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

Educational Objective
To understand the vulnerability of homeless shelters to COVID-19
1 Credit CME

In the United States, 567 715 people were homeless on a single night in January 2019.1 The congregate nature and hygienic challenges of shelter life create the potential for rapid transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this vulnerable population.

On March 13, 2020, the Boston Health Care for the Homeless Program (BHCHP), in partnership with city and state public health agencies and community partners, rolled out a coronavirus disease 2019 (COVID-19) response strategy that included respiratory symptom screening at shelter front doors, expedited referrals for SARS-CoV-2 testing and isolation for those with respiratory symptoms, dedicated treatment settings for individuals with positive test results, and contact tracing of confirmed COVID-19 cases.

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Article Information

Corresponding Author: Travis P. Baggett, MD, MPH, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA 02114 (tbaggett@mgh.harvard.edu).

Published Online: April 27, 2020. doi:10.1001/jama.2020.6887

Conflict of Interest Disclosures: Dr Baggett reported receiving royalties from UpToDate for authorship of a topic review on homeless health care. Mr Keyes reported receiving nonfinancial support from the Massachusetts Department of Public Health and the shelter where the testing was conducted during the conduct of the study. No other disclosures were reported.

Previous Posting: This manuscript was posted as a preprint on medRxiv.org on April 15, 2020. doi:10.1101/2020.04.12.20059618

Additional Contributions: We thank Alfred DeMaria, MD, and colleagues at the Massachusetts Department of Public Health Bureau of Infectious Disease for facilitating the testing described in this article. We thank Joana Barbosa Teixeira, MA; Andrea Joyce, MA; Elijah Rodriguez, BA; Erin Ford, BA (Massachusetts General Hospital); and Alexei Alvarado, BA (Boston Health Care for the Homeless Program), for their assistance with data entry. None of these individuals were compensated for their contributions.

References
1.
Henry  M , Watt  R , Mahathey  A , Ouellette  J , Sitler  A . The 2019 Annual Homeless Assessment Report (AHAR) to Congress. Part 1: Point-in-Time Estimates of Homelessness. US Department of Housing and Urban Development; 2020.
2.
Interim guidance for homeless service providers to plan and respond to coronavirus disease 2019 (COVID-19). Centers for Disease Control and Prevention. Accessed April 2, 2020. https://www.cdc.gov/coronavirus/2019-ncov/community/homeless-shelters/plan-prepare-respond.html
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