Researchers from San Francisco have found an effective way to help homeless residents suffering from mild to moderate cases of COVID-19: hosting them in hotel rooms, thereby reducing the burden on hospitals flooded with more seriously ill patients.
The findings, published on Tuesday in the JAMA Network Open, highlight the public health benefits of providing stable housing and services to those who need it most.
“What they did makes perfect sense to me,” said Dr. Miriam Komaromy, an intern who specializes in anti-addiction medicine at Boston Medical Center. “I think that’s what needs to happen in communities across the country.”
One of the first things that anyone exposed to or infected with the coronavirus needs to do is quarantine or isolate – that is, stay at home and avoid others for several days to prevent the virus from spreading.
This is not an option for the more than half a million homeless people in the United States, who do not have an independent and reliable shelter. Nor is it viable for those who live in “marginal” housing, where people can live in crowded rooms or with shared facilities, often due to high housing prices.
Both groups are at greater risk of being infected and of transmitting the virus to others. And spending time in a homeless shelter carries its own dangers, as many have become hot spots in the COVID-19.
This was a major concern for public health officials in San Francisco, where 8,000 people live homeless every night and 18,000 low-income people live in single-room hotels with a shared kitchen and bathroom.
Even in the early days of the pandemic, there was clearly a need to create alternative housing to prevent the spread of SARS-CoV-2, said the study’s lead author, Dr. Jonathan Fuchs, an epidemiologist with the San Francisco Health and UC San Diego Public Department. Francisco.
The researchers acted quickly. On March 19, three days after San Francisco declared one of the country’s first health shelter orders, the team began welcoming patients as guests at the first of five isolation and quarantine hotels.
For their report, the researchers evaluated the program from March 19 to May 31. Of the 1,009 guests staying in hotel rooms for isolation and quarantine, 501 were homeless or not; the rest were people with marginal shelters who lived in overcrowded or otherwise risky conditions.
Overall, 463 were diagnosed with COVID-19, 379 were under investigation and awaiting test results and 146 needed to be quarantined because they were close contacts with a person who had COVID-19.
In the hotels, a team of nurses, health professionals and security guards supervised by a doctor provided free and uninterrupted support to guests, who were monitored for the symptoms of COVID-19 and called twice a day for health checks. Those with problems using alcohol or other substances were offered consultations with specialists in addiction medicine through telemedicine.
Guests received hygiene kits and meals that met dietary restrictions. Those with young children were given diapers and powdered milk, and pets were allowed to stay on the premises. The researchers also stored guests’ belongings, provided laundry services and offered $ 20 gift cards at the end of their stay. The average stay in the hotel was 10 days.
The incentives seemed to work: about 81% of guests completed the program. Those who survived stayed an average of 13.1 days, compared with 5.5 days among those who left prematurely.
“The hotel-based strategy was probably successful for these populations because it met their needs beyond isolation and quarantine,” wrote Dr. Joshua A. Barocas of Boston Medical Center and Dr. Esther K. Choo from Oregon Health and Science University. accompanying the paper.
By joining the program, hotel guests likely helped to reduce the spread of the virus and, at the same time, released limited hospital resources – including the staff needed to care for the most seriously ill patients.
“It really helped to decompress the hospital, especially during the early days of the pandemic, when it was really important,” said Fuchs.
In addition, of the 346 patients who were transferred to the hotel program of a large public hospital in the county, only 4% needed to return to the hospital due to the worsening symptoms of COVID-19.
“This, I think, is a testament to the kind of care and support that we were able to offer people in hotels,” said Fuchs. “So I think it is an important marker of success.”
After the quarantine and isolation periods ended, study participants were given shelter and housing options.
Komaromy, who was not involved in the San Francisco study, but implemented a smaller and somewhat similar program in Boston, said such practices should become the norm for treating homeless patients across the country.
She emphasized the importance of helping participants find ways to avoid returning to the street or shelter once their quarantine or isolation period ends. In Boston, for example, case managers were able to help a quarter of patients move in with relatives or join long-term programs to treat substance use or mental health disorders.
“This was not even nearly adequate – it was painful to send someone back to the street – but I was happy to be able to help a significant percentage of people,” she said.
Both Fuchs and Komaromy said the pandemic highlighted the urgent need to address and reduce the number of homeless people, even after the virus had stopped spreading. Barocas and Choo agreed, pointing to the fact that the number of homeless people is likely to increase if the national eviction moratorium expires.
Homeless people suffer disproportionately from chronic health conditions, such as heart disease, diabetes and substance use disorders, as well as overdoses and suicide. On average, their lives are 20 years shorter than those of people with stable housing.
“Considering that millions of people are at risk of becoming homeless this year, there was no better or more urgent time to end homelessness in the United States,” wrote Barocas and Choo. “It is clear what needs to be done: expand low-income and low-income housing, establish ways to recover stable housing and begin to transform the national mentality among health professionals that housing is health.”