CDC reports uptick in coronavirus-infected at homeless shelters, many asymptomatic

The Centers for Disease Control and Prevention on Friday recommended that homeless shelters take immediate steps to protect their populations, including social distancing and testing everyone at shelters that have recorded cases, given the presence of asymptomatic and presymptomatic coronavirus-infected people.

The CDC said homeless shelters should apply social distancing guidelines including separating residents’ heads by at least six feet apart when sleeping and promote the use of cloth face coverings for all residents.

“Given the high proportion of positive tests in the shelters with identified clusters and evidence for presymptomatic and asymptomatic transmission of SARS-CoV-2, testing of all residents and staff members regardless of symptoms at shelters where clusters have been detected should be considered,” the CDC in its report. “If testing is easily accessible, regular testing in shelters before identifying clusters should also be considered.”

Public health officials detected a sudden spike in coronavirus cases last month among America’s homeless in densely populated cities and were baffled that many did not show symptoms of the virus.

The CDC gathered data on 19 homeless shelters across Atlanta, Boston, San Francisco and Seattle and found nearly 25% of residents at homeless shelters tested positive for the virus and nearly 11% of staff at the shelters tested positive, too.

The CDC collected data on 1,192 residents and 313 staff members at the shelters from March 27 to April 15.

Boston-area public health officials were among the first to discover the coronavirus in a small cluster of their homeless population and tested all the inhabitants of a shelter in April. Boston Health Care for the Homeless’ Dr. Jim O’Connell said of the 408 inhabitants of the Pine Street Inn shelter at the time, 147 tested positive, which was included in the CDC’s new report. About 88% were asymptomatic and 12% displayed mild symptoms.

Dr. O’Connell said his organization, which is federally funded and oversees health care for the homeless in the Boston area, has helped administer the more than 1,500 coronavirus tests of homeless people in the Boston region, yielding more than 500 positive results as of Friday morning. Despite the relatively high infection rate, Dr. O’Connell said only a handful of people have been hospitalized. He said he knew of two deaths.

“We don’t really know what these asymptomatic and mildly symptomatic folks are really doing: Are they passing this onto other people who are very vulnerable and getting very sick or is this truly a version of the virus that only causes mild illness?” Dr. O’Connell said. “I’m tending to think it’s not a separate strain of the illness but there’s something in whatever’s going on in the shelters, either that they’re not getting the huge inoculation you might get when people are coughing or there’s something that is protecting poor or homeless people for reasons we cannot figure out, but I suspect that those that are very vulnerable are going to get very sick when they get this virus.”

Maria Foscarinis, executive director of the National Law Center on Homelessness & Poverty, said she thinks more needs to be done to protect the homeless during the outbreak.

“Some communities now have placed people in hotels and motels or other forms of housing, [and] they need to keep doing that and they need to increase it,” Ms. Foscarinis said. “No one should think that in the process of opening up an economy or a city that people should be put back on the street; that would be devastating.”

The National Law Center on Homelessness & Poverty filed a motion in federal court Friday seeking an order to prevent San Diego officials from towing and impounding mobile homes and vehicles used as homes amid the coronavirus.

Given the uptick in the coronavirus among the homeless in group settings, the vehicles present the best and often only option for homeless people attempting to safely shelter, she said.

Concerns about the asymptomatic carriers may ultimately give way to better news: If they never become ill, they may shed new light on the coronavirus and how to fight it.

“When you have people who are usually poor and vulnerable in those settings, my guess is the only way we’ll control the virus is to be universally testing those folks and probably doing it repeatedly, and I think that’s going to be an important new component of how to control this epidemic around the country,” Dr. O’Connell said.