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We estimated the probability of averting a COVID-19 outbreak when an exposed individual is introduced into a representative homeless shelter of 250 residents and 50 staff over 30\u2009days under different infection control strategies, including daily symptom-based screening, twice-weekly PCR testing, and universal mask wearing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The proportion of PCR-positive residents and staff at the shelters with observed outbreaks ranged from 2.6 to 51.6%, which translated to the basic reproduction number (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ) estimates of 2.9\u20136.2. With moderate community incidence (~\u200930 confirmed cases\/1,000,000 people\/day), the estimated probabilities of averting an outbreak in a low-risk (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      =\u00a01.5), moderate-risk (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      =\u00a02.9), and high-risk (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      =\u00a06.2) shelter were respectively 0.35, 0.13, and 0.04 for daily symptom-based screening; 0.53, 0.20, and 0.09 for twice-weekly PCR testing; 0.62, 0.27, and 0.08 for universal masking; and 0.74, 0.42, and 0.19 for these strategies in combination. The probability of averting an outbreak diminished with higher transmissibility (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sub>0<\/jats:sub>\n                      ) within the simulated shelter and increasing incidence in the local community.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In high-risk homeless shelter environments and locations with high community incidence of COVID-19, even intensive infection control strategies (incorporating daily symptom screening, frequent PCR testing, and universal mask wearing) are unlikely to prevent outbreaks, suggesting a need for non-congregate housing arrangements for people experiencing homelessness. In lower-risk environments, combined interventions should be employed to reduce outbreak risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-021-01965-y","type":"journal-article","created":{"date-parts":[[2021,5,7]],"date-time":"2021-05-07T08:03:55Z","timestamp":1620374635000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Comparison of infection control strategies to reduce COVID-19 outbreaks in homeless shelters in the United States: a simulation study"],"prefix":"10.1186","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7727-7102","authenticated-orcid":false,"given":"Lloyd A. 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NCL has received funding from the World Health Organization for unrelated work.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"116"}}