San Francisco researchers have found an effective way to help homeless people suffering from mild to moderate cases of COVID-19: house it in hotel rooms, which reduces the burden on hospitals with seriously ill patients.
The findings, published Tuesday at the JAMA Network Open, highlight the health benefits of providing stable housing and services to those most in need.
“What they did is absolutely meaningful to me,” said Dr. Miriam Komaromy, an internist specializing in addiction medicine at Boston Medical Center, said. “I think that’s what needs to happen in communities across the country.”
One of the first things someone who has been exposed to or should do to the coronavirus is to quarantine or isolate – that is, to enter the home and avoid other people for a few days to further spread the disease. to prevent the virus.
This is not an option for the more than half a million homeless people in the US who do not have an independent and reliable shelter. It is also not feasible for those living in ‘marginal’ housing, where people can live in cramped residences or with shared facilities, often due to high house prices.
Both groups are at greater risk of becoming infected and of transmitting the virus to others. And spending time in a homeless shelter poses its own dangers, as many have become COVID-19 hotspots.
It was a major concern for public health officials in San Francisco, where 8,000 people experience homelessness during the night, and 18,000 low-income people live in single-room hotels with shared kitchens and bathrooms.
Even in the early days of the pandemic, there was clearly a need to introduce alternative housing to stop the spread of SARS-CoV-2, the study’s lead author, Dr. Jonathan Fuchs, a physician epidemiologist at the San Francisco Department of Public said. Health and UC San Francisco.
The researchers acted quickly. On March 19, three days after San Francisco declared one of the nation’s first health orders in the country, the team began welcoming patients as guests into 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 checked into hotel rooms for isolation and quarantine, 501 were sheltered or unprotected homeless; the rest were people who lived in overcrowded or otherwise risky conditions.
Overall, 463 were diagnosed with COVID-19, 379 were examined and awaited test results, and 146 had to be quarantined because it was close contact with a person who had COVID-19.
At the hotels, a team of nurses, health workers and security staff, supervised by a doctor, provided free, 24-hour support to guests, who were checked for COVID-19 symptoms and called twice a day for wellness examinations. Those with alcohol or other drug use problems were discussed via telemedicine with specialists in addiction medicine.
Guests received hygiene kits and meals that met their dietary restrictions. Those with young children were offered diapers and formulas, and pets may stay on the premises. The researchers also stored guests’ belongings, provided laundry services and offered $ 20 gift cards at the end of the stay. The average hotel stay was ten days.
The incentives seem to be working: about 81% of guests have completed the program. Those who got through it stayed an average of 13.1 days, compared to 5.5 days among those who left prematurely.
“The hotel-based strategy was probably successful for these populations because it meets their needs beyond isolation and quarantine,” said Dr. Joshua A. Barocas of Boston Medical Center and dr. Esther K. Choo of Oregon Health and Science University wrote in a comment. which accompanies the paper.
As a result of the program, the hotel guests probably helped reduce the spread of the virus, while also freeing up limited hospital resources, including the staff needed to care for more seriously ill patients.
“It helped decompress the hospital, especially during the early days of the pandemic, when it was really important,” Fuchs said.
Of the 346 patients transferred to the hotel program of a large provincial hospital, only 4% had to return to the hospital due to worsening COVID-19 symptoms.
“This, I think, is a testament to the kind of care and support we were able to provide in the hotels,” Fuchs said. “I think this is an important sign of success.”
After the quarantine and isolation periods were over, study participants were offered shelter and housing options.
Komaromy, which was not involved in the San Francisco study but implemented a smaller, somewhat similar program in Boston, said such practices should become the norm for treating homeless patients across the country.
She stresses the importance of helping participants find ways to prevent them from returning to the street or shelters once their period of quarantine or isolation ends. In Boston, for example, case managers were able to help a quarter of patients move in with family members or engage in long-term programs to treat drug use or mental health disorders.
“It was not nearly enough – it was painful to send someone back to the street – but I was glad we were able to help a significant percentage of the people,” she said.
Both Fuchs and Komaromy said the pandemic underscores the urgent need to address and reduce homelessness, even after the virus no longer spreads. Barocas and Choo agreed, pointing out that homelessness is likely to increase if the national eviction moratorium expires.
People who experience homelessness suffer excessively from chronic health conditions such as heart disease, diabetes and drug use disorders, as well as overdoses and suicide. Their lives are on average 20 years shorter than those of people with stable housing.
“As millions of people are at risk of becoming homeless again this year, there has been no better or more urgent time to end homelessness in the United States,” Barocas and Choo wrote. “It’s clear what needs to be done: expand affordable and low-income housing, establish roads to regain stable housing and begin to change the national mindset among health workers that housing is health care.”