Abstract
BackgroundOvercrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in Marseille, France, taking into account different types of accommodation.MethodsA consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to have a validated rapid antibody assay for immunoglobulins M (IgM) and G (IgG) and to answer a questionnaire on medical health conditions, comorbidities, and previous COVID-19 symptoms. Information on their housing conditions since the COVID-19 crisis was also collected from the participants.ResultsFrom June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. The overall seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3–7.0), ranging from 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P = 0.009). Around one third of the seropositive participants reported COVID-19 symptoms. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced a significantly increased risk of SARS-CoV-2 infection (|z| = 3.65 > 1.96).ConclusionThese findings highlight the need for regular screening among the homeless to prevent clustering in overcrowded or inadequate accommodations. It is also necessary to provide essential resources to keep homeless people healthy, the vast majority of whom have cumulative risk factors for SARS-CoV-2 infection.
Highlights
In 2016, nearly 5.3 million individuals (i.e., 2% of the population) had been without shelter, or in emergency or temporary accommodation at least once in their lifetime across Europe [1]
Seroprevalence of SARS-CoV-2 antibodies among homeless people in France living as well as full housing trajectory and comorbidities
Homeless people should be vulnerable to SARS-CoV-2 infection: on the one hand, they cumulate risk factors for SARS-CoV-2 contamination, such as living in overcrowded or inadequate accommodation, or having frequent contact with people through community aid services; on the other hand, they are at increased risk for severe SARS-CoV-2 disease, being exposed to a high prevalence of comorbidities, respiratory and heart diseases, in addition to an ageing issue [8,9,10,11]
Summary
In 2016, nearly 5.3 million individuals (i.e., 2% of the population) had been without shelter, or in emergency or temporary accommodation at least once in their lifetime across Europe [1] This surpassed previous estimates by far, which ranged from 0.1% to 0.3% across European countries [2, 3]. Previous literature has pointed out the challenge of providing care for the homeless during the SARS-CoV-2 pandemic [9] and reported explorations of SARS-CoV-2 prevalence using virological tests in one, three or five shelters [12,13,14], in U.S settings Such explorations provided interesting clues on the environmental factors favouring the spread of SARS-CoV-2 transmission, such as moves between homeless accommodations, overcrowded and congregate settings, where physical distancing was challenging. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in Marseille, France, taking into account different types of accommodation
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