A 66-Year-Old Homeless Man with Covid-19

Dr. Denise De Las Nueces: A 66-year-old homeless man who had sought refuge at a local men’s congregate shelter for the past several years was evaluated for cough and rhinorrhea during the pandemic of coronavirus disease 2019 (Covid-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Nine days before the current evaluation, the patient presented to a Boston Health Care for the Homeless Program (BHCHP) clinic at a local homeless shelter for evaluation of dry cough and rhinorrhea that had developed earlier that morning. He reported no fever, chills, sore throat, anosmia, myalgias, headache, chest pain, shortness of breath, hemoptysis, diarrhea, nausea, vomiting, or fatigue. He had had no known sick contacts or exposure to anyone with a diagnosis of Covid-19. He had received a seasonal influenza vaccination. A review of systems was notable for cough, rhinorrhea, insomnia, and chronic musculoskeletal pain.

The patient’s medical history was notable for ischemic stroke 9 years earlier with residual mild ambulatory deficits, type 2 diabetes mellitus, hypertension, hyperlipidemia, abdominal aortic aneurysm, hyperthyroidism, and obesity. Medications included aspirin, atorvastatin, insulin glargine, metformin, empagliflozin, dulaglutide, losartan, chlorthalidone, amlodipine, metoprolol, and methimazole, along with trazodone, gabapentin, and acetaminophen as needed.