What if you can't stay home?

COVID-19 provides homeless populations with new challenges.

The spread of the coronavirus reminds us that the safest place to be is at home. As one in three people around the world is currently under a lockdown or stay-at-home order, the ones without a home are left in the streets or at the mercy of last-minute government initiatives scrambling to find them shelter.

For the United States’ more than half a million homeless residents, COVID-19 is a particularly dire challenge. The Centers for Disease Control and Prevention outline five recommendations for everyone to maintain in order to limit the spread of the virus and prevent getting sick. Three of these are nearly impossible for homeless people to implement on a daily basis.

The CDC recommends to “avoid close contact,” a feat that the sheltered and unsheltered homeless are finding hard to achieve. In New York City, 62,679 homeless people live in shelters with an average of 8 to 12 beds per room. In shelters like this across America, homeless people sleep in close quarters and share bathrooms, kitchens and common spaces.

These arrangements provide the perfect conditions for a virus to spread. An outbreak at the largest homeless shelter in San Francisco led to the infection of 70 people in five days.

“They're literally breathing each other's air,” Dr. Nicholas Pleace, director of the Centre for Housing Policy at the University of York, said on a Skype call. “Really as soon as you’re in a situation where you’re not adequately housed, you’re at advanced risk to catch the virus.”

Handwashing with soap has been proven to destroy the coronavirus, but for homeless people without access to soap or water, this remains difficult. The alternative is hand-sanitizer, a commodity which has become scarce and expensive in the United States. Household disinfectants, detergents and soaps are similarly selling out at stores as people follow CDC guidelines to clean and disinfect objects and surfaces. This is equally difficult for homeless people who are unable to afford these products and sanitize their belongings.

Preventing the spread of COVID-19 is paramount to protecting homeless populations, who are generally more at risk of severe complications associated with the disease.

“Homeless people are disproportionately affected by a variety of chronic health conditions, such as diabetes, high blood pressure, HIV/AIDS, and other infectious diseases, which could complicate treatment for COVID-19 and make them more vulnerable,” said Dr. Elizabeth Bowen, assistant professor of social work at the University at Buffalo, in an email.

People who are not safely housed are more likely to contract COVID-19 and more likely to experience complications in treatment. Every step of their fight with the disease is harder than the general population.

“If a homeless person does acquire COVID-19, it may be hard for them to recover in the community without adequate shelter and food,” Bowen said.

States around the country are currently housing their homeless residents in temporary, and often makeshift, facilities. Experts and service providers say that this sort of widespread sheltering is something that should have happened before – and should continue after the virus is contained.

How are states housing their homeless during the outbreak?

Looking forward

Once the pandemic is contained, decisions made now will likely affect social service provision in the future. But it is unclear whether this type of social housing and state-provided shelter will be a commodity still available to the homeless population.

“Ultimately this is a political decision,” Pleace said. “There are longstanding narratives from the political right – the extreme right – that the state can’t afford to provide, for example, social housing.”

But Pleace said it’s not that simple, “It's a balance between the evident human costs of keeping existing economic structures versus a different kind of approach to things like housing policy. And if, as people are saying, the impact of the virus and what may well be a major depression in the wake of the virus goes on for several years, and there's a lot of economic as well as physical casualties from the virus, then there may be a lot more popular support for building affordable housing at scale.”

Right now, all of the measures that have been used to shelter the homeless population are temporary. Once emergency measures are lifted, many unsheltered homeless people will presumably be back on the streets.

“The virus has just highlighted the extent of housing inequality throughout much of the developed world,” Pleace said. “Essentially it's kind of putting a big bright light on what the consequences of housing inequality could be.”

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