Prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic

Linh Luong,Michaela Beder,Joe Hester,Stephen W Hwang,Harvey Manning,Cynthia Damba,Cindy Bruce-Barrett,Ryan Emond,Victoria Williams,Yick Kan Cheung,Vanessa Wright,Mona Loutfy,Rosane Nisenbaum,Wilfred Cheung,Suvendrini Lena,Jonathan Wong,Andrew Boozary,Miriam Vanmeurs,Aaron Orkin

doi:10.17269/s41997-021-00591-8

Abstract

ObjectivesPeople experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates.MethodsThe study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17–April 25; T2: April 26–May 23; T3: May 24–June 25).ResultsThe overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06–0.75) during T2 and 0.14 times lower (95% CI: 0.04–0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding.ConclusionDuring the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks, and/or individual site characteristics.

Highlights

The COVID-19 pandemic has disproportionately impacted and continued to pose extraordinary challenges for people experiencing homelessness (Perri et al, 2020; Turnbull et al, 2021), especially those from Indigenous and racialized communities
This study provides insights into SARS-CoV-2 infection rates and shelter-level factors associated with positivity rates in the homeless population in Toronto
Our study found a high prevalence of SARS-CoV-2 infection among people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic

Summary

Introduction

The COVID-19 pandemic has disproportionately impacted and continued to pose extraordinary challenges for people experiencing homelessness (Perri et al, 2020; Turnbull et al, 2021), especially those from Indigenous and racialized communities. People experiencing homelessness who identified as Indigenous are overrepresented in the outdoor homeless populations (36%). There is a great contrast between outdoor and indoor homeless populations, with men experiencing homelessness more likely to be sleeping outdoors (73%) compared to women (City of Toronto, 2018). The majority of individuals staying at single adults (67%) and 24-hour respite sites (59%) are male, whereas women are overrepresented in family shelters (75%). A total of 29% of people experiencing homelessness reported living both outdoors and in shelters in 2018 (City of Toronto, 2018). There is an increasing number of refugees and asylum claimants (40%) in the Toronto shelter system in 2018 compared to previous years, and 80% of those living in the family shelters identified themselves as refugees/asylum claimants (City of Toronto, 2018)

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