Background A better understanding of the risk for coronavirus disease 2019 (COVID-19) that people experiencing homelessness (PEH) face in congregate shelters versus unsheltered encampments is critical for an effective pandemic response. Methods We analyzed factors associated with current and past severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among PEH in day and overnight shelters and encampments in Denver, Colorado, during June 2–July 28, 2020, and constructed multivariable logistic regression models to examine risk factors for SARS-CoV-2 RNA and seropositivity with age, race/ethnicity, testing location, testing month, and symptom status as predictor variables. Results A total of 823 participants were tested for SARS-CoV-2 RNA, and 276 individuals were tested for SARS-CoV-2 antibodies. A greater percentage of PEH at overnight shelters tested positive for SARS-CoV-2 RNA (8.6% vs 2.5%, P < .01) and antibodies (21.5% vs 8.7%, P = .03) compared with encampments. In regression models, testing at an overnight shelter compared with testing at encampments (odds ratio [OR] = 3.03, 95% confidence interval [CI]: 1.16–9.02) had increased odds of a positive SARS-CoV-2 RNA result. Age >60 years compared with age <40 years (OR = 5.92; 95% CI: 1.83–20.3), Hispanic ethnicity (OR = 3.43; 95% CI: 1.36–8.95), and non-Hispanic Black race compared with non-Hispanic White race (OR = 3.07; 95% CI: 1.16–8.26), and testing at an overnight shelter compared to testing at encampments (OR = 2.45; 95% CI: 1.04–6.17) had increased odds of a positive antibody result. Conclusions Our findings support the need for continuing assessment of mitigation strategies in shelters, increasing access to individual rooms and linkage to housing options for PEH, and supporting people to remain in encampments when these options are not available.

中文翻译：

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与过夜避难所相比，在户外营地测试的无家可归者中严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 感染的患病率较低：科罗拉多州丹佛市，2020 年 6 月至 7 月

背景 更好地了解无家可归者 (PEH) 在聚集避难所和无遮蔽营地中面临的 2019 年冠状病毒病 (COVID-19) 风险对于有效应对大流行至关重要。方法 我们分析了 2020 年 6 月 2 日至 7 月 28 日期间在科罗拉多州丹佛市的日间和夜间避难所和营地中 PEH 中当前和过去严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 感染的相关因素，并构建了多变量逻辑回归模型，以年龄、种族/民族、测试地点、测试月份和症状状态作为预测变量来检查 SARS-CoV-2 RNA 和血清阳性的风险因素。结果共有 823 名参与者接受了 SARS-CoV-2 RNA 检测，276 名参与者接受了 SARS-CoV-2 抗体检测。与营地相比，过夜避难所中更多的 PEH 检测出 SARS-CoV-2 RNA（8.6% 对 2.5%，P < .01）和抗体（21.5% 对 8.7%，P = .03）呈阳性。在回归模型中，与在营地进行的测试相比，在过夜避难所进行的测试（优势比 [OR] = 3.03，95% 置信区间 [CI]：1.16-9.02）增加了 SARS-CoV-2 RNA 结果阳性的可能性。年龄＞60 岁与年龄＜40 岁（OR = 5.92；95% CI：1.83-20.3）、西班牙裔（OR = 3.43；95% CI：1.36-8.95）和非西班牙裔黑人种族相比非西班牙裔白人（OR = 3.07；95% CI：1.16-8.26），与在营地测试相比，在过夜避难所进行测试（OR = 2.45；95% CI：1.04-6.17）增加了抗体阳性的几率结果。