Background
The COVID-19 pandemic has revealed major inequities in communities around the world as vulnerable populations have been disproportionately impacted. Among those most vulnerable are people experiencing homelessness (PEH). The risk of COVID-19 infection increases among PEH given the higher prevalence of co-existing medical conditions and their lack of safe and adequate housing. A recent study highlighted that the spread of COVID-19 happens more quickly and goes undetected in shelter populations as they have less access to health care and social services.
To better understand the impacts of COVID-19 among people experiencing homelessness, researchers at the Canadian Observatory on Homelessness (COH) conducted a literature review exploring the spread of COVID-19 in homeless shelters and hostels as well as the infection, prevention, and control practices in these settings. Specifically, we aimed to answer the following two research questions using a scoping review:
- What is known about COVID-19 positivity rates among residents of homeless shelters/hostels and the staff serving this population?
- What infection, prevention, and control (IPAC) measures have been implemented by, or recommended for, homeless shelters/hostels to prevent and mitigate COVID-19 outbreaks?
The results of this scoping review were published in Systematic Reviews, an open-access journal.
Methods
Between June and August 2021, COH researchers searched through academic and grey literature databases. This included MEDLINE, PsycInfo, the World Health Organization’s COVID-19 Global Health Portal, Google Scholar, United Nations Database, OpenGrey, and the Dahdaleh COVID-19 portal. Literature that specifically examined the prevalence of COVID-19 among populations experiencing sheltered homelessness (in shelters and hostels) from high-income countries was included in the review. We also included infection, prevention, and control measures within shelters/hostels in high-income countries in this review.
Results
In total, this review included 77 documents (37 academic and 40 grey literature) from seven high-income countries. A small number (7.8%) of these documents were multi-country which we defined as including information for multiple high-income countries. These documents were published between March 2020 and July 2021. The majority (53.2%) of the literature is from the United States followed by Canada (24.7%), France (5.2%), the United Kingdom (3.9%), Italy (2.6%), Germany (1.3%), and Belgium (1.3%).
Four key themes were identified across the documents in this review which included the following:
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Profiling COVID‑19 in homeless shelters. A profile of sub-populations that were overrepresented among the shelter residents testing positive was identified. These sub-populations included, adults aged 40, and older, males, and People of Colour.
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Asymptomatic spread. Asymptomatic carriers of the COVID-19 virus were commonly identified among shelter residents and staff testing positive in 2020 and 2021.
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Pre‑existing vulnerability of people experiencing homelessness and staying in shelters. People experiencing homelessness have existing vulnerabilities that increase their risk of contracting COVID-19 including:
- Pre-existing health conditions
- Barriers to healthcare
- Overcrowding in shelter settings
- Limited access to protective resources (e.g., personal protective equipment).
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Inconsistency and effectiveness of IPAC implementation. Infection, prevention, and control strategies were inconsistent across documents and geographic areas. While it is assumed that a combination of IPAC strategies would be the most effective application of IPAC in shelter settings, additional research is required to prove this theory.
Implications
The findings from this scoping review support existing calls for transformations to the shelter systems in high-income countries. These transformations need to include the expansion of shelter spaces, and upgrades to heating, ventilation, and air conditioning systems to prevent the spread of COVID-19 and other airborne illnesses in these spaces. Similarly, IPAC plans and strategies that consider the unique contexts and populations served in homeless shelters/hostels are needed. Without major transformations within shelter systems people experiencing homelessness, and certain groups of people experiencing homelessness (i.e., males, People of Colour, and older adults) that are more impacted by COVID-19 than others, will continue to feel the disproportionate effects of this unprecedented health crisis.
This review also emphasizes that the best response for preventing people experiencing homelessness from contracting COVID-19 in homeless shelters is homelessness prevention. By shifting toward homelessness prevention to solve the crisis of homelessness and eliminating entry into the shelter system, the spread of air-borne illnesses like COVID-19 in these settings can be reduced. To learn more about homelessness prevention check out this resource: