Homeless people (PEH) in Chicago were 2.5 times less likely to have COVID-19 infection if they were accommodated in individual hotel rooms with medical and social support than if they stayed in a shelter of the city, according to an observational study yesterday in JAMA network open.
A team of researchers from the University of Chicago, the Lawndale Christian Health Center, and the Chicago Department of Public Health studied the infection rates, blood pressure, and hemoglobin A1c of 259 PEHs recruited from 16 shelters and housed in hotel rooms rented by the city of Chicago starting April 2. as of September 3, 2020. Their results were compared with those of people staying in shelters, which the authors say can accommodate up to 400 people in open rooms.
Hemoglobin A1c, a measure of average blood sugar over the past 3 months, is used to diagnose prediabetes and diabetes.
To be eligible for single rooms, participants had to be at least 60 years old, 55 with a high-risk chronic disease, or under 35 with an underlying high-risk medical condition. Healthcare workers monitored hotel residents daily for symptoms of COVID-19 and performed regular SARS-CoV-2 testing and chronic disease management. On-site treatment for mental illness and substance use disorders, as well as other social services and meal delivery, were also provided.
During the first month of the study, under state lockdown orders, hotel residents were largely confined to their rooms, but were then allowed to leave for necessary groceries, smoke or participate in supervised activities.
Blood pressure improvement, hemoglobin A1c
There were 54.7 cases of COVID-19 per 1,000 people in the hotel group, compared to 137.1 per 1,000 people in homeless shelters. From baseline, the adjusted change in systolic blood pressure (higher number of a reading) among the hotel group was 5.7 points lower and hemoglobin A1c was 1.4% lower.
Of the 259 hotel residents, 4.2% were hospitalized with severe COVID-19, but none died. Just over 28% started taking new psychiatric drugs and 10.1% started treatment for an opioid use disorder. About half of the participants (51%) were subsequently placed in permanent or transitional housing.
Of the 259 participants, 40.2% were 65 and older, 73.4% were male, 71.4% were black, and 18.9% were white. Common underlying conditions included high blood pressure, diabetes, obesity, weakened immunity, chronic respiratory conditions, and mental illness.
The median hotel stay was 59 days. During the study, 16,116 daily medical visits were made, 60.9% of which were for serious medical problems.
Avoid emergency room visits
In a press release from the University of Chicago Medical Center, co-author Elizabeth Tung, MD, said the study had important implications for public health. “When you think of the time and money spent every time someone is in the emergency room [emergency room] because they are experiencing homelessness and cannot meet their medical needs – it is more expensive, it is worse for the patient, and you end up with terrible results, ”she said. “These data show us that a medical housing approach could help.”
Researchers noted that PEHs are at increased risk of COVID-19 as they often live in gathering places such as shelters, have limited access to personal protective equipment, and are more likely to suffer from chronic diseases at high levels. risk.
“These results suggest that with appropriate wrap-around supports (i.e. wrote.
The authors called for flexible, integrated and sustainable sources of funding at national, state and local levels to enable the purchase, renovation and improvement of new and existing shelters.
“Support is also needed to fund initiatives that proactively identify PEHs with high-risk medical and behavioral needs, and provide intensive and comprehensive services to stabilize their condition and facilitate a successful transition to permanent supportive housing,” they wrote. “This model is not only relevant for the pandemic era, but is a critical component in meeting the heterogeneous needs of PEH across the United States.”