COVID-19 can spread rapidly within and between congregate housing facilities, such as homeless shelters. COVID-19 in homeless shelters, however, has not been well described.

What is added by this report? On April 1, 2020, a COVID-19 outbreak was detected at three affiliated homeless shelters. Testing for SARS-CoV-2 immediately offered to all residents and staff members identified additional unrecognized COVID-19 cases. Enhanced Surveillance and repeat tTesting identified and confirmed COVID-19 in 43 persons at these sites.

What are the implications for public health practice? Interrupting COVID-19 Transmission in homeless shelters is challenging. In settings with known COVID-19 outbreaks, assistance with enforcement of shelter-in-place orders, tTesting of residents and staff members, and prompt isolation of symptomatic or residents with confirmed disease are needed to prevent further Transmission in homeless shelters.

On March 30, 2020, Public Health – Seattle and King County (PHSKC) was notified of a confirmed case of coronaVirus disease 2019 (COVID-19) in a resident of a homeless shelter and day center (shelter A). Residents from two other homeless shelters (B and C) used shelter A’s day center services. Testing for SARS-CoV-2, the Virus that causes COVID-19, was offered to available residents and staff members at the three shelters during March 30–April 1, 2020. Among the 181 persons tested, 19 (10.5%) had positive test results (15 residents and four staff members). On April 1, PHSKC and CDC collaborated to conduct site assessments and symptom screening, isolate ill residents and staff members, reinforce infection Prevention and control practices, provide face masks, and advise on sheltering-in-place. Repeat tTesting was offered April 7–8 to all residents and staff members who were not tested initially or who had negative test results. Among the 118 persons tested in the second round of tTesting, 18 (15.3%) had positive test results (16 residents and two staff members). In addition to the 31 residents and six staff members identified through tTesting at the shelters, two additional cases in residents were identified during separate symptom screening events, and four were identified after two residents and two staff members independently sought health care. In total, COVID-19 was diagnosed in 35 of 195 (18%) residents and eight of 38 (21%) staff members who received tTesting at the shelter or were evaluated elsewhere. COVID-19 can spread quickly in homeless shelters; rapid interventions including tTesting and isolation to identify cases and minimize Transmission are necessary. CDC recommends that homeless service providers implement appropriate infection control practices, apply physical distancing measures including ensuring resident’s heads are at least 6 feet (2 meters) apart while sleeping, and promote use of cloth face coverings among all residents.

Suggested citation for this article: 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. ePub: 22 April 2020. DOI: http://dx.doi.org/10.15585/mmwr.mm6917e2

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