Addressing COVID-19 Among People Experiencing Homelessness: Description, Adaptation, and Early Findings of a Multiagency Response in Boston
Addressing COVID-19 Among People Experiencing Homelessness: Description, Adaptation, and Early Findings of a Multiagency Response in Boston
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DOI：
10.1177/0033354920936227
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发表时间：
2020-06-09
影响因子：
3.3
通讯作者：
Gaeta, Jessie M.
中科院分区：
文献类型：
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作者：
Baggett, Travis P.;Racine, Melanie W.;Gaeta, Jessie M.
无家可归的人感染2019冠状病毒病（COVID-19）的风险很高。2020年3月，波士顿无家可归者医疗保健计划与城市和州公共卫生机构、市政领导人和无家可归者服务提供者合作，为这一弱势群体开发并实施了全市范围的COVID-19护理模式。组成部分包括在庇护所前门进行症状筛查，在弹出式站点快速检测，对正在接受调查的有症状人员和确诊疾病人员进行隔离和管理场所，对无症状暴露者进行隔离场所，以及对接触者进行调查和追踪。在行动第三周期间，在COVID-19大规模避难所爆发的实时疾病监测工作表明，需要对护理模式进行若干调整，以更好地应对当地无家可归者的疾病流行病学。鉴于在大规模检测中发现的大量无症状或轻微症状感染，不再强调症状筛查；在假定受庇护人群普遍接触的情况下，逐步取消了接触者追踪和隔离；隔离和管理场所迅速扩大，以容纳新诊断的COVID-19患者激增。在手术的前6周，1297名接受检测的人中有429人（33.1%）对COVID-19呈阳性；其中，395人在测试时无家可归，约占波士顿成年无家可归人口的10%。在资源允许的情况下，普遍检测是减轻COVID-19对这一弱势群体影响的持续努力的重点。
People experiencing homelessness are at high risk for coronavirus disease 2019 (COVID-19). In March 2020, Boston Health Care for the Homeless Program, in partnership with city and state public health agencies, municipal leaders, and homeless service providers, developed and implemented a citywide COVID-19 care model for this vulnerable population. Components included symptom screening at shelter front doors, expedited testing at pop-up sites, isolation and management venues for symptomatic people under investigation and for people with confirmed disease, quarantine venues for asymptomatic exposed people, and contact investigation and tracing. Real-time disease surveillance efforts in a large shelter outbreak of COVID-19 during the third week of operations illustrated the need for several adaptations to the care model to better respond to the local epidemiology of illness among people experiencing homelessness. Symptom screening was de-emphasized given the high number of asymptomatic or minimally symptomatic infections discovered during mass testing; contact tracing and quarantining were phased out under the assumption of universal exposure among the sheltered population; and isolation and management venues were rapidly expanded to accommodate a surge in people with newly diagnosed COVID-19. During the first 6 weeks of operation, 429 of 1297 (33.1%) tested people were positive for COVID-19; of these, 395 people were experiencing homelessness at the time of testing, representing about 10% of the homeless adult population in Boston. Universal testing, as resources permit, is a focal point of ongoing efforts to mitigate the effect of COVID-19 on this vulnerable group of people.