14 ms·

Covid-19 at a homeless shelter in Boston: Implications for universal testing

209 points by stillsut 6y ago

zadkey 6y ago
(Regarding the Headline) Surely you mean 35% of homeless who were tested. We can't say for certain that the sample is an exact representation of the general population of the homeless in Boston. "Upon observing a cluster of COVID-19 cases from a single large homeless shelter in Boston, Boston Health Care for the Homeless Program conducted symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2 among all guests residing at the shelter over a 2-day period. Of 408 participants, 147 (36.0%) were PCR-positive for SARS-CoV-2" The key thing here is they tested people from one single homeless shelter. Is this one homeless shelter in Boston representative of all homeless shelters in Boston? There is not enough info in this article to make that assumption. Nor is it enough information to make generalizations about the populations of the homeless who do not live in shelters.
- smallgovt 6y ago
  > We can't say for certain that the sample is an exact representation of the general population. I actually think we can say for certain this is NOT a good representation of the general population. The general population has not been living in close quarters with multiple COVID positive people.
- basseq 6y ago
  This is fair feedback on the headline, as the linked article does NOT make that claim. Instead, it makes the same point as @zadkey that "illustrate the rapidity with which COVID-19 can be widely transmitted in a homeless shelter setting and suggest that universal PCR testing, rather than a symptom triggered approach, may be a better strategy for identifying and mitigating COVID-19 among people experiencing homelessness."
- dang 6y ago
  We've changed the title in accordance with the site guidelines. Submitted title was 'Boston study finds 35% of homeless are Covid+ (via PCR)'
rb808 6y ago
Also 15% of pregnant Moms in NYC had the virus. This could already be much more widely spread that people think. https://www.nbcnewyork.com/news/local/nyc-hospital-finds-high-covid-19-infection-rate-but-few-symptoms-in-pregnant-women/2372863/ https://www.nbcnewyork.com/news/local/nyc-hospital-finds-hig...
- easytiger 6y ago
  Yup. And for far longer.
  - gnulinux 6y ago
    It seems to indicate this disease infected a lot more than what we see, and maybe mortality rate is lower than what we currently assume. Maybe it's around 0.1% to 0.5%. So is it possible this disease appeared in China way before December, maybe a few months back. Then in December it reached a saturation point (i.e. infected hundreds of thousands of people, so deaths started to get noticed by respiratory specialists). Then around January/February this disease spread to the world, but it went unnoticed. Then in March it reached the same saturation point that the deaths became too many not to notice. Is this a realistic scenario?
    - raphlinus 6y ago
      No. We know from genomic analysis [1] that "The common ancestor of circulating viruses appears to have emerged in Wuhan, China, in late Nov or early Dec 2019." It's fun to speculate about other possibilities, but I personally like to stick to what the science tells us. [1]: https://twitter.com/nextstrain/status/1248707010750640128 https://twitter.com/nextstrain/status/1248707010750640128
      - gnulinux 6y ago
        Very interesting, thanks for the link. In that case, how should that change our mental model? It seems like more people in Western countries are infected than visible, doesn't that mean the same would apply to China? How would it spread so fast in December?
jcp2fa 6y ago
> Cough (7.5%), shortness of breath (1.4%), and fever (0.7%) were all uncommon among COVID-positive individuals It seems the more important point here is that the majority of the COVID-positive individuals were asymptomatic, putting another datapoint towards the conclusion that there are orders of magnitude more people that have this disease than have tested positive. We need more studies to gather data on these asymptomatic cases if we want to reopen the economy soon. Imagine if 10+% of the population already had COVID and where immune, we'd be much closer to heard immunity than we currently think.
- drtillberg 6y ago
  There are several variables here but it's also important to keep in mind that the 36% positive rate in this cohort presumably does not include people who had the virus and recovered.
  - gnulinux 6y ago
    A Diamond Princess ex-passenger died as late as March 24. The first patient was tested positive on February 1, and the ship was quarantined on Feb 4, and everyone left the ship on March 1. It doesn't seem unlikely you can die from this virus a month (or even two months?) after testing positive. Or maybe I'm missing something?
    - irishcoffee 6y ago
      Occams Razor would suggest that they may not have caught the virus on the boat then but perhaps after, no?
      - gowld 6y ago
        Why? 23 days for the longest time to succumb isn't surprisingly long. small exposure, healthy person / lucky genes, good medical treatment, but not quite healthy/lucky/good enough.
        6y ago
kens 6y ago
Regarding the title "Covid+", it seems that most people (even on the news) don't care about the difference between SARS-CoV-2 (the virus) and COVID-19 (the disease). Is this distinction being abandoned? (I'm not trying to be pedantic here; I'm just curious about the common usage.)
- _bxg1 6y ago
  For the practical purposes of decision-making by regular people, the distinction probably doesn't matter and would be confusing
- gowld 6y ago
  "Covid+" was a tweet, not the research article. As always, the distinction between two tightly bound things is not important when you talking about features common to both, such as which people have them. Humans tend to migrate toward shorter more pronouncable, easier to type terms. Language evolves like a virus ;-) https://www.merriam-webster.com/words-at-play/synecdoche-metonymy-usage-differences https://www.merriam-webster.com/words-at-play/synecdoche-met...
- marcosdumay 6y ago
  Nobody ever cared. The names are confusing (the virus is named after the disease, and the disease after the virus), and the virus name obtuse. The obvious consequence is that nobody ever used the virus name, and never will. The best you can hope for is for people to call it the "COVID19 virus".
- RandallBrown 6y ago
  SARS-CoV-2 vs. COVID-19 vs. Coronavirus vs. Covid Doesn't matter for nearly 100% of my daily discussion about the pandemic. I typically say Coronavirus or sometimes covid because it's faster to say or type.
- casefields 6y ago
  "I am realizing more and more how unusual, unscientific, unmedical, and counterproductive it is for WHO to select the name #COVID19 and reject SARS2. In fact it would be most consistent with medical practice to just call it SARS. Here's why..." https://threadreaderapp.com/thread/1245791851342229504.html https://threadreaderapp.com/thread/1245791851342229504.html
downerending 6y ago
As always, "compared to what?". If non-homeless, demographically matched, are also around 35%, this might not mean much.
turbostyler 6y ago
I'm surprised it's that low.
- deleted 6y ago
  [deleted]
joshypants 6y ago
Lots of comments here about what this means for asymptomatic spread amongst the housed population. Is it too obvious to be said that the government needs to house homeless people in hotels immediately, and that group shelters are going to get people killed? 62 comments as of writing and no one is talking about unhoused people as if they are worth considering for their own sake.
hairytrog 6y ago
A good dose of skepticism: https://swprs.org/contact/ https://swprs.org/contact/
- jshevek 6y ago
  Most of the links on that page are unrelated to COVID19. Three were related. Are you recommending one of those three? Which?
analog31 6y ago
I certainly don't have a better read on the numbers than anybody else. But I think that the rising number of reported cases and deaths is going to make it harder and harder to think that there is a huge hidden pool of asymptomatic or immune people in the population. For instance as of today, the number of unreported to reported cases in the US can't be more than about 500. The time period when the disease could have been prevalent in the US can't have been very long, because at its present level it kills about 15000 per week -- a number that could not have gone unnoticed even a month ago. Eventually, the curves of hopes, reported data, and reality will all have to intersect, I just don't know where or when.
dfsajlkjadfalk 6y ago
Open America Now!
JulianMorrison 6y ago
I really wish they'd tested inability to smell/taste as a symptom. I'd be interested to see if it leads other symptoms.

