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Source/Disclosures
Disclosures: Baggett reports receiving personal fees from UpToDate outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
January 11, 2021
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Daily screenings, alternative care sites could lower SARS-CoV-2 rates in homeless shelters

Source/Disclosures
Disclosures: Baggett reports receiving personal fees from UpToDate outside the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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Daily symptom screenings and the use of nonhospital alternative care sites could lower SARS-CoV-2 rates and costs among adults in homeless shelters, according to the results of a modeling study published in JAMA Network Open.

“The crowded circumstances of homeless shelters place this population at increased risk of contracting COVID-19,” Travis P. Baggett, MD, MPH, assistant professor of medicine at Harvard Medical School and staff physician at the Boston Health Care for the Homeless Program, and colleagues wrote. “The high burden of COVID-19 among sheltered homeless populations highlights an urgent need to understand the clinical outcomes and costs of CDC-recommended and other prevention and treatment strategies.”

Baggett and colleagues used a decision analytic model to simulate a group of 2,258 adults living in homeless shelters throughout Boston. They adapted cohort characteristics and costs from the Boston Health Care Homeless Program and acquired disease progression transmission and outcomes data from national databases and published literature.

In comparison to no interventions, daily symptom screenings with alternative care sites — such as large tents or nonhospital facilities — for confirmed COVID-19 or pending tests was associated with a 37% decrease in infections (1,954 vs. 1,239) and 46% lower costs ($6.1 million vs. $3.27 million), the researchers reported.

PCR testing every 2 weeks was associated with a more substantial drop in infection. Temporary housing with a PCR test every 2 weeks was found to be the most effective method but was significantly more expensive than the other interventions, according to the study.

“This analysis does not account for other potential benefits of temporary housing on physical or mental health,” the researchers wrote. “Ultimately, broader policies around supportive housing measures for people experiencing homelessness should account for more than COVID-19 mitigation, recognizing that the COVID-19 pandemic is among many health risks of homelessness.”