ABSTRACT
Background People experiencing homelessness (PEH) may be at increased risk of SARS-CoV-2 infection and severe COVID-19. The Dutch government established emergency shelters and introduced preventive measures for homelessness services and there were no major SARS-CoV-2 outbreak noticed among PEH during the first two waves of infections. This study aimed to assess the prevalence of current and past infections among PEH and staff at the end of the second COVID-19 wave by conducting an on-site COVID-19 screening project at homelessness services in Amsterdam, the Netherlands. Methods We assessed the proportion of visitors and staff members of four homelessness services at two locations in Amsterdam with positive SARS-CoV-2 qPCR and antibody results (IgG/IgM Rapid Test, Biozek) in May 2021. We also assessed sociodemographic, clinical and lifestyle characteristics, compliance with basic prevention measures and intention to vaccinate against COVID-19 among PEH and staff.Results A total of 138 visitors and 53 staff members filled out a questionnaire and were tested. Among PEH, the SARS-CoV-2 positivity rate was 0% (0/133;95%CI=0-1.9) and the antibody positivity rate was 1.6% (2/131;95%CI=0.8-7.5). Among staff, these percentages were 3% (1/32;95%CI=0.1-16.2) and 11% (5/53;95%CI=3.6-23.6), respectively. Most participants were frequently compliant with the basic preventive measures ‘not shaking hands’, ‘wearing a face mask’ and ‘washing hands’, but not with ‘physical distancing’. Overall, intention to vaccinate for COVID-19 was low (30% for visitors, 10% for staff) or medium (28% for visitors, 35% for staff). Trust in COVID-19 policies were also, for the most part, low (27% for visitors, 17% for staff) or neutral (32% for visitors, 53% for staff).Conclusions We observed a low prevalence of past and current SARS-CoV-2 infections among PEH, which may be explained by instated shelter policies, limited daily activities of PEH and compliance with certain prevention measures. Vaccine hesitancy and mistrust among visitors and staff could hinder vaccination uptake, suggesting that improvements in public heath communication and interventions towards visitors and staff of homelessness services are needed.
Subject(s)
COVID-19ABSTRACT
Background Surveillance data in high-income countries have reported more frequent SARS-CoV-2 diagnoses in ethnic minority groups. We examined the cumulative incidence of SARS-CoV-2 and its determinants in six ethnic groups in Amsterdam, the Netherlands. Methods We analyzed participants enrolled in the population-based HELIUS cohort, who were tested for SARS-CoV-2-specific antibodies and answered COVID-19-related questions between June 24-October 9, 2020 (after the first wave) and November 23, 2020-March 31, 2021 (during the second wave). We modeled SARS-CoV-2 incidence from January 1, 2020-March 31, 2021 using Markov models adjusted for age and sex. We compared incidence between ethnic groups over time and identified determinants of incident infection within ethnic groups. Findings 2,497 participants were tested after the first wave; 2,083 (83·4%) were tested during the second wave. Median age at first visit was 54 years (interquartile range=44-61); 56·6% were female. Compared to Dutch-origin participants (15·9%), cumulative SARS-CoV-2 incidence was higher in participants of South-Asian Surinamese (25·0%; adjusted hazard ratio [aHR]=1·66;95%CI=1·16-2·40), African Surinamese (28·9%;aHR=1·97;95%CI=1·37-2·83), Turkish (37·0%;aHR=2·67;95%CI=1·89-3·78), Moroccan (41·9%;aHR=3·13;95%CI=2·22-4·42), and Ghanaian (64·6%;aHR=6·00;95%CI=4·33-8·30) origin. Compared to those of Dutch origin, differences in incidence became wider during the second versus first wave for all ethnic minority groups (all p for interaction<0.05), except Ghanaians. Having household members with suspected SARS-CoV-2 infection, larger household size, and low health literacy were common determinants of SARS-CoV-2 incidence across groups. Interpretation SARS-CoV-2 incidence was higher in the largest ethnic minority groups of Amsterdam, particularly during the second wave. Prevention measures, including vaccination, should be encouraged in these groups. Funding ZonMw, Public Health Service of Amsterdam, Dutch Heart Foundation, European Union, European Fund for the Integration of non-EU immigrants.