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01-12-2021 | SARS-CoV-2 | Research article

Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

Authors: Lloyd A. C. Chapman, Margot Kushel, Sarah N. Cox, Ashley Scarborough, Caroline Cawley, Trang Q. Nguyen, Isabel Rodriguez-Barraquer, Bryan Greenhouse, Elizabeth Imbert, Nathan C. Lo

Published in: BMC Medicine | Issue 1/2021

Abstract

Background

COVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.

Methods

We developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing.

Results

The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R₀) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R₀ = 1.5), moderate-risk (R₀ = 2.9), and high-risk (R₀ = 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R₀) within the simulated shelter and increasing incidence in the local community.

Conclusions

In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.

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Title: Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study
Authors: Lloyd A. C. Chapman
Margot Kushel
Sarah N. Cox
Ashley Scarborough
Caroline Cawley
Trang Q. Nguyen
Isabel Rodriguez-Barraquer
Bryan Greenhouse
Elizabeth Imbert
Nathan C. Lo
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: SARS-CoV-2
COVID-19
Polymerase Chain Reaction
Published in: BMC Medicine / Issue 1/2021
Electronic ISSN: 1741-7015
DOI: https://doi.org/10.1186/s12916-021-01965-y

At a glance: The STEP trials

Springer Medicine

Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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