Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study

Autor: Margot Kushel, Trang Huyen Nguyen, Caroline Cawley, Ashley Scarborough, Elizabeth Imbert, Bryan Greenhouse, Nathan Lo, Isabel Rodriguez-Barraquer, Lloyd A. C. Chapman, Sarah N. Cox
Rok vydání: 2020
Předmět:
0301 basic medicine
Cross-sectional study
Psychological intervention
Medical and Health Sciences
law.invention
Disease Outbreaks
0302 clinical medicine
law
Epidemiology
Infection control
Mass Screening
030212 general & internal medicine
screening and diagnosis
Transmission (medicine)
Incidence (epidemiology)
Homeless Persons
Homelessness
General Medicine
Detection
Infectious Diseases
Geography
Transmission (mechanics)
COVID-19 Nucleic Acid Testing
Ill-Housed Persons
Medicine
Infection
Research Article
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
03 medical and health sciences
General & Internal Medicine
Environmental health
medicine
Humans
Computer Simulation
Cities
Symptom-based screening
Infection Control
business.industry
SARS-CoV-2
Prevention
Outbreaks
Outbreak
COVID-19
PCR testing
Universal masking
Shelters
United States
4.1 Discovery and preclinical testing of markers and technologies
Local community
030104 developmental biology
Emerging Infectious Diseases
Good Health and Well Being
Cross-Sectional Studies
Housing
business
Basic reproduction number
Zdroj: BMC Medicine
BMC medicine, vol 19, iss 1
BMC Medicine, Vol 19, Iss 1, Pp 1-13 (2021)
ISSN: 1741-7015
Popis: BackgroundCOVID-19 outbreaks have occurred in homeless shelters across the US, highlighting an urgent need to identify the most effective infection control strategy to prevent future outbreaks.MethodsWe developed a microsimulation model of SARS-CoV-2 transmission in a homeless shelter and calibrated it to data from cross-sectional polymerase chain reaction (PCR) surveys conducted during COVID-19 outbreaks in five homeless shelters in three US cities from March 28 to April 10, 2020. We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30 days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing.ResultsThe proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (R0) estimates of 2.9–6.2. With moderate community incidence (~ 30 confirmed cases/1,000,000 people/day), the estimated probabilities of averting an outbreak in a low-risk (R0= 1.5), moderate-risk (R0= 2.9), and high-risk (R0= 6.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (R0) within the simulated shelter and increasing incidence in the local community.ConclusionsIn high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.
Databáze: OpenAIRE
Externí odkaz: