From left to right: Nick Turner, Tyffany Locklear, Deborah Murray, Maria Miggs and Juliann Rush. (Source: Elizabeth Petzold)
DURHAM, N.C. — Like many other settings, homeless shelters around the country have experienced high infectivity rates, posing many challenges to this vulnerable and growing population. Shelters in Durham such as the Durham Rescue Mission (DRM) struggled with continuing to provide services while keeping residents and staff safe. In response to a request for help from the local homeless shelters, Duke University School of Medicine informally assembled an interdisciplinary team of health providers and researchers to provide guidance to homeless shelters and COVID testing.
Founded in 1974, DRM is NC’s oldest and largest long-term homeless shelter, with current capacity for over 550 residents. Beginning as a men’s only shelter, it substantially expanded over the years and now operates several programs including the Shelter for Men, and the Good Samaritan Inn, which provides shelter for women and mothers with children. When Duke providers learned of the DRM’s need for assistance, a team was established including Dr. Jacob Feigal of the Duke Healthcare for the Homeless Clinic, Dr. Nick Turner of the Duke Infectious Diseases program and Dr. Liz Petzold from the Duke Center for Applied Genomics and Precision Medicine (CAGPM) Infectious Disease research team.
Up until that time, DRM and other local shelters had no access to SARS-CoV-2 testing and most residents do not have comprehensive healthcare; their only access to care is through local emergency departments. Through the work of the Duke team, the DRM now has access to regular SARS-CoV-2 testing and surveillance, along with two other Durham homeless shelters — TROSA (Triangle Residential Options for Substance Abusers, Inc.) and the United Ministries of Durham (UMD). The team works in close collaboration with the Durham County Department of Public Health (DPH) and recently received a CLIA waiver to be able to offer COVID rapid antigen tests at DRM. Since June 2020, the teams have carried out approximately 800 SARS-CoV-2 tests and helped DRM implement new quarantine and testing policies to enable continued services to those in need. Testing was initially provided with support from the Duke Clinical Microbiology laboratory under Dr. Chris Polage and the DHVI IQVA team under Tom Denny. Currently, rapid testing is provided by the Durham County Public Health team.
Shelter residents who test positive for COVID, as well as any residents and staff in close contact with them, are eligible to participate in an observational research study called the Molecular and Epidemiological Study of Suspected Infection (MESSI). Led by Drs. Chris Woods and Petzold from the Duke CAGPM Infectious Disease team, MESSI launched in March 2020. The major goal of the study is to monitor participants closely through the first 28 days following infection or an exposure (with an option for extended follow-up to 12 months). In addition to symptom data, biological samples (blood, nasal swabs, urine, saliva) are collected to conduct epigenetic and immunological assays to assess changes over time. In total, that results in about 6 to 7 in-person visits with each participant.
To date, 61 people from DRM have enrolled in the MESSI study and Dr. Petzold’s team continues to follow many participants into long-term follow up. The frequent visits mean that team members get to know study participants quite well, and visits eventually “become like visiting an old friend,” said Dr. Petzold. The team has observed a higher than average rate of positive but asymptomatic residents in the shelters, in line with a recently published paper on homeless shelters in the Annals of Internal Medicine.
The Duke team has also worked with Granville/Vance Public Health department to help with testing symptomatic people at community COVID testing events. The Duke team also recently completed a wish list to provide Christmas gifts for residents at the shelters. “Working with the DRM has been such a rewarding experience, and allows us to give back to the community while we carry out our research trying to better understand COVID,” said Dr. Petzold. “It’s a difficult time for all of us, and so, to be able to offer some support and kindness to our local community has been a silver lining.”