79 - Detroit’s Response to COVID-19 in Homeless Shelters

Background: Detroit, Michigan has a poverty rate nearly three times the national average. Homeless shelters are at risk for infectious outbreaks due to reduced healthcare access for residents, compounded by overcrowding, hygienic challenges, lack of resources, and transient nature of residents. Prior to the first reported COVID-19 case in Michigan, the Detroit Health Department prioritized screening of both asymptomatic and symptomatic homeless residents residing in the city's shelters. Early identification of COVID-19 positive cases allowed for implementation of strategies to halt further spread.

Methods: A surveillance strategy was implemented prior to the first confirmed COVID-19 case in Michigan. Surveillance involved temperature and symptom checks at each homeless shelter, three times weekly. 24 shelters were screened for symptoms, 13 shelters had universal testing performed. Two city-operated quarantine sites for COVID-positive and –suspected homeless individuals were organized. If a shelter resident tested positive, that shelter was placed in quarantine, and new referrals stopped for 14 days. Temperature and symptom check frequency increased to daily for 14 days. If a patient was positive for fever or symptoms, they were transferred to the quarantine center for testing and isolation.

Results: Over 23,000 temperature and symptom checks occurred in 24 shelters across Detroit since February 22. This identified 15 patients who were referred to the quarantine site. From April 11 to May 31, 721 residents from 13 homeless shelters were screened with universal testing for COVID-19, and 93 (12.9%) tested positive (Figure 1). Of 95 homeless residents who were referred through shelter surveillance, from the local hospital system and via unsheltered street outreach, and tested on-site at the quarantine and isolation shelter, 29 (31%) tested positive for COVID-19, and 66 (69%) tested negative.Figure 1. System-wide homeless shelter testing of COVID-19


Conclusion: Homeless populations across the US are especially vulnerable to COVID-19, with high risk for rapid spread due to crowding and difficulty with physical distancing. The need for increased testing- and prevention-based strategies in this population is crucial. The process performed in Detroit’s homeless shelters can be a model for other communities at risk for COVID-19 outbreaks.