Assessment of SARS-CoV-2 infection through rapid serology testing in the homeless population in the City of Rome, Italy. Preliminary results

  • Massimo Ralli
    Department of Sense Organs, Sapienza University of Rome, Italy. https://orcid.org/0000-0001-8776-0421
  • Chiara Cedola
    Primary Care Services, Eleemosynaria Apostolica, Vatican City State.
  • Suleika Urbano
    Primary Care Services, Eleemosynaria Apostolica, Vatican City State.
  • Ottavio Latini
    San Gallicano Dermatological Institute IRCCS, Rome, Italy.
  • Natalia Shkodina
    Primary Care Services, Eleemosynaria Apostolica, Vatican City State.
  • Aldo Morrone
    Scientific Director, San Gallicano Dermatological Institute IRCCS, Rome, Italy. https://orcid.org/0000-0002-6108-8996
  • Andrea Arcangeli
    Direzione di Sanità ed Igiene, Vatican City State.
  • Lucia Ercoli
    Primary Care Services, Eleemosynaria Apostolica, Vatican City State.

ABSTRACT

Background: The development of COVID-19 pandemic has affected all segments of the population; however, it had a significant impact on vulnerable subjects, such as in people experiencing homelessness. The aim of this study was to evaluate the prevalence of COVID-19 spread in homeless persons in the city of Rome, Italy.

Design and Methods
: Patients included in the study underwent a clinical evaluation and rapid antibody analysis on capillary blood for the presence of immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies to SARS-CoV-2 virus. Symptomatic patients were not included in the screening and immediately referred to local hospitals for further evaluation.
Results: One-hundred seventy-three patients of both sexes were tested for SARS-CoV-2 infection through rapid serological test. Age range was 8-80 years; people came from 35 different countries of origin and 4 continents. Test results were negative for most patients (170-98.2%); two patients had positive IgM (1.2%) and one patient had positive IgG (0.6%).

Conclusions:
 Our study is the first to evaluate the prevalence of SARS-CoV-2 infection in people experiencing homelessness in the city of Rome, Italy. Most patients were negative for COVID-19, although several factors may have had an impact on this result, such as the exclusion of symptomatic patients, the limited sensitivity of rapid serological tests in the initial stage of infection and the prevention measures adopted in these populations. Larger studies on fragile populations are needed to prevent and intercept new clusters of infection in the upcoming months.

AUTHOR BIOGRAPHIES

Massimo Ralli, Department of Sense Organs, Sapienza University of Rome

Primary Care Services, Eleemosynaria Apostolica, Vatican City State

Chiara Cedola, Primary Care Services, Eleemosynaria Apostolica

Istituto di Medicina Solidale, Rome, Italy

Suleika Urbano, Primary Care Services, Eleemosynaria Apostolica

Istituto di Medicina Solidale, Rome, Italy

Natalia Shkodina, Primary Care Services, Eleemosynaria Apostolica

Istituto di Medicina Solidale, Rome, Italy

Andrea Arcangeli, Direzione di Sanità ed Igiene

Department of Emergency, Anesthesiology and Resuscitation Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Lucia Ercoli, Primary Care Services, Eleemosynaria Apostolica

Istituto di Medicina Solidale, Rome, Italy; Direzione di Sanità ed Igiene, Vatican City State; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy

REFERENCES

Tsai J, Wilson M. COVID-19: a potential public health problem for homeless populations. Lancet Public Health 2020;5:e186-e7. DOI: https://doi.org/10.1016/S2468-2667(20)30053-0

Bodkin C, Mokashi V, Beal K, et al. Pandemic planning in homeless shelters: A pilot study of a COVID-19 testing and support program to mitigate the risk of COVID-19 outbreaks in congregate settings. Clin Infect Dis 2020.

Lewer D, Braithwaite I, Bullock M, et al. COVID-19 among people experiencing homelessness in England: a modelling study. Lancet Respir Med 2020;8:1181-91. DOI: https://doi.org/10.1016/S2213-2600(20)30396-9

Schiff R, Buccieri K, Schiff JW, et al. COVID-19 and pandemic planning in the context of rural and remote homelessness. Can J Public Health 2020. DOI: https://doi.org/10.17269/s41997-020-00415-1

Albon D, Soper M, Haro A. Potential implications of the COVID-19 pandemic on the homeless population. Chest 2020;158:477-8. DOI: https://doi.org/10.1016/j.chest.2020.03.057

Mosites E, Parker EM, Clarke KEN, et al. Assessment of SARS-CoV-2 infection prevalence in homeless shelters – Four U.S. Cities, March 27-April 15, 2020. MMWR Morb Mortal Wkly Rep 2020;69:521-2. DOI: https://doi.org/10.15585/mmwr.mm6917e1

Lima NNR, de Souza RI, Feitosa PWG, et al. People experiencing homelessness: Their potential exposure to COVID-19. Psychiatry Res 2020;288:112945. DOI: https://doi.org/10.1016/j.psychres.2020.112945

Ralli M, Cedola C, Urbano S, et al.Homeless persons and migrants in precarious housing conditions and COVID-19 pandemic: peculiarities and prevention strategies. Eur Rev Med Pharmacol Sci 2020;24:9765-7.

