ABSTRACT
Most vulnerable individuals are particularly affected by the COVID-19 pandemic. This study takes place in a large city in France. The aim of this study is to describe the mobility of the homeless population at the begin-ning of the health crisis and to analyze its impact in terms of COVID-19 prevalence. From June to August 2020 and September to December 2020, 1272 homeless people were invited to be tested for SARS-CoV-2 antibodies and virus in and completed questionnaires. Our data show that homeless populations are sociologically dif-ferent depending on where they live. We show that people living on the street were most likely to be relocated to emergency shelters than other inhabitants. Some neighborhoods are points of attraction for homeless peo-ple in the city while others emptied during the health crisis, which had consequences for virus circulation. People with a greater number of different dwellings reported became more infected. This first study of the mo-bility and epidemiology of homeless people in time of pandemic provides unique information about mobility mapping, sociological factors of this mobility, mobility at different scales and epidemiological consequences. We suggest that homeless policies need to be radically transformed since actual model exposes people to infection in emergency.
Subject(s)
COVID-19ABSTRACT
Background: Studies showed high prevalence of SARs-CoV-2 among homeless people in shelters, but no longitudinal studies confirmed these findings, put them into perspective, or considered homeless populations beyond shelters. Methods: All homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible. There were two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face surveys. The primary outcome was the occurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank test were performed to evaluate risk factors associated with seroconversion. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population.Findings: A total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% [4.7-7.3] during the first session to 18.9% [16.0-21.7] during the second one, compared to 3.0% [1.9-4.2] and 6.5% [4.5-8.7] in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 [1.18 – 3.15]), being an isolated parent (1.64 [1.07-2.52]) and having contact with more than 5-15 people per day (1.84 [1.27 – 2.67]). By contrast, smoking (0.46 (0.32 – 0.65)), having financial resources (0.70 (0.51 – 0.97)) and psychiatric or addictive comorbidities (0.52 (0.32 – 0.85)) were associated with a lower risk.Interpretation: We confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters.Funding Information: French Directorate of Health care facilities (DGOS) – research grant PHRC COVID-19 (COVID-homeless 0047)Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: All participants provided a written informed consent. The COVIDHomeless study was designed and carried out in compliance with the Declaration of Helsinki and with legal and regulatory provisions. It was approved by the ethics committee on May 28, 2020 (CPP IDF VI - number 44-20; ID: 2020-AO1398-31). The database was anonymized and declared to the French data protection commission (Commission Nationale de l’Informatique et des Libertés, CNIL, n°2018172v0).
Subject(s)
COVID-19ABSTRACT
Background: Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in France, taking into account different community settings. Methods: A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to receive a validated rapid assay for immunoglobulins M (IgM) and G (IgG) antibodies and to answer a questionnaire on medical health conditions, comorbidities, historic of symptoms compatible with COVID-19, with a retrospective calendar of types of accommodation since COVID-19 crisis. Results: From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. Seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3–7.0), with a range of 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P=0.009). Around one third of the seropositive participants reported symptoms with COVID-19. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced an significant increased risk of SARS-CoV-2 infection (|z|=3.65 > 1.96). Conclusion: These results highlight the need for organizing regular screening to prevent clusters forming in homeless accommodations and for providing basic resources for health maintenance.
Subject(s)
COVID-19ABSTRACT
Background: Mainland France has been seriously affected by the Covid-19 epidemic, which has brought significant and unexpected morbidity and mortality. Precarious people cared for in accommodation centers are particularly at risk of infection because of collective housing, their dependence on the support system and therefore their difficulty in applying barrier measures. These populations are also subject to a risk of more severe infections or a delay in seeking treatment. This study aims to identify the factors associated with SARS-CoV2 infection in the most vulnerable populations in Marseille.Methods: The sample on which the study was carried out consists of association users, whether or not presenting a symptomatology suggestive of Covid-19, and routinely treated between March 2020 and May 2020. Through univariate and multivariate analyzes, we studied the influence of several variables on morbidity attributable to SARS-CoV2. Results: 64 participants were enrolled in the study with 29 cases and 35 control subject. Median age was 21.16 years old with a younger age in the case group (p < 0.005). Sex ratio was 7. Risk factors of SARS-CoV2 in multivariate analysis were living in a shared apartment and a low compliance for distancing measure. Participants presented frequent mental health problems such as anxiety. Conclusions: The allocation of housing to structures involved with the most precarious people appears to be a decisive factor in the fight against the spread of SARS-CoV2 and therefore deserves more attention from public authorities.