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TORONTO – People experiencing homelessness have high rates of COVID-19 reinfection, further endangering the health of an already vulnerable population, according to a paper published Friday in the journal BMC Infectious Diseases.
Homeless people in Toronto who had had COVID-19 were more than twice as likely to get it again than other people with housing, said leader Lucie Richard, senior research associate at the MAP Centre for Urban Health Solutions in St. Petersburg. John’s. Michael’s Hospital.
The higher reinfection rates are likely due to greater exposure to the virus, as homeless people are “forced to live in congregated, crowded shared settings that are open to transmission,” Richard said.
They are also more likely than the general public to suffer from underlying health problems that make them more vulnerable to disease, he said.
The researchers followed 381 homeless people who had previously been infected with COVID-19 for about a year. The study period lasted from June 2021 to October 2022 — a timeframe that began when the Delta variant was dominant and ended when the more infectious Omicron variant had taken hold.
They used PCR and immediate antigen tests to check for reinfections among the homeless group, comparing them to existing knowledge about the rate of reinfection in the general population, and found that it is twice as high.
But the researchers went a step further and also took blood samples provided through homeless participants. These serological tests detected even more COVID reinfections than PCR and immediate antigen tests.
This localization showed that knowledge of PCR underestimates infections, Richard said, noting that more serological testing needs to be done in the general population to get a more accurate reading of the extent of COVID reinfections in the era of Omicron and its subvariants.
“Omicron comes along, and all of a sudden, everyone who was already inflamed gets inflamed again. And other people who were never inflamed became inflamed for the first time,” Richard said.
When the results of the blood tests were factored in, the researchers found that about one-third of participants without homes had been reinfected with COVID-19 at least once.
Multiple infections can increase the threat of negative health consequences in the future, adding long COVID, Richard said.
Although more reinfections would likely be detected in the general population if blood tests were used, Richard and other experts not involved in the study agree that the risk of reinfection for people experiencing homelessness would still be disproportionately higher.
“We’re finding that some of those trends are occurring clinically and . . . from a patient care perspective,” said Dr. Andrew Boozary, number one care physician and executive director of the University Health Network’s Gattuso Centre for Social Medicine in Toronto.
“You can do everything you can and get out there to avoid COVID. But if you’re in a shelter where there are a much larger number of people, the air quality or the situations are different,” said Boozary, who was not interested in the study.
“This (research) follows previous studies showing that there were death rates five times higher for homelessness and other waves of COVID than for the general public,” he said.
Although the study was conducted in Toronto, the findings would apply to other cities as well, said Dr. Brian Conway, president and chief medical officer of the Vancouver Centre for Infectious Diseases.
“It’s a warning that we want to take care of our urban centers, especially our homeless (people),” said Conway, who also didn’t worry about the study.
“We have more homeless people. We have more people living in shelters and in our downtown, other people who are very inadequately housed in substandard housing,” she said.
Boozary and Conway shared Richard’s fear that higher rates of COVID reinfection would lead to a greater threat of long COVID among the homeless.
“When you look at the prospect of reinfection, and then the increased likelihood of long COVID, it just exacerbates disparities for other people who find themselves experiencing homelessness,” Boozary said.
“We know that there is already a higher rate of chronic ailments and chronic ailments that other homeless people have to deal with. And then when you get on board with this devastating long COVID syndrome. . . it’s devastating,” Array said.
Conway said it’s important to give people experiencing homelessness access to the latest COVID-19 vaccine targeting the XBB subvariant to help reduce reinfection, and it’s also important to address the housing issue.
“It isn’t us and them. It’s us and us. And these people are us, and they’re obviously living under circumstances that seem to have them reacquire COVID repeatedly. And we owe it to them to try and change those conditions,” he said.
This report via The Canadian Press was first published on February 2, 2024.
The Canadian Press’ fitness policy is supported by a partnership with the Canadian Medical Association. CP is for this content only.
Nicole Ireland, The Canadian Press
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