Abstract
BackgroundSubgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates.MethodsA total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms.ResultsWe found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic.ConclusionThis study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.
Highlights
Like all crises, the coronavirus outbreak is escalating already existing social inequalities
SARSCoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates
We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARSCoV-2 positivity (20–30% in two shelters)
Summary
The coronavirus outbreak is escalating already existing social inequalities. Precarious populations accumulate health risks, namely lower life expectancy, more frequent co-morbidities and a more fragile mental health [1]. They are more exposed to stress, to precarious work, and more frequently live in unsanitary and overcrowded conditions. Subgroups of precarious populations, such as homeless people, are vulnerable They are more exposed to infections and at higher risk of developing severe forms of COVID-19, compared to the general population [2]. Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. The objective of the study was to describe SARSCoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates
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