Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Key Points

Question

Can persons experiencing homelessness with confirmed or suspected coronavirus disease 2019 (COVID-19) and mild to moderate symptoms be safely monitored in designated isolation and quarantine (I/Q) hotels?

Findings

In this cohort study among 1009 I/Q hotel guests referred from hospitals, outpatient settings, and public health surveillance, 81% completed their recommended I/Q course, and only 4% of those transferred from the county hospital required readmission for COVID-19 progression.

Meaning

This study suggests that, during the COVID-19 pandemic, a hotel-based I/Q strategy that delivers integrated medical and behavioral health support to people experiencing homelessness can be done safely outside the hospital setting.

Abstract

Importance

Several jurisdictions in the United States have secured hotels to temporarily house people experiencing homelessness who require isolation or quarantine for confirmed or suspected coronavirus disease 2019 (COVID-19). To our knowledge, little is known about how these programs serve this vulnerable population outside the hospital setting.

Objective

To assess the safety of a hotel-based isolation and quarantine (I/Q) care system and its association with inpatient hospital capacity.

Design, Setting, and Participants

This retrospective cohort study of a hotel-based I/Q care system for homeless and unstably housed individuals in San Francisco, California, was conducted from March 19 to May 31, 2020. Individuals unable to safely isolate or quarantine at home with mild to moderate COVID-19, persons under investigation, or close contacts were referred from hospitals, outpatient settings, and public health surveillance to 5 I/Q hotels. Of 1009 I/Q hotel guests, 346 were transferred from a large county public hospital serving patients experiencing homelessness.

Exposure

A physician-supervised team of nurses and health workers provided around-the-clock support, including symptom monitoring, wellness checks, meals, harm-reduction services, and medications for opioid use disorder.

Main Outcomes and Measures

Characteristics of I/Q hotel guests, program retention, county hospital readmissions, and mean length of stay.

Results

Overall, the 1009 I/Q hotel guests had a median age of 44 years (interquartile range, 33-55 years), 756 (75%) were men, 454 (45%) were Latinx, and 501 (50%) were persons experiencing sheltered (n = 295) or unsheltered (n = 206) homelessness. Overall, 463 (46%) received a diagnosis of COVID-19; 303 of 907 (33%) had comorbid medical disorders, 225 of 907 (25%) had comorbid mental health disorders, and 236 of 907 (26%) had comorbid substance use disorders. A total of 776 of 955 guests (81%) completed their I/Q hotel stay; factors most strongly associated with premature discontinuation were unsheltered homelessness (adjusted odds ratio, 4.5; 95% CI, 2.3-8.6; P < .001) and quarantine status (adjusted odds ratio, 2.6; 95% CI, 1.5-4.6; P = .001). In total, 346 of 549 patients (63%) were transferred from the county hospital; of 113 ineligible referrals, 48 patients (42%) had behavioral health needs exceeding I/Q hotel capabilities. Thirteen of the 346 patients transferred from the county hospital (4%) were readmitted for worsening COVID-19. Overall, direct transfers to I/Q hotels from emergency and outpatient departments were associated with averting many hospital admissions. There was a nonsignificant decrease in the mean hospital length of stay for inpatients with confirmed or suspected COVID-19 from 5.5 to 2.7 days from March to May 2020 ( P = .11).

Conclusions and Relevance

To support persons experiencing homelessness during the COVID-19 pandemic, San Francisco rapidly and safely scaled a hotel-based model of I/Q that was associated with reduced strain on inpatient capacity. Strategies to improve guest retention and address behavioral health needs not met in hotel settings are intervention priorities.

Abstract

This cohort study assesses the safety of a hotel-based isolation and quarantine care system and its association with hospital inpatient capacity during the COVID-19 pandemic.

Related collections

Most cited references 23

Record: found
Abstract: found
Article: not found

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Samantha K. Brooks, Rebecca K Webster, Louise E. Smith … (2022)

Summary The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.

