People experiencing homelessness are more likely to be infected with and die of COVID-19 than the general Ontario population

In Ontario, people experiencing homelessness were more likely to be tested, test positive, be hospitalized, receive intensive care for, and die of COVID-19 compared to the general population, according to a new study by researchers at ICES and Lawson Health Research Institute.

The study, published today in CMAJ Open, examined COVID-19 testing in Ontario, measuring test positivity and complications (i.e. hospitalization; admission to intensive care; and death within 21 days of a positive test) between January 23 and July 31, 2020. The researchers compared individuals with a recent history of homelessness and community-dwelling individuals.

“Legitimate concerns exist about the impact of the COVID-19 pandemic on persons experiencing homelessness. In Ontario, we found that during the first wave, this vulnerable population was more likely to test positive for COVID-19, even once priority testing was relaxed, and substantially more likely to experience COVID-19 related complications,” says Lucie Richard, lead author of the study and research analyst at ICES Western.

The study of 29,407 individuals with a recent history of homelessness showed, once testing was equally available to all Ontarians, that the homeless were:

• 45 per cent more likely to be tested (287.4 per 1,000 vs. 87.4/1,000)
• 76 per cent more likely to test positive (9.3 per 1,000 vs. 2.0/1,000)

At the height of the first wave, individuals with a recent history of homelessness were also:

• Over 20 times more likely to be hospitalized with COVID-19 (3.5 per 1,000 vs. 0.2/1,000)
• Over 10 times more likely to be admitted into intensive care with COVID-19 (0.51 per 1,000 vs. 0.07/1,000)
• Over 5 times more likely to die within 21 days of a COVID-19 infection (0.34 per 1,000 vs. 0.05/1,000)

Given incomplete data on homelessness, the study likely represents only about a third of people with a recent history of homelessness. Among the 29,407 individuals studied, 8,451 individuals tested for SARS-CoV-2 were identified, of whom 274 tested positive. Of these, 104 were admitted to hospital with COVID-19, including 15 admitted to ICU, and a total of 10 died within 21 days of their positive test diagnosis.

“This pandemic has highlighted health inequities that exist across the globe. For persons experiencing homelessness, high population density in shelters and high rates of morbidity has put them at increased risk from COVID-19. Our findings illustrate that the pandemic has taken a heavy toll on this vulnerable population.” says Dr. Salimah Shariff, senior author on the study and ICES scientist.

While numerous shelters have reported COVID-19 outbreaks, the researchers say little research has been done on the risk faced by people experiencing homelessness relative to the general population in Canada, in part because accurately capturing the homeless population is a challenge. The homeless population in this study was identified using a newly validated case definition that leverages administrative data collected during hospital health encounters. Previous work estimated that 1 in 200 Ontario adults experienced homelessness in 2016.

The researchers add that their findings corroborate recent warnings from experts about the risk faced by people experiencing homelessness during the pandemic, underscoring the value of measures aimed to protect this population from outbreaks.

Author block: Lucie Richard, Richard Booth, Jennifer Rayner, Kristin K. Clemens, Cheryl Forchuk and Salimah Z. Shariff.

The article “Testing, infection and complication rates of coronavirus disease 2019 (COVID-19) among people with a recent history of homelessness in Ontario, Canada: a retrospective cohort study,” is published in the January 12, 2021 issue of CMAJ Open.

About Lawson Health Research Institute 
As the research institute of London Health Sciences Centre and St. Joseph's Healthcare London, and working in partnership with Western University, Lawson Health Research Institute is committed to furthering scientific knowledge to advance healthcare around the world. www.lawsonresearch.ca 

For more information, please contact:

Deborah Creatura
Communications Strategist, ICES
[email protected]
647-406-5996