COVID-19 prevalence and infection control measures at homeless shelters and hostels in high-income countries: a scoping review

Background: The COVID-19 pandemic has disproportionately impacted homeless populations and service workers, especially within homeless shelter/hostel settings. To date, there have been few evidence syntheses examining outbreaks of COVID-19 among both homeless shelters residents and service workers, nor has there been a critically engaged summary of relevant infection control and prevention (IPAC) measures. This scoping review offers a timely and much-needed synthesis of COVID-19 prevalence within homeless shelters and a review of current and pertinent IPAC measures. Methods: We conducted a scoping review in June 2021 that synthesized academic and grey literature published from March 2020 to July 2021 pertaining to 1) the prevalence of COVID-19 among both residents and staff in homeless shelters and hostels in high-income countries, and 2) COVID-19 IPAC strategies applied in these settings. Two reviewers independently screened the results of the literature search of several databases that included MEDLINE, PsycInfo, and the WHO’s COVID-19 Global Health Portal. All the extracted data was mapped, categorized, and thematically discussed. Results: Thematic analysis of included literature revealed five key themes: 1) the demographics of COVID-19 in homeless shelters, 2) asymptomatic spread, 3) pre-existing vulnerability of the homeless and shelters, 4) the limited application of IPAC, and 5) IPAC effectiveness. Conclusion: This review offers a useful glimpse into the landscape of COVID-19 outbreaks in homeless shelters/hostels and the major contributing factors to these events. The scoping review revealed that there is no clear indication of generally accepted IPAC standards for homeless populations and shelter care workers. This review also illustrated a great need for future research to establish IPAC best practices as well as additional resources for shelter systems to protect residents and staff at homeless shelters/hostels in high-income countries. Finally, the findings from this review reaffirm that homelessness prevention is a key to limiting disease outbreaks, and the associated negative health outcomes in shelter populations.