Across also sources reviewed, the ideal scenario is provision of safe self-isolating spacesin private accommodation(ideally own room and bathroom) through negotiations with hotels/hostels/community centers
Where self-isolation in private accommodation is not possible, consider risk stratification and cohorting of residentsin congregate sheltersalong a continuum of(cases/suspected)to (asymptomatic/medically vulnerable); recognizing the resulting impact of reduced bed density on bed capacity
Ideally designate shelters by cohort with testing and transfer protocols in place·Ensure infection control measures are in place, both at the institutional and personal infection control level –including education and visual cues.
Designate staff to specific cohortswith no transfer of staff between sites/cohorts·For those remainingon the streets/ sheltering outside, distribute supplies (water, hand sanitizer, food), information (symptomsphysical distancing, and access to health care), and provide access to public washrooms/ portable toilets & handwashing facilities
Working with established tent cities or establishing tent cities may be important to consider
Badea, A; Abonyi, S; Hanson, L; Bourassa, C; Dalidowicz, M; Young, C; Howell-Spooner, B. What are the best practices for self-isolation for transient populations? 2020 Apr 19; Document no.: VPL041601 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 11 p. (CEST rapid review report)
Reassessing procedures ofopioid agonist therapy(OAT)–reducing requirements to allow more to access OAT
Considerations of reducing contact by increasing duration of OAT carries for those previously ineligible, and ensuring closing of provision gaps due to weekends/stat holidays/etc.
Increased provision ofsuppliesfor patients
Changes to controlled substance regulations allow for phamacists to extend prescriptions, transfer prescriptions to other pharmacists, accept refills/prescriptions from providers by phone, and allowing the delivery of controlled substances; Recommendations around the prescription of “safe supply” of stimulants and illicit benzodiazepines include the prescription of low-dose medications under (virtual) supervision to reduce the potential for withdrawal
Deferring medical withdrawal management and dose reductions, considerations of transitioning to lower risk OAT
Ensuring access to culturally relevant psychosocial support, and allowing for pharmacological treatment without a requirement of abstinence or psychosocial therapy
Badea, A; Fornssler, B; Dalidowicz, M; Young, C; Howell-Spooner, B. What are the best practices for delivery of harm reduction services to people who are self-isolating 2020 Apr 20; Document no.: VPL041602 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 10 p. (CEST rapid review report)