We read with interest the article by Self et al.1 that assessed the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), along with shelter characteristics and prevention practices, in 63 homeless shelters in seven US urban areas. The authors reported an infection prevalence of 2.9%; furthermore, they highlighted the importance of adequate sleeping arrangements and staffing policies in reducing virus spread and the fact that shelters with medical services were less likely to have a high prevalence of infection.1
The topic discussed in this article is notable, and the prevalence rate and the suggested control measures reported by the authors are in line with available evidence.2–4 However, the reported prevalence may significantly vary when the focus is not only on homeless individuals being hosted in shelters but also on the fraction of them living in the streets.
In our experience of homeless individuals regardless of their living arrangements, we have found a slightly higher infection prevalence. Since the beginning of the pandemic, we have evaluated SARS-CoV-2 prevalence in the homeless population in downtown Rome, Italy, through the primary care services of the Eleemosynaria Apostolica of the Vatican City, Holy See. As of March 2021, we had evaluated 1411 homeless individuals (1029 males and 382 females) using antigen (940 tests) and reverse transcriptase–polymerase chain reaction (617 tests) tests. Individuals’ average age was 62 years, and they came from 96 different countries. A total of 1350 patients tested negative and 61 tested positive; the positivity rate was 4.32% (Figure 1).
FIGURE 1—
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Testing (a) Types and Number Performed and (b) Results: Rome, Italy, 2021
Note. RT PCR = reverse transcriptase–polymerase chain reaction.
Our higher prevalence rate might be explained by the different homeless sample, one that also included unsheltered people. Whereas prevention and control measures such as use of hygiene protocols, adequate distancing and sleeping arrangements, daily symptom screening, and routine testing for SARS-CoV-2 were routinely applied in homeless shelters, they could not be guaranteed for individuals living on the street.
Because homeless shelters often have rapid resident turnover, sometimes from uncontrolled settings, it is of utmost importance to pay special attention to new admissions.5 This is highlighted by the fact that significant numbers of COVID-19 patients are asymptomatic and could cause infection outbreaks.6 Therefore, to identify and isolate positive cases, it is important to perform careful surveillance with rapid antigen and polymerase chain reaction nasopharyngeal tests for SARS-CoV-2 among current and, especially, new admissions to homeless shelters in addition to applying the suggested control measures.
ACKNOWLEDGMENTS
We thank His Holiness Pope Francis for providing direction, structures, and equipment to make health care available for vulnerable populations through the Offices of Papal Charities (Eleemosynaria Apostolica) and Cardinal Konrad Krajewski, Apostolic Almoner, for extraordinary efforts in the realization of this mission.
CONFLICTS OF INTEREST
The authors report no conflicts of interest.
REFERENCES
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