0 comments Cited 5503 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

Joel Hellewell, Sam Abbott, Amy Gimma … (2020)

Summary Background Isolation of cases and contact tracing is used to control outbreaks of infectious diseases, and has been used for coronavirus disease 2019 (COVID-19). Whether this strategy will achieve control depends on characteristics of both the pathogen and the response. Here we use a mathematical model to assess if isolation and contact tracing are able to control onwards transmission from imported cases of COVID-19. Methods We developed a stochastic transmission model, parameterised to the COVID-19 outbreak. We used the model to quantify the potential effectiveness of contact tracing and isolation of cases at controlling a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-like pathogen. We considered scenarios that varied in the number of initial cases, the basic reproduction number (R 0), the delay from symptom onset to isolation, the probability that contacts were traced, the proportion of transmission that occurred before symptom onset, and the proportion of subclinical infections. We assumed isolation prevented all further transmission in the model. Outbreaks were deemed controlled if transmission ended within 12 weeks or before 5000 cases in total. We measured the success of controlling outbreaks using isolation and contact tracing, and quantified the weekly maximum number of cases traced to measure feasibility of public health effort. Findings Simulated outbreaks starting with five initial cases, an R 0 of 1·5, and 0% transmission before symptom onset could be controlled even with low contact tracing probability; however, the probability of controlling an outbreak decreased with the number of initial cases, when R 0 was 2·5 or 3·5 and with more transmission before symptom onset. Across different initial numbers of cases, the majority of scenarios with an R 0 of 1·5 were controllable with less than 50% of contacts successfully traced. To control the majority of outbreaks, for R 0 of 2·5 more than 70% of contacts had to be traced, and for an R 0 of 3·5 more than 90% of contacts had to be traced. The delay between symptom onset and isolation had the largest role in determining whether an outbreak was controllable when R 0 was 1·5. For R 0 values of 2·5 or 3·5, if there were 40 initial cases, contact tracing and isolation were only potentially feasible when less than 1% of transmission occurred before symptom onset. Interpretation In most scenarios, highly effective contact tracing and case isolation is enough to control a new outbreak of COVID-19 within 3 months. The probability of control decreases with long delays from symptom onset to isolation, fewer cases ascertained by contact tracing, and increasing transmission before symptoms. This model can be modified to reflect updated transmission characteristics and more specific definitions of outbreak control to assess the potential success of local response efforts. Funding Wellcome Trust, Global Challenges Research Fund, and Health Data Research UK.

0 comments Cited 1159 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response

Giacomo Grasselli, Antonio Pesenti, Maurizio Cecconi (2020)

0 comments Cited 954 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): JAMA Netw Open

Journal ID (iso-abbrev): JAMA Netw Open

Journal ID (pmc): JAMA Netw Open

Title: JAMA Network Open

Publisher: American Medical Association

ISSN (Electronic): 2574-3805

Publication date (Electronic): 2 March 2021

Publication date Collection: March 2021

Publication date PMC-release: 2 March 2021

Volume: 4

Issue: 3

Electronic Location Identifier: e210490

Affiliations

[1 ]San Francisco Department of Public Health, San Francisco, California

[2 ]Department of Medicine, University of California, San Francisco

[3 ]Benioff Homelessness and Housing Initiative, University of California, San Francisco

[4 ]Division of HIV, Infectious Diseases and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco

[5 ]Department of Emergency Medicine, University of California, San Francisco

Author notes

Article Information

Accepted for Publication: January 11, 2021.

Published: March 2, 2021. doi:10.1001/jamanetworkopen.2021.0490

Corresponding Author: Jonathan D. Fuchs, MD, MPH, San Francisco Department of Public Health, 25 Van Ness Ave, Ste 500, San Francisco, CA 94102 ( jonathan.fuchs@ 123456sfdph.org ).

Author Contributions: Drs Fuchs and Kanzaria had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Fuchs, Evans, Imbert, Bloome, Fann, Skotnes, Sears, Moughamian, Reed, Rosenthal, Bobba, Kushel, Kanzaria.

Acquisition, analysis, or interpretation of data: Fuchs, Carter, Evans, Graham-Squire, Fann, Sears, Pfeifer-Rosenblum, Eveland, Borne, Lee, Jain, Kushel, Kanzaria.

