In a new comment published in Lancet Public Health, public health experts consider the effects of the coronavirus and COVID-19 on the homeless population in North America. The authors, Jack Tsai and Michal Wilson of the University of Texas, point to the unique vulnerability of these populations, given the lack of access to hygiene measures that might help curb the spread. Additionally, these populations often live in congregate living settings, which further increase the chance of contagion.
“People experiencing homelessness are a vulnerable group, and their potential exposure to COID-19 might negatively affect their ability to be housed, and their mental and physical health,” they write.
A large number of people in the United States and Canada, especially the cities, face the reality of homelessness. Homeless people are more vulnerable to abuse, even in places like hospitals that are meant to protect them. This lack of power leaves them exposed to coercion. For example, past research has documented the deliberate recruitment of homeless people into dangerous pharmaceutical drug trials.
The homeless population in the United States regularly faces systemic discrimination, as evidenced in policies allowing them to be committed against their will and laws that seek to punish the destitute for their homeless status. People with a ‘mental illness’ diagnosis often become homeless, and many report that their diagnosis makes them a target of discrimination and disrespect. In addition, those who intend to help the homeless are also often targeted and punished.
Research suggests that severe mental distress and homelessness have a reciprocal and cyclic relationship, and people who are unhoused and diagnosed with a ‘mental disorder’ are more likely to be met with mandates that treat them like criminals. Past research has also shown that community-centric healthcare models operating in shelters are likely to help the homeless and reduce the cost to hospitals. Additionally, some cities have taken steps like opening walk-in care centers to provide housing and care for people in mental distress who are homeless.
In this comment, Tsai and Wilson note that the homeless population in the United States is over 500,000, and in Canada, around 35,000 people experience homelessness on a given night. The authors suggest that the formal (shelters) and informal (abandoned buildings) congregate living settings, and lack of hygiene supplies, makes this group uniquely exposed to the coronavirus disease.
The homeless population’s lack of access to healthcare, accompanying mental and physical health problems, continually mobile lifestyle, and increased chances of substance abuse all lead to higher chances of contracting the virus as well. Further, these same factors make treating, tracking, and quarantining homeless people who contract the virus difficult and problematic.
The authors suggest that it is essential that homeless care providers and street outreach programs are taught to recognize the symptoms of coronavirus disease and be given testing kits for administration. Homeless people are also especially vulnerable to city lockdowns, where public spaces are closed for use. Currently, there are few provisions and spaces made available for the homeless during the coronavirus pandemic. If shelters are locked down, it might further aggravate the physical and mental health of the homeless. They write:
“In such a scenario, closures of shelters and other high-density communal settings (e.g., drop-in centers and soup kitchens) are possible, which could increase the number of unsheltered people experiencing homelessness and reduce their access to needed services.”
As emergency lockdowns use homeless shelters to quarantine patients, the homeless are further displaced and put at risk of contagion. The authors suggest that if cities do not take immediate steps to help the homeless, the spread of coronavirus disease and homelessness are likely going to make each other worse.
Tsai, J. & Wilson, M. (2010). COVID-19: a potential public health problem for homeless populations. Lancet Public Health. Published online March 11, 2020. https://doi.org/10.1016/S2468-2667(20)30053-0 (Link)