• Isaac Ghinai, Elizabeth S Davis, Stockton Mayer, Karrie-Ann Toews, Thomas D Huggett, Nyssa Snow-Hill, Omar Perez, Mary K Hayden, Seena Tehrani, A Justine Landi, Stephanie Crane, Elizabeth Bell, Joy-Marie Hermes, Kush Desai, Michelle Godbee, Naman Jhaveri, Brian Borah, Tracy Cable, Sofia Sami, Laura Nozicka, Yi-Shin Chang, Aditi Jagadish, Mark Chee, Brynna Thigpen, Christopher Llerena, Minh Tran, Divya Meher Surabhi, Emilia D Smith, Rosemary G Remus, Roweine Staszcuk, Evelyn Figueroa, Paul Leo, Wayne M Detmer, Evan Lyon, Sarah Carreon, Stacey Hoferka, Kathleen A Ritger, Wilnise Jasmin, Prathima Nagireddy, Jennifer Y Seo, Marielle J Fricchione, Janna L Kerins, Stephanie R Black, Lisa Morrison Butler, Kimberly Howard, Maura McCauley, Todd Fraley, M Allison Arwady, Stephanie Gretsch, Megan Cunningham, Massimo Pacilli, Peter S Ruestow, Emily Mosites, Elizabeth Avery, Joshua Longcoy, Elizabeth B Lynch, and Jennifer E Layden.
• Chicago Department of Public Health, Chicago, Illinois, USA.
• Open Forum Infect Dis. 2020 Nov 1; 7 (11): ofaa477.

BackgroundPeople experiencing homelessness are at increased risk of coronavirus disease 2019 (COVID-19), but little is known about specific risk factors for infection within homeless shelters.MethodsWe performed widespread severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction testing and collected risk factor information at all homeless shelters in Chicago with at least 1 reported case of COVID-19 (n = 21). Multivariable, mixed-effects log-binomial models were built to estimate adjusted prevalence ratios (aPRs) for SARS-CoV-2 infection for both individual- and facility-level risk factors.ResultsDuring March 1 to May 1, 2020, 1717 shelter residents and staff were tested for SARS-CoV-2; 472 (27%) persons tested positive. Prevalence of infection was higher for residents (431 of 1435, 30%) than for staff (41 of 282, 15%) (prevalence ratio = 2.52; 95% confidence interval [CI], 1.78-3.58). The majority of residents with SARS-CoV-2 infection (293 of 406 with available information about symptoms, 72%) reported no symptoms at the time of specimen collection or within the following 2 weeks. Among residents, sharing a room with a large number of people was associated with increased likelihood of infection (aPR for sharing with >20 people compared with single rooms = 1.76; 95% CI, 1.11-2.80), and current smoking was associated with reduced likelihood of infection (aPR = 0.71; 95% CI, 0.60-0.85). At the facility level, a higher proportion of residents leaving and returning each day was associated with increased prevalence (aPR = 1.08; 95% CI, 1.01-1.16), whereas an increase in the number of private bathrooms was associated with reduced prevalence (aPR for 1 additional private bathroom per 100 people = 0.92; 95% CI, 0.87-0.98).ConclusionsWe identified a high prevalence of SARS-CoV-2 infections in homeless shelters. Reducing the number of residents sharing dormitories might reduce the likelihood of SARS-CoV-2 infection. When community transmission is high, limiting movement of persons experiencing homelessness into and out of shelters might also be beneficial.© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

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