text: Assessment of a Hotel Based Protective Housing Program for Incidence of SARS CoV 2 Infection and Management of Chronic Illness Among Persons Experiencing Homelessness Persons experiencing homelessness PEH are at higher risk for SARS CoV 2 infection and severe illness due to COVID 19 because of a limited ability to physically distance and a higher burden of underlying health conditions To describe and assess a hotel based protective housing intervention to reduce incidence of SARS CoV 2 infection among PEH in Chicago Illinois with increased risk of severe illness due to COVID 19 This retrospective cohort study analyzed PEH who were provided protective housing in individual hotel rooms in downtown Chicago during the COVID 19 pandemic from April 2 through September 3 2020 Participants were PEH at increased risk for severe COVID 19 defined as 1 aged at least 60 years regardless of health conditions 2 aged at least 55 years with any underlying health condition posing increased risk or 3 aged less than 55 years with any underlying health condition posing substantially increased risk eg HIV AIDS Participants were housed in individual hotel rooms to reduce the risk of SARS CoV 2 infection on site health care workers provided daily symptom monitoring regular SARS CoV 2 testing and care for chronic health conditions Additional on site services included treatment of mental health and substance use disorders and social services The main outcome measured was SARS CoV 2 incidence with SARS Cov2 infection defined as a positive upper respiratory specimen using any polymerase chain reaction diagnostic assay authorized for emergency use by the Food and Drug Administration Secondary outcomes were blood pressure control glycemic control as measured by hemoglobin A1c and housing placements at departure Of 259 participants from 16 homeless shelters in Chicago 104 40 2 were aged at least 65 years 190 73 4 were male 185 71 4 were non Hispanic Black and 49 18 9 were non Hispanic White There was an observed reduction in SARS CoV 2 incidence during the study period among the protective housing cohort 54 7 per 1000 people 95 CI 22 4 87 1 per 1000 people compared with citywide rates for PEH residing in shelters 137 1 per 1000 people 95 CI 125 1 149 1 per 1000 people P 001 There was also an adjusted change in systolic blood pressure at a rate of 5 7 mm Hg 95 CI 9 3 to 2 1 mm Hg and hemoglobin A1c at a rate of 1 4 95 CI 2 4 to 0 4 compared with baseline More than half of participants 51 n 132 departed from the intervention to housing of some kind eg supportive housing This cohort study found that protective housing was associated with a reduction in SARS CoV 2 infection among high risk PEH during the first wave of the COVID 19 pandemic in Chicago These findings suggest that with appropriate wraparound supports ie multisector services to address complex needs such housing interventions may reduce the risk of SARS CoV 2 infection improve noncommunicable disease control and provide a pathway to permanent housing 