COVID-19 related morbidity and mortality in people experiencing homelessness in the Netherlands

Introduction People who are homeless might be more at risk for getting infected by the SARS-COV-2 virus or for experiencing severe course of the infection due to their often more fragile health, unmet health needs, and poorer living conditions. This study aims to gain insight into the morbidity and mortality of the SARS-COV-2 virus among the homeless population in the Netherlands. Methods In this observational retrospective study, anonymized data about patients experiencing homelessness who contacted a street doctor were gathered in nine cities in the Netherlands from March 2020 until March 2021. Data included patient characteristics, COVID-19 -related symptoms, diagnosis, and disease course of a SARS-COV-2 infection. Results Of the total 1419 patients in whom 1544 COVID-19 related consults were registered, 16% tested positive for a SARS-COV-2 infection, and an additional 12% were clinically suspected of having a SARS-COV-2 infection but were seen before there were any COVID-19 tests available in General Practice or for some other reason not tested. Significantly more (p = <0.001) patients born outside the European Union tested positive for a SARS-COV-2 infection (36%) compared to the remainder of the population (20%). The most discerning symptom for being tested positive was loss of taste and smell (29% vs 6% in the negative tested group and 2% in the suspected group), fever (24% vs 13% in the negative tested group but 18% in the suspected group), and headache (26% vs 17% resp 14%), and fatigue (29% vs 20 resp 17%). Cough, dyspnea and common cold were more often seen in the clinically suspected but not tested group). Of the group that tested positive for a SARS-COV-2 infection, 10% were hospitalized. Two patients were admitted to intensive care and one patient died. Of patients who were clinically suspected of a SARS-COV-2 infection, 5% were hospitalized. Conclusion COVID-19 was not widespread among people experiencing homelessness in the Netherlands, but the number of hospitalizations in this study was relatively high. Monitoring this population during a pandemic is necessary to take prompt action when needed.