1/The prevalence of SARS-CoV-2 infection in homeless shelters differs by whether there has been a known “cluster” according to new data from @cdcgov My illustrations and thoughts follow (inspired by @kellymdoran) https://www.cdc.gov/mmwr/volumes/69/wr/mm6917e1.htm?s_cid=mm6917e1_w

2/Across 19 shelters in 4 cities, the % of homeless shelter residents with SARS-CoV-2 differed GREATLY based on whether testing followed “cluster” (>2 cases in 2 weeks), a case, or no known cases

3/Similar with staff: Across 19 shelters in 4 cities, % of shelter STAFF with SARS-CoV-2 differs GREATLY based on whether testing followed “cluster” (>2 cases in 2 weeks), a case, or no known cases.

4/But note the risk here is notable even with no case: Finding 4% of residents positive is
(a)Quite high, & could lead to spread, not just in the shelter but elsewhere
(b)Not much different from 5% ( starting with 1 case)

5/CDC calls for 6 feet distance between heads when sleeping +"face coverings"
Like @kellymdoran I have worry about social distancing with shared bathrooms and meal space, and people squeezing between rows of beds 6 feet apart https://twitter.com/KellyMDoran/status/1253030007397658625?s=20

6/We must expand testing but here’s the ethics problem: if we test for COVID19 without spaces to protect persons who are +ve, then we are HARMING the person we tested. They'll be blocked from every shelter! (obviously) we should not hurt people in the name of public health.

7/Here in Birmingham, I salute the incredible group of city, county @uabnews and others all focused on finding and assuring that space is available. #Bhamstrong @randallwoodfin - It’s tough to do, and ultimately requires political will + funds, including @hudgov @drmarkewilson

8/Also, I agree with @kellymdoran: sporadic case-based testing is not a common sense proposition if so many infections have no symptoms https://twitter.com/KellyMDoran/status/1253032805245870086?s=20

9/Finally, please remember, today’s “homeless” are not “forever-homeless” They are tomorrow’s renters. Today’s low-income renters can easily become homeless. Only by preventing homelessness do we advance community well-being AND public health #COVID19 #solidarity