key: cord-0942934-75zcqrss
authors: HUSAIN, Maya; RACHLINE, Anne; COUSIEN, Anthony; ROLLAND, Simon; ROUZAUD, Claire; Marie FERRE, Valentine; GOMEZ, Maria VARGAS.; TEURNIER, Maï LE.; WICKY-THISSE, Marie; DESCAMPS, Diane; YAZDANPANAH, Yazdan; CHARPENTIER, Charlotte; PASQUET-CADRE, Armelle
title: Impact of the COVID-19 pandemic on the homeless: results from a retrospective closed cohort in France (March-May 2020)
date: 2021-06-07
journal: Clin Microbiol Infect
DOI: 10.1016/j.cmi.2021.05.039
sha: 8d709687641179c7d388fde27fedebd4b4930931
doc_id: 942934
cord_uid: 75zcqrss

OBJECTIVES: To evaluate SARS-CoV-2 infection attack, hospitalization and fatality rates in residents of homeless shelters run by Samusocial of Paris. METHODS: We conducted a retrospective serological study on all residents and staff members of three homeless shelters run by Samusocial of Paris, between July and August 2020: 2 centres providing healthcare accommodation (HCA) and one women’s dormitory. We included all adults present in the shelters or who died of a proven SARS-CoV-2 infection during the first wave (March-May). SARS-CoV-2 antibodies were detected in serum samples using the SARS-CoV-2 IgG Architect (Abbott) test. Any participant with a positive PCR or serology was defined as a confirmed SARS-CoV-2 case. RESULTS: We included 100 residents and 83 staff members. The confirmed SARS-CoV-2 rate by PCR or serology was 72/100 (72.0%) for residents and 17/83 (20.5%) for staff members. Women accommodated in the dormitory had the highest infection attack rate (90.6%). Hospitalization rate in residents was 17/72 (23.6%) and the death rate 4/72 (5.6%). All hospitalizations and deaths occurred among HCA residents. 34/68 (50%) of the residents of HCA shelters presented at least two comorbidity factors associated with being at high risk for severe SARS-CoV-2 infection. CONCLUSION: SARS-CoV-2 infection rate was high in residents of these homeless shelters (10.6% seroprevalence in the Île-de-France region during the first wave). Severe SARS-CoV-2 infection was highly associated with the prevalence of comorbidities. This population should be considered as a priority in vaccination campaigns and in access to individual housing units when at risk.

severe SARS-CoV-2 infection. France on 24 January 2020 (1) . After a rapid spread, a national lockdown was implemented in 62 France on 17 March 2020. 63 Homeless populations are particularly vulnerable to health issues and experience higher rates 64 of illness and death compared with the general population, with a 17.5-to 30-year reduction in life expectancy (2). Despite their high vulnerability, homeless people have been neglected 66 by research during the current SARS-CoV-2 pandemic. Some studies show a high prevalence 67 of SARS-CoV-2 infection among the homeless (3)(4) whose comorbidities (5) put them at 68 high risk for severe SARS-CoV-2 infection (6). 69 We conducted a study in three homeless shelters to estimate the SARS-CoV-2 infection 70 attack rate (IAR) and studied hospitalization and mortality rates among residents and staff 71 members. Table 1 120 Infection attack rates among residents and staff members 121 The overall IAR was 72.0% (n=72, 95% CI=62.0-80.3) including 29/97 (29.9%) positive 122 PCR tests and 67/96 (69.8%) positive serologies. IAR was higher in the dormitory centre 123 compared to HCA (90.6% and 63.2%, respectively; p=0.0042) ( Table 1) (4) . Moreover, in our study, staff members had an IAR of 20.5%, which 149 is consistent with the range of 4% to 45% reported in another study in this population (8).

Our study is consistent with previous studies showing that homeless populations are at high 151 risk for severe infection and death (5). The hospitalization rate was 23.6% and the infection 152 fatality rate 5.6%, which is notably higher than in general population in France (3.6% and 153 0.7%, respectively)(9) or in other developed countries (10). A study found that the estimated 154 hospitalization incidence for SARS-CoV-2 was three times higher in homeless populations 155 than in the general population (11).

Our study has several limitations. First, the participation rate was low (70%), as we lost over 157 30% of the initial population, which thus limits the interpretation of the findings. Second, we 158 lacked statistical power to perform multivariate analysis due to the small sample size and 159 heterogeneity of the groups. Finally, we were likely to miss infections since: (i) PCR tests 

Clinical and virological data of the first cases of COVID-19 in Europe: a case 208 series

Mortality 210 among the homeless: Causes and meteorological relationships

Outbreak in a San Francisco Homeless Shelter. Clin 214 Infect Dis

Seroprevalence and risk factors of exposure 218 to COVID-19 in homeless people

The health of homeless people in high-income 221 countries: descriptive epidemiology, health consequences, and clinical and 222 policy recommendations

Excluded residents: -5 under guardianship -14 refusals -15 unreachable -1 death unrelated to SARS-CoV-2 -2 hospitalized Excluded staff members: -4 refusals -10 absent Population studied: residents and staff members who gave consent for the serology study 2 and those who died of proven SARS-CoV-2 during the period of interest

SARS-CoV-2 rate: 17 (20.5%) Hospitalization rate: 0 (0%) Death rate: 0 (0%) Included residents

SARS-CoV-2 rate: 72 (72%) Hospitalization rate: 17 (23.6%) Death rate: 4 (5.6%) Included staff members

Flow chart Exclusion of residents and staff members who refused participation, who could not give consent to the study 1 and residents that died of a cause unrelated to SARS-CoV-2 infection Inclusion period: 22