The COVID-19 pandemic has caused the loss of income and employment wages for millions of people who are out of work or whose businesses have been affected. This means that many people are now at risk of becoming homeless due to joblessness and evictions, whereas they may have been able to avoid this had the pandemic never happened.

Homelessness is a problem in and of itself, but when you combine that with the risk of contracting a dangerous respiratory illness for which there is no cure, the need to get off the streets and into a real home becomes so much more critical.

However, many homeless people are uncomfortable with the idea of staying in shelters and sleeping around others. The risk of an outbreak spreading through a homeless shelter’s residents is a very real possibility. The fear of this happening to someone may cause them to choose to stay outside or even in unsheltered, outdoor homeless encampments. Some might argue that people staying indoors are safer because homeless shelters would be taking more precautions than in communities of people living outdoors.

Nowadays, most shelters are taking visitor’s temperatures before they enter buildings and are screening them for any symptoms that might be consistent with having COVID-19. But others may argue that regardless of these measures, simply living or sleeping in such close proximity to others is gambling with one’s health and the possibility of becoming sick is ever-present.

Sheltered vs. Unsheltered Statistics
So what do the statistics or numbers say about sheltered and unsheltered people and their compared risk of contracting SARS-CoV-2, the virus that causes COVID-19? Well, there haven’t been many studies on the matter and this is likely due to the fact that there are so many variables and factors involved.

Add to this the fact that the COVID-19 pandemic is still a relatively new pandemic, and it’s easy to see why there isn’t much data to go on yet. However, there have been a few studies that have been published and peer-reviewed which can help give us an indicator as to what’s riskier between sleeping in shelters or sleeping outside.

The Atlanta Study
A study conducted in Atlanta, Georgia during the beginning stages of the pandemic outbreak in the USA found that people living in homeless shelters were more at risk of catching the virus. Those sleeping in shelters were over four times more likely to test positive for SARS-CoV-2 than those living without any type of shelter. Employees who were working in the shelters and included in the study tested positive almost three times as frequently as those living on the streets or who were otherwise unsheltered. ¹⁾Yoon, JC et al., COVID-19 Prevalence among People Experiencing Homelessness and Homelessness Service Staff during Early Community Transmission in Atlanta, Georgia, April-May 2020. Clin Infect Dis. 2020 Sep 8:ciaa1340. doi: 10.1093/cid/ciaa1340. Epub ahead of print. PMID: 32898272; PMCID: PMC7499502.

However, this is simply one study and there are many different factors involved that could contribute to these numbers. For example, the same study found that there was a smaller percentage of people testing positive in shelters during the follow-up over the next month than there were when the study initiated.

This means that it’s possible that some of the shelters or employees involved in the study began to implement more intervention measures to prevent transmission of the virus in the shelters. Homeless people sleeping or living in the shelters may also have taken their own precautionary steps to try to avoid catching the virus.

It’s important to keep in mind that this study was conducted during the early stages of the outbreak in the United States, before many began to consider it as a possible threat and when interventions and precautions were not being widely carried out.

The Centers for Disease Control and Prevention (CDC) has since issued a recommendation for all shelters in the U.S. to test all residents whether they have symptoms or not (when testing is easily accessible).²⁾Mosites E, Parker EM, Clarke KE, et al. Assessment of SARS-CoV-2 Infection Prevalence in Homeless Shelters — Four U.S. Cities, March 27–April 15, 2020. MMWR Morb Mortal Wkly Rep 2020;69:521–522.

Regardless, when one simply looks at the comparison between the unsheltered participants in the study and both the residents and employees who were in the shelters, it’s difficult to not conclude that staying in the shelter posed its own risks. Now that more shelters and residents are aware of how easily the virus is transmitted, the risk-level may be lower than what it was initially.

The San Francisco Study
A month after the initial first cases of COVID-19 in San Francisco were identified, the largest homeless shelter in the city suffered its own outbreak. In this case, about 67% of residents and over 17% of employees became quickly infected. At the time, the overall percentage of people in the general population in San Francisco who were testing positive was less than 1%.³⁾Imbert, Elizabeth et al., Coronavirus Disease 2019 (COVID-19) Outbreak in a San Francisco Homeless Shelter, Clinical Infectious Diseases, ciaa1071. 3 Aug. 2020, doi:10.1093/cid/ciaa1071

Not all of those who were sleeping in the shelter were tested, but out of the 150 who were tested, 101 tested positive. By simply looking at these numbers, it’s easy to see how easily the virus transmits between people living in close proximity to one another.

What Happens After Residents Test Positive?
When a homeless shelter suffers an outbreak, what happens next is entirely based on what city or country the shelter is located in and how severe the outbreak is. Different jurisdictions may take different steps. In the case of the previously mentioned San Francisco homeless shelter, the shelter was temporarily closed while most of the residents were relocated to hotels which were re-designated as isolation and quarantine locations. Those who had worrisome or severe symptoms were hospitalized.

Why Would Shelters Be More Dangerous?
When comparing homeless shelters and outside spaces, it’s easy to see why shelters may pose a higher risk for contracting COVID-19. A major reason may simply be because those infected don’t always look infected. The researchers in the San Francisco study discovered that more than half of those who tested positive for the virus were asymptomatic at the time of testing.

To further support this, another study that involved many shelters in Washington reported similar statistics where the majority of positive cases were shelter residents with no symptoms.⁴⁾Rogers, JH et al., Characteristics of COVID-19 in Homeless Shelters : A Community-Based Surveillance Study. Ann Intern Med. 2020 Sep 15. doi: 10.7326/M20-3799. Epub ahead of print. PMID: 32931328.

This means that while temperature checks and monitoring residents for possible symptoms may greatly reduce the likelihood of an outbreak, it doesn’t completely reduce all risk. It’s simply not enough, which is what the researchers in the study concluded with as well.

However, as stated previously, there are too many factors involved to definitely say that shelters are more dangerous than sleeping outside. As anybody who has been homeless knows, sleeping outside carries its own level of danger in the form of harsh weather, physical threats, and legal consequences if one is caught sleeping somewhere where they shouldn’t be.

As more shelters have become aware of how easily the SARS-CoV-2 virus transmits between people, hopefully more precautions have been taken since the aforementioned studies were originally carried out.