Sars-Cov-2 Prevalence, Transmission, Health-Related Outcomes And Control Strategies In Homeless Shelters: Systematic Review And Meta-Analysis

Background: People experiencing homelessness (PEH) may be at risk for COVID19. We synthesised evidence on SARS-Cov-2 infection, transmission, outcomes of disease, effects of non-pharmaceutical interventions (NPI), and the effectiveness of strategies for infection prevention and control (IPC). Methods: Systematic review of articles, indexed in electronic databases (EMBASE, WHO--Covid19, Web of Science), institutional websites and the Norwegian Institute of Public Health's live map of COVID-19 evidence, and published from December 1st, 2019, to March 3rd, 2021. Empirical papers of any study design addressing Covid19 and health(-related) outcomes in PEH or shelters' staff were included. (PROSPERO-2020-CRD42020187033) Findings: Of 536 publications, 37 studies were included (two modelling, 31 observational, four qualitative studies). Random-effect meta-analysis yields a baseline SARS-Cov-2 prevalence of 2.32% (95% Confidence Interval, 95%CI=1.30-3.34) in PEH and 1.55% (95%CI=0.79-2.31) in staff. In outbreaks, the pooled prevalence increases to 31.59% (95%CI=20.48-42.71) in PEH and 14.80% (95%CI=10.73-18.87) in staff. Main IPC strategies were universal rapid testing, expansion of non-congregate housing, and in-shelter measures (bed spacing, limited staff rotation, reduction in number of residents). Interpretation: 32% of PEH and 15% staff are infected during outbreaks of SARS-Cov-2 in homeless shelters. Most studies were conducted in the USA. No studies were found quantifying health-related outcomes of NPI. Overview and evaluation of IPC strategies for PEH, a better understanding of disease transmission, and reliable data on PEH within Covid-19 notification systems are needed. Qualitative studies may serve to voice PEH and shelter staff experiences, and guide future evaluations and IPC strategies. Funding: None. (c) 2021 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)