Miller JP, Phillips G, Hutton J, et al. COVID-19 and emergency care for adults experiencing homelessness. Emerg Med Australas 2020;32:1084-6. DOI: https://doi.org/10.1111/1742-6723.13652

Flook M, Grohmann S, Stagg HR. Hard to reach: COVID-19 responses and the complexities of homelessness. Lancet Respir Med 2020;8:1160-1. DOI: https://doi.org/10.1016/S2213-2600(20)30446-X

Karb R, Samuels E, Vanjani R, et al. Homeless shelter characteristics and prevalence of SARS-CoV-2. West J Emerg Med 2020;21:1048-53. DOI: https://doi.org/10.5811/westjem.2020.7.48725

Yoon JC, Montgomery MP, Buff AM, et al. COVID-19 prevalence among people experiencing homelessness and homelessness service staff during early community transmission in Atlanta, Georgia, April-May 2020. Clin Infect Dis 2020. DOI: https://doi.org/10.1093/cid/ciaa1340

Barbieri A. CoViD-19 in Italy: homeless population needs protection. Recenti Prog Med 2020;111:295-6.

Grove BP, Ver C, Mohanan S. COVID-19's impact on health disparities. Am Fam Physician 2020;102:326.

Mesa Vieira C, Franco OH, Gomez Restrepo C, Abel T. COVID-19: The forgotten priorities of the pandemic. Maturitas 2020;136:38-41. DOI: https://doi.org/10.1016/j.maturitas.2020.04.004

Perri M, Dosani N, Hwang SW. COVID-19 and people experiencing homelessness: challenges and mitigation strategies. CMAJ 2020;192:e716-9. DOI: https://doi.org/10.1503/cmaj.200834

Imbert E, Kinley PM, Scarborough A, et al. Coronavirus Disease 2019 (COVID-19) outbreak in a San Francisco homeless shelter. Clin Infect Dis 2020. DOI: https://doi.org/10.1093/cid/ciaa1071

Kelly D, Murphy H, Vadlamudi R, et al. Successful public health measures preventing coronavirus disease 2019 (COVID-19) at a Michigan homeless shelter. Infect Control Hosp Epidemiol 2020. DOI: https://doi.org/10.1017/ice.2020.439

Tobolowsky FA, Gonzales E, Self JL, et al. COVID-19 outbreak among three affiliated homeless service sites – King County, Washington, 2020. MMWR Morb Mortal Wkly Rep 2020;69:523-6. DOI: https://doi.org/10.15585/mmwr.mm6917e2

Tsai J, Gelberg L, Rosenheck RA. Changes in physical health after supported housing: results from the collaborative initiative to end chronic homelessness. J Gen Intern Med 2019;34:1703-8. DOI: https://doi.org/10.1007/s11606-019-05070-y

Maremmani AG, Bacciardi S, Gehring ND, et al. Substance use among homeless individuals with schizophrenia and bipolar disorder. J Nerv Ment Dis 2017;205:173-7. DOI: https://doi.org/10.1097/NMD.0000000000000462

Gelberg L, Andersen RM, Leake BD. The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res 2000;34:1273-302.

De Maio G, Van den Bergh R, Garelli S, et al. Reaching out to the forgotten: providing access to medical care for the homeless in Italy. Int Health 2014;6:93-8. DOI: https://doi.org/10.1093/inthealth/ihu002

Laurenti P, Bruno S, Quaranta G, et al. Tuberculosis in sheltered homeless population of Rome: an integrated model of recruitment for risk management. ScientificWorldJournal 2012;2012:396302. DOI: https://doi.org/10.1100/2012/396302

Atella V, Deb P, Kopinska J. Heterogeneity in long term health outcomes of migrants within Italy. J Health Econ 2019;63:19-33. DOI: https://doi.org/10.1016/j.jhealeco.2018.10.002

Di Meco E, Di Napoli A, Amato LM, et al. Infectious and dermatological diseases among arriving migrants on the Italian coasts. Eur J Public Health 2018;28:910-6. DOI: https://doi.org/10.1093/eurpub/cky126

D'Egidio V, Mipatrini D, Massetti AP, et al. How are the undocumented migrants in Rome? Assessment of quality of life and its determinants among migrant population. J Public Health (Oxf) 2017;39:440-6.

Deeks JJ, Dinnes J, Takwoingi Y, et al. Antibody tests for identification of current and past infection with SARS-CoV-2. Cochrane Database Syst Rev 2020;6:CD013652. DOI: https://doi.org/10.1002/14651858.CD013652

Ong DSY, de Man SJ, Lindeboom FA, Koeleman JGM. Comparison of diagnostic accuracies of rapid serological tests and ELISA to molecular diagnostics in patients with suspected coronavirus disease 2019 presenting to the hospital. Clin Microbiol Infect 2020;26:1094. DOI: https://doi.org/10.1016/j.cmi.2020.05.028

Van Elslande J, Houben E, Depypere M, et al. Diagnostic performance of seven rapid IgG/IgM antibody tests and the Euroimmun IgA/IgG ELISA in COVID-19 patients. Clin Microbiol Infect 2020;26:1082-7. DOI: https://doi.org/10.1016/j.cmi.2020.05.023

Moura DTH, McCarty TR, Ribeiro IB, et al. Diagnostic characteristics of serological-based COVID-19 testing: A systematic review and meta-analysis. Clinics (Sao Paulo) 2020;75:e2212. DOI: https://doi.org/10.6061/clinics/2020/e2212

Lisboa Bastos M, Tavaziva G, Abidi SK, et al. Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. BMJ 2020;370:m2516. DOI: https://doi.org/10.1136/bmj.m2516

Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020;55:2001260. DOI: https://doi.org/10.1183/13993003.01260-2020