COVID: Asymptomatic homeless patients in Boston


Jim O'Connell and Jessie Gaeta from Boston HealthCare for the Homeless responded to the blog on asymptomatic OB patients (http://gmodestmedblogs.blogspot.com/2020/04/covid-asymptomatic-ob-patients.html) with the following eye-popping account:



The issue of testing has been particularly acute in our homeless population and we are trying to get CDC to pay closer attention to these vulnerable folks living in shelters throughout the country.  The unavailability of tests and testing supplies is appalling and an issue of equity.

After a small cluster of initial COVID+ folks at Pine Street Inn, DPH allowed us to do a one-time testing of all the guests at the shelter about 10 days ago.  To our surprise, 146 of the 397 guests tested positive, and not a single one had a fever or symptoms.  Our screening tool, which we had been using at all of the shelters at great effort and energy, turns out to be 0% sensitive.

We admitted 52 of these folks to our COVID floor at McInnis House and another 84 to the beds at the old Kindred Hospital that we opened together with the BPHC.  And over the weekend, we opened the 500-bed medical shelter for COVID+ homeless persons at the Convention Center (alongside Partners' 500-bed field hospital).   Interestingly, most of these folks did not develop any symptoms in the week since testing, and only one became ill enough to be transferred to BMC. 

All of this was orchestrated by the amazing Jessie Gaeta along with Barry Bock our CEO.  Travis Baggett has been working on the evaluation and there should be a pre-print online version of these results today or tomorrow.

The issue for me revolves around the other shelters in town given that there is no capacity as yet to do universal testing.  I suspect we have many asymptomatic homeless folks who are unknowingly transmitting the virus to the others in those shelters (not to mention wandering around town each day).  

So we are yet another voice crying in the wilderness about the critical need for testing, especially of select populations forced to stay in shelters, prisons, nursing homes.


i did add the bold above.  i will send out the pre-print online version of this when it is available.

we are so handicapped by not having adequate rapid tests available for testing mildly symptomatic people: those who are prodromic (though highly communicable to others, before the cough and fever combo that happens later) as well as exposed and some asymptomatic ones...

geoff​

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