209 points by stillsut 6y ago

(Regarding the Headline) Surely you mean 35% of homeless who were tested. We can't say for certain that the sample is an exact representation of the general population of the homeless in Boston. "Upon observing a cluster of COVID-19 cases from a single large homeless shelter in Boston, Boston Health Care for the Homeless Program conducted symptom assessments and polymerase chain reaction (PCR) testing for SARS-CoV-2 among all guests residing at the shelter over a 2-day period. Of 408 participants, 147 (36.0%) were PCR-positive for SARS-CoV-2" The key thing here is they tested people from one single homeless shelter. Is this one homeless shelter in Boston representative of all homeless shelters in Boston? There is not enough info in this article to make that assumption. Nor is it enough information to make generalizations about the populations of the homeless who do not live in shelters.

smallgovt 6y ago
> We can't say for certain that the sample is an exact representation of the general population. I actually think we can say for certain this is NOT a good representation of the general population. The general population has not been living in close quarters with multiple COVID positive people.
basseq 6y ago
This is fair feedback on the headline, as the linked article does NOT make that claim. Instead, it makes the same point as @zadkey that "illustrate the rapidity with which COVID-19 can be widely transmitted in a homeless shelter setting and suggest that universal PCR testing, rather than a symptom triggered approach, may be a better strategy for identifying and mitigating COVID-19 among people experiencing homelessness."
dang 6y ago
We've changed the title in accordance with the site guidelines. Submitted title was 'Boston study finds 35% of homeless are Covid+ (via PCR)'

rb808 6y ago

Also 15% of pregnant Moms in NYC had the virus. This could already be much more widely spread that people think. https://www.nbcnewyork.com/news/local/nyc-hospital-finds-high-covid-19-infection-rate-but-few-symptoms-in-pregnant-women/2372863/ https://www.nbcnewyork.com/news/local/nyc-hospital-finds-hig...

easytiger 6y ago
Yup. And for far longer.
- gnulinux 6y ago
  It seems to indicate this disease infected a lot more than what we see, and maybe mortality rate is lower than what we currently assume. Maybe it's around 0.1% to 0.5%. So is it possible this disease appeared in China way before December, maybe a few months back. Then in December it reached a saturation point (i.e. infected hundreds of thousands of people, so deaths started to get noticed by respiratory specialists). Then around January/February this disease spread to the world, but it went unnoticed. Then in March it reached the same saturation point that the deaths became too many not to notice. Is this a realistic scenario?
  - raphlinus 6y ago
    No. We know from genomic analysis [1] that "The common ancestor of circulating viruses appears to have emerged in Wuhan, China, in late Nov or early Dec 2019." It's fun to speculate about other possibilities, but I personally like to stick to what the science tells us. [1]: https://twitter.com/nextstrain/status/1248707010750640128 https://twitter.com/nextstrain/status/1248707010750640128
    - gnulinux 6y ago
      Very interesting, thanks for the link. In that case, how should that change our mental model? It seems like more people in Western countries are infected than visible, doesn't that mean the same would apply to China? How would it spread so fast in December?

