LAUSR

To the Editor: We read with interest the article by Rebecca Karb et al1 titled “Homeless shelter characteristics and prevalence of SARS-CoV-2,” published in the Western Journal of Emergency Medicine. We appreciated the authors focusing on people experiencing homelessness, a population that has been particularly impacted by the recent coronavirus disease 19 (COVID-19) pandemic and that is more at risk of contracting COVID-19 for specific environmental and individual characteristics.2 In this article, the authors compared the characteristics of five different homeless shelters in Rhode Island, USA, and evaluated the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection among their residents (n = 299) using reverse transcription polymerase chain reaction (RT-PCR) nasopharyngeal swabbing. The overall prevalence across all shelters was 11.7%; however, a large difference was found between shelters, as 3/5 had no cases while two had 21.6% and 35.3% of positive cases, respectively. The authors concluded that shelters with more transient residents, higher occupation rate, admission of new residents, and absence of daily education had a higher prevalence of SARS-CoV-2 infection.1 In addition, the authors highlighted the importance of the population density of the neighborhood; in fact, shelters in more densely populated areas had a higher prevalence of COVID-19.1 Our group performed an active surveillance over a period of six months (April-September 2020) in a cohort of nearly 200 homeless persons living in shelters in the downtown area of Rome, Italy, through the medical facilities of the Eleemosynaria Apostolica, Holy See; they included the Madre di Misericordia Primary Care Center, an advanced mobile medical unit and an ambulance. In these persons, hosted in homeless shelters managed by the Eleemosynaria Apostolica, prevention strategies were adopted including the use of face masks and hygienizing gels by residents and staff, adequate social distancing, daily Sapienza University of Rome, Department of Sense Organs, Rome, Italy Eleemosynaria Apostolica, Primary Care Services, Vatican City State Directorate of Health and Hygiene, Vatican City State Fondazione Policlinico Universitario A. Gemelli IRCCS, Department of Anesthesiology, Intensive Care and Emergency Medicine, Rome, Italy Scientific Director, San Gallicano Dermatological Institute, IRCCS, Rome, Italy Tor Vergata University of Rome, Department of Biomedicine and Prevention, Rome, Italy * †