This report describes the prevalence and charactierstics of COVID-19 cases emerging from a single large homeless shelter in Boston, MA. Findings 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.

The circumstances of homelessness create the potential for rapid transmission of SARS-CoV-2 in this vulnerable population. 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 (≥18 years old) residing at the shelter over a 2-day period.

408 individuals underwent symptom assessment and COVID-19 PCR testing. Characteristics of these individuals included:

• Mean age: 51.6 years
• 71.6% male
• 33.1% Black or African American
  18.6% Hispanic or Latino
• 8.1% reported cough, 0.7% reported shortness of breath, and 5.9% reported other symptoms, including 1.2% with diarrhea.
  Mean body temperature: 98.4

147 (36.0%) individuals were PCR-positive for SARS-CoV-2. COVID-positive individuals were more likely to be male (p<0.001) but did not differ significantly from COVID-negative individuals with respect to other demographic and clinical characteristics. Cough (7.5%), shortness of breath (1.4%), and fever (0.7%) were all uncommon among COVID-positive individuals.