jcp2fa 6y ago

> Cough (7.5%), shortness of breath (1.4%), and fever (0.7%) were all uncommon among COVID-positive individuals It seems the more important point here is that the majority of the COVID-positive individuals were asymptomatic, putting another datapoint towards the conclusion that there are orders of magnitude more people that have this disease than have tested positive. We need more studies to gather data on these asymptomatic cases if we want to reopen the economy soon. Imagine if 10+% of the population already had COVID and where immune, we'd be much closer to heard immunity than we currently think.

drtillberg 6y ago
There are several variables here but it's also important to keep in mind that the 36% positive rate in this cohort presumably does not include people who had the virus and recovered.
- gnulinux 6y ago
  A Diamond Princess ex-passenger died as late as March 24. The first patient was tested positive on February 1, and the ship was quarantined on Feb 4, and everyone left the ship on March 1. It doesn't seem unlikely you can die from this virus a month (or even two months?) after testing positive. Or maybe I'm missing something?
  - irishcoffee 6y ago
    Occams Razor would suggest that they may not have caught the virus on the boat then but perhaps after, no?
    - gowld 6y ago
      Why? 23 days for the longest time to succumb isn't surprisingly long. small exposure, healthy person / lucky genes, good medical treatment, but not quite healthy/lucky/good enough.
      - 6y ago

kens 6y ago

Regarding the title "Covid+", it seems that most people (even on the news) don't care about the difference between SARS-CoV-2 (the virus) and COVID-19 (the disease). Is this distinction being abandoned? (I'm not trying to be pedantic here; I'm just curious about the common usage.)

_bxg1 6y ago
For the practical purposes of decision-making by regular people, the distinction probably doesn't matter and would be confusing
gowld 6y ago
"Covid+" was a tweet, not the research article. As always, the distinction between two tightly bound things is not important when you talking about features common to both, such as which people have them. Humans tend to migrate toward shorter more pronouncable, easier to type terms. Language evolves like a virus ;-) https://www.merriam-webster.com/words-at-play/synecdoche-metonymy-usage-differences https://www.merriam-webster.com/words-at-play/synecdoche-met...
marcosdumay 6y ago
Nobody ever cared. The names are confusing (the virus is named after the disease, and the disease after the virus), and the virus name obtuse. The obvious consequence is that nobody ever used the virus name, and never will. The best you can hope for is for people to call it the "COVID19 virus".
RandallBrown 6y ago
SARS-CoV-2 vs. COVID-19 vs. Coronavirus vs. Covid Doesn't matter for nearly 100% of my daily discussion about the pandemic. I typically say Coronavirus or sometimes covid because it's faster to say or type.
casefields 6y ago
"I am realizing more and more how unusual, unscientific, unmedical, and counterproductive it is for WHO to select the name #COVID19 and reject SARS2. In fact it would be most consistent with medical practice to just call it SARS. Here's why..." https://threadreaderapp.com/thread/1245791851342229504.html https://threadreaderapp.com/thread/1245791851342229504.html

downerending 6y ago

As always, "compared to what?". If non-homeless, demographically matched, are also around 35%, this might not mean much.

turbostyler 6y ago

I'm surprised it's that low.

deleted 6y ago
[deleted]

joshypants 6y ago

Lots of comments here about what this means for asymptomatic spread amongst the housed population. Is it too obvious to be said that the government needs to house homeless people in hotels immediately, and that group shelters are going to get people killed? 62 comments as of writing and no one is talking about unhoused people as if they are worth considering for their own sake.

hairytrog 6y ago

A good dose of skepticism: https://swprs.org/contact/ https://swprs.org/contact/

jshevek 6y ago
Most of the links on that page are unrelated to COVID19. Three were related. Are you recommending one of those three? Which?

analog31 6y ago

I certainly don't have a better read on the numbers than anybody else. But I think that the rising number of reported cases and deaths is going to make it harder and harder to think that there is a huge hidden pool of asymptomatic or immune people in the population. For instance as of today, the number of unreported to reported cases in the US can't be more than about 500. The time period when the disease could have been prevalent in the US can't have been very long, because at its present level it kills about 15000 per week -- a number that could not have gone unnoticed even a month ago. Eventually, the curves of hopes, reported data, and reality will all have to intersect, I just don't know where or when.

dfsajlkjadfalk 6y ago

Open America Now!

JulianMorrison 6y ago

I really wish they'd tested inability to smell/taste as a symptom. I'd be interested to see if it leads other symptoms.