Using Geocoding to Identify COVID-19 Outbreaks in Congregate Residential Settings: San Francisco’s Outbreak Response in Single-Room Occupancy Hotels

Abstract

More than 500 single-room occupancy hotels (SROs), a type of low-cost congregate housing with shared bathrooms and kitchens, are available in San Francisco. SRO residents include essential workers, people with disabilities, and multigenerational immigrant families. In March 2020, with increasing concerns about the potential for rapid transmission of COVID-19 among a population with disproportionate rates of comorbidity, poor access to care, and inability to self-isolate, the San Francisco Department of Public Health formed an SRO outbreak response team to identify and contain COVID-19 clusters in this congregate residential setting. Using address-matching geocoding, the team conducted active surveillance to identify new cases and outbreaks of COVID-19 at SROs. An outbreak was defined as 3 separate households in the SRO with a positive test result for COVID-19. From March 2020 through February 2021, the SRO outbreak response team conducted on-site mass testing of all residents at 52 SROs with outbreaks identified through geocoding. The rate of positive COVID-19 tests was significantly higher at SROs with outbreaks than at SROs without outbreaks (12.7% vs 6.4%; P < .001). From March through May 2020, the rate of COVID-19 cases among SRO residents was higher than among residents of other settings (ie, non–SRO residents), before decreasing and remaining at an equal level to non–SRO residents during later periods of 2020. The annual case fatality rate for SRO residents and non–SRO residents was similar (1.8% vs 1.5%). This approach identified outbreaks in a setting at high risk of COVID-19 and facilitated rapid deployment of resources. The geocoding surveillance approach could be used for other diseases and in any setting for which a list of addresses is available.

San Francisco’s Citywide COVID-19 Response: Strategies to Reduce COVID-19 Severity and Health Disparities, March 2020 Through May 2022

“…10,11 SFDPH also used address-matched geocoding to rapidly detect new COVID-19 cases in SNFs and other congregate housing settings with shared spaces, which triggered response testing events. 12 By May 2022, SNF residents composed 1% of all COVID-19 cases and 18% of all COVID-19–related deaths in San Francisco.…”

“…10,11 SFDPH also used address-matched geocoding to rapidly detect new COVID-19 cases in SNFs and other congregate housing settings with shared spaces, which triggered response testing events. 12 By May 2022, SNF residents composed 1% of all COVID-19 cases and 18% of all COVID-19-related deaths in San Francisco. Following a COVID-19 outbreak of more than 100 people in a homeless shelter in April 2020, shelter occupancy was reduced to a capacity level of 30% to 40%, beds were spaced >6-feet apart, and people with COVID-19 comorbidities were transferred to hotels.…”