Drafting of the manuscript: Fuchs, Carter, Evans, Graham-Squire, Fann, Pfeifer-Rosenblum, Reed, Rosenthal, Kanzaria.

Critical revision of the manuscript for important intellectual content: Fuchs, Graham-Squire, Imbert, Bloome, Fann, Skotnes, Sears, Pfeifer-Rosenblum, Moughamian, Eveland, Borne, Lee, Rosenthal, Jain, Bobba, Kushel, Kanzaria.

Statistical analysis: Fuchs, Carter, Evans, Graham-Squire, Fann, Pfeifer-Rosenblum.

Obtained funding: Kushel.

Administrative, technical, or material support: Fuchs, Bloome, Fann, Sears, Pfeifer-Rosenblum, Moughamian, Eveland, Kushel, Kanzaria.

Supervision: Fuchs, Fann, Bobba, Kushel, Kanzaria.

Conflict of Interest Disclosures: Dr Fuchs reported receiving grants from the Centers for Disease Control and Prevention outside the submitted work. Dr Jain reported receiving grants from the Centers for Disease Control and Prevention and President’s Emergency Plan for AIDS Relief outside the submitted work. Dr Kanzaria reported serving as an unpaid clinical advisory board member for Collective Medical and has received reimbursement for travel and accommodation-related expenses outside the submitted work. No other disclosures were reported.

Funding/Support: The analysis of the work described was supported by the Benioff Homelessness and Housing Initiative at the University of California, San Francisco.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The views expressed herein do not necessarily reflect the official policies of the City and County of San Francisco nor does mention of trade names, commercial products, or organizations imply endorsement.

Additional Contributions: We thank Jessica Knaster Wasse, MPH, Public Health–Seattle & King County for her early insights as we launched our San Francisco isolation and quarantine hotel model, and Erin Hartman, MS, University of California, San Francisco Benioff Homelessness and Housing Initiative for her editorial assistance with this manuscript. They were not compensated for their contributions. We would like to acknowledge the tireless efforts of the San Francisco Health Services Administration, Department of Homelessness and Supportive Housing, and Department of Public Health Containment Branch staff, including teams of nurses, behavioral health specialists, and disaster service workers who established and maintained San Francisco’s isolation and quarantine hotel system of care: Trent Rhorer, MPP; Daniel Kaplan, MPA; Noelle Simmons, MPP; Dariush Kayhan, MA; Kira Barrera, BA; Robert Walsh, MPA; Doris Barone, MPA, CEM; Abigail Stewart-Kahn, MS; Scott Walton, BA; Kelly Hiramoto, LCSW; Spencer Williams, BA; Saba Shahid, PsyD; Rafaella Wilson, RN; Jason Albertson, LCSW; Sarah Strieff, BSN, RN; Jose Luis Guzman, BS; and John Trinidad, MSW; they were not compensated for their contributions to this article. We also thank San Francisco Department of Public Health leaders Ayanna Bennett, MD; Tomas Aragon, MD, DrPH; and Grant Colfax, MD, and Mayor London Breed for their unwavering support; they were not compensated for their contributions to this article.

Article

Publisher ID: zoi210030

DOI: 10.1001/jamanetworkopen.2021.0490

PMC ID: 7926291

PubMed ID: 33651111

SO-VID: 608d3dcd-53ae-46e5-a3a8-a6647fc0e46f

License:

This is an open access article distributed under the terms of the CC-BY License.

History

Date received : 9 November 2020

Date accepted : 11 January 2021

Comments

Comment on this article

scite_

Cited by 37

See all cited by

- Version 1

Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing Homelessness

Read this article at

Key Points

Question

Findings

Meaning

Abstract

Importance

Objective

Design, Setting, and Participants

Exposure

Main Outcomes and Measures

Results

Conclusions and Relevance

Abstract

Related collections

Novel Coronavirus Disease COVID-19

Most cited references 23

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts

Critical Care Utilization for the COVID-19 Outbreak in Lombardy, Italy: Early Experience and Forecast During an Emergency Response

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 501

Cited by 37