer

Braithwaite

Bullock

et al. 2020

The Lancet Respiratory Medicine

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“…As shown in PRISMA ow diagram (Fig. 1), among them 16 articles [38,39,[52][53][54][55][56][57][58][59][60][61][62][63][64][65] were included for the quantitative meta-analysis and 99 were excluded after full text review due to the lack of information about incidence of asymptomatic COVID-19 case.…”

Section: Study Selectionmentioning

confidence: 99%

Asymptomatic people with SARS-CoV-2 as unseen carriers of COVID-19: A systematic review and meta-analysis

Syangtan

Bista

Dawadi

et al. 2020

Preprint

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Background The asymptomatic patients with SARS-CoV-2 can act as an unseen carrier for magnifying the transmission of COVID-19. Aims This study was designed to appraise the burden of asymptomatic individuals and estimate their occurrence among different age groups and gender by reviewing the existing published data on asymptomatic people with COVID-19. Methods Three electronic databases: PubMed, Embase and Web of Science (WoS) were used to search studies as per the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the search was limited to English language. The study population of this review includes asymptomatic individuals infected by COVID-19. All original articles which have reported cases of the COVID-19 patients with no symptoms until 31 April 2020 were included in the study. Random effects model was applied to analyze pooled data on the prevalence of symptomless cases among total COVID-19 infected patients and also on different age groups and gender. Results In the meta-analysis of 16 studies, comprising 2,788 COVID-19 infected patients, the pooled prevalence of asymptomatic cases was 48.2% (95% CI, 30%-67%). Among the asymptomatic patients, 55.5% (95% CI, 43.6%-66.8%) were female and 49.6% (95% CI, 20.5%-79.1%) were children. Conclusion About half of the COVID-19 infected patients were asymptomatic cases. Children and females were more apparent to be asymptomatic patient of COVID-19 and could act as unseen carrier of SARS-CoV-2. Symptom based screening only, might fail to identify all SARS-CoV-2 infections escalating the threat of global spread of SARS-CoV-2. Therefore, mass surveillance system tracking asymptomatic cases is a pressing need of public health, paying special attention to female and young children, which could aid in prevention and containment of this unprecedented pandemic.

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“…In Boston, 88% of the COVID-19 positive cases were asymptomatic. (7) In Japan, 30.8% of Japanese citizens evacuated from Wuhan were asymptomatic (8) and 51.7% of COVID-19 cases in the "Diamond Princess" were also asymptomatic. (9) The viral RNA can be detected in the respiratory secretions of asymptomatic patients for no less than 3-5 days.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological characterization of symptomatic and asymptomatic COVID-19 cases and positivity in subsequent RT-PCR tests in the United Arab Emirates

Al‐Rifai

Acuña

Hossany

et al. 2020

Preprint

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Background The COVID-19 RT-PCR confirmed cases could be symptomatic or asymptomatic. In the United Arab Emirates (UAE), the identified COVID-19 RT-PCR confirmed cases are yet to be characterized. In this study, we characterized the first cohort of COVID-19 RT-PCR confirmed cases reported in the Abu Dhabi Emirate, UAE, according to symptomatic state, and identified factors associated with the symptomatic state. Also, the strength of association between the symptomatic state and testing positive in three subsequent RT-PCR testing rounds was examined and quantified. Method We analyzed data collected from the first cohort of the RT-PCR confirmed COVID-19 cases reported to the health authorities in the Abu Dhabi Emirate, UAE between February 28 and April 08, 2020. Self-reported sociodemographic, working status, travel history, and chronic comorbidities of 1,249 COVID-19 cases were analyzed according to symptomatic state (symptomatic and asymptomatic). After the first RT-PCR confirmatory test, the results of three subsequent testing rounds were also analyzed. Results A total of 791 confirmed cases with a mean age of 35.6 years (range: 1-81 years) and information on the symptomatic state were analyzed. Nearly, 56.0% were asymptomatic cases. The most frequent two symptoms were fever (58.0%) and cough (41.0%). The mean age of symptomatic (36.3 year, 12.6SD) was significantly higher than that of asymptomatic cases (34.5 year, 12.7SD). Compared to non-working populations, working in public places (aOR, 1.76, 95% CI: 1.11-2.80), healthcare settings (aOR, 2.09, 95% CI: 1.01-4.31), or in the aviation and tourism sector (aOR, 2.24, 95% CI: 1.14-4.40), were independently associated with the symptomatic state. Reporting at least one chronic comorbidity was also associated with symptomatic cases (aOR, 1.76, 5% CI: 1.03-3.01). Compared to asymptomatic, symptomatic COVID-19 cases had consistent odds of two or more of testing positive to COVID-19 in three subsequent testing rounds. Conclusions A substantial proportion of the diagnosed COVID-19 cases in the Abu Dhabi Emirate was asymptomatic. Quarantine of asymptomatic cases along with prevention measures and raising awareness of populations working in high-risk settings is warranted. Further, follow up research is needed to understand viral clearance and clinical outcomes according to the symptomatic state of the COVID-19 cases.

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Prevalence of SARS-CoV-2 Infection in Residents of a Large Homeless Shelter in Boston

Abstract: This study characterizes the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected on polymerase chain reaction (PCR) screening of a large homeless shelter population in Boston prompted by an outbreak of COVID-19 cases among shelter residents.

Cited by 320 publications

References 0 publications

COVID-19 among people experiencing homelessness in England: a modelling study

COVID-19 among people experiencing homelessness in England: a modelling study

Asymptomatic people with SARS-CoV-2 as unseen carriers of COVID-19: A systematic review and meta-analysis

Epidemiological characterization of symptomatic and asymptomatic COVID-19 cases and positivity in subsequent RT-PCR tests in the United Arab Emirates

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