Factors associated with SARS-CoV-2 positivity in 20 homeless shelters in Toronto, Canada, from April to July 2020: a repeated cross-sectional study

Tara Kiran; Amy Craig-Neil; Paul Das; Joel Lockwood; Ri Wang; Nikki Nathanielsz; Esther Rosenthal; Carolyn Snider; Stephen W. Hwang

doi:10.9778/cmajo.20200253

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Figure 1:
Shelter positivity rate versus 7-day rolling average of new COVID-19 cases in Toronto. Letters refer to individual shelters.

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Table 1:

Sociodemographic and health characteristics, shelter use and symptom prevalence for residents tested during mobile outreach

Characteristic	No. (%) of shelter residents^*^† n = 872
Age, yr
0–15	38 (4.4)
16–24	37 (4.2)
25–49	417 (47.9)
50–64	277 (31.8)
> 65	102 (11.7)
Age, mean ± SD, yr	45.8 ± 16.3
Sex, female	159 (18.3)
Provincial health insurance number available	589 (67.6)
Race
Black	77 (23.0)
East or Southeast Asian	23 (6.9)
Latino	9 (2.7)
Middle Eastern	9 (2.7)
South Asian	22 (6.6)
White	134 (40.0)
Other	34 (10.1)
Prefer not to disclose	27 (8.0)
Past medical history
Any chronic condition	248 (81.6)
CV disease	17 (5.6)
Chronic lung disease	19 (6.2)
HIV	9 (3.0)
Diabetes	26 (8.6)
Current smoker	168 (55.3)
Mental health diagnosis	82 (27.0)
Substance use	93 (30.6)
Other	38 (12.5)
Prefer not to disclose	25 (8.2)
Symptoms
Any symptoms	32 (9.7)
Cough	20 (6.0)
Shortness of breath^‡	− (< 2.0)
Fever	0 (0.0)
Other	12 (3.6)
Visited another shelter in last 14 days	41 (11.8)

Note: CV = cardiovascular, SD = standard deviation
↵* Unless indicated otherwise.
↵† 871 residents reported age and 868 reported sex. Race (n = 335), past medical history (n = 304), symptoms (n = 331) and whether the individual visited another shelter (n = 348) were based on demographic information collected for only 348 respondents.
↵‡ Exact number suppressed for confidentiality.

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Table 2:

Comparison of sociodemographic and health characteristics, symptom prevalence, and shelter use for residents who did or did not test positive for SARS-CoV-2 at shelter test dates where there was more than one positive case^*

Characteristic	No. (%) of residents^†		Adjusted odds ratio^‡ (95% CI)	p value
Characteristic	Positive for SARS-CoV-2 n = 78	Negative for SARS-CoV-2 n = 326	Adjusted odds ratio^‡ (95% CI)	p value
Age, yr				0.31
0–15	7 (9.0)	31 (9.5)	Reference
16–49	34 (43.6)	141 (43.3)	0.74 (0.18 to 2.74)
50–64	23 (29.5)	113 (34.7)	0.65 (0.14 to 2.74)
> 65	14 (18.0)	41 (12.6)	1.36 (0.27 to 6.17)
Age, mean ± SD, yr	48.3 ± 18.0	45.5 ± 18.5	1.00 (1.00 to 1.00)	0.08
Sex, female	6 (7.7)	35 (10.7)	1.46 (0.38 to 5.45)	0.57
Provincial health insurance number available	42 (53.9)	236 (72.4)	1.87 (1.08 to 3.24)	0.03
Race				0.20
Racialized	26 (61.9)	90 (47.6)	1.98 (0.94 to 4.37)
White	12 (25.0-30.0)	82 (43.5)	Reference
Prefer not to disclose	> 6 (5.0-10.0)	17 (9.0)	1.58 (0.39 to 5.33)
Past medical history				0.40
Any chronic condition	28 (77.8)	142 (82.8)	1.48 (0.57 to 3.55)
Symptoms				0.43
Any symptom	> 6 (> 15.0)	17 (8.6)	0.64 (0.23 to 2.08)
Visited another shelter in last 14 days	0 (0.0)	35 (17.7)	N/A	< 0.01

Note: CI = confidence interval, N/A = not applicable, SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2, SD = standard deviation.
↵* The following shelters and dates were included in the analysis: Shelter A (Apr. 23); Shelter A (May 6); Shelter A (May 8); Shelter E (May 21); Shelter A (May 26); Shelter F (May 28); Shelter F (June 1); Shelter H (June 11). Detailed demographic information was collected for 44 residents who tested positive for SARS-CoV-2 and 198 residents who tested negative for SARS-CoV-2, including race (n = 42 and n = 198, respectively), past medical history (n = 36 and n = 173, respectively), symptoms (n = 44 and n = 198, respectively) and whether the individual visited another shelter (n = 44 and n = 198, respectively).
↵† Cell sizes > 6 have been suppressed.
↵‡ Odds ratio is adjusted for shelter site.