March 9th 2020

By Bill Berkowitz and Gale Bataille 

With Donald Trump tripping all over himself to assure the American people that COVID-19 is under control; that a vaccine may be attainable within months – contrary to the opinion of scientists; that people could go to work with symptoms; and, none of the early mishaps are his fault, what is the capacity of health care systems to deal with the highly vulnerable poor and homeless populations? What plans are being made to outreach to, and treat people who have little to no access to health care, and a high prevalence of underlying chronic conditions? How can self-isolation possibly work for people who have no safe places to go? How can people without stable housing follow hand washing protocols when they don’t have access to running water? What will happen at overcrowded shelters? 

Nan Roman, president and CEO of the National Alliance to End Homelessness, recently pointed out that "All these preventive things that are being done, like washing your hands — they [the homeless] can't do any of those. They don't have access to that. We need to make sure that homeless people get the services they need so it doesn't spread to everyone else."

Local public health departments have or are designing plans to support non-profits and homeless service providers to deal with outbreaks within homeless encampments and shelters across the country. But even in times where there is no threat of an infectious  disease outbreak, it is difficult to provide safe and healthy environments for people with homelessness and housing instability. With the spread of the coronavirus, these challenges far outstrip the capabilities of those folks providing health and social support services. And, given the fact that testing kits have not yet been widespread, homeless encampments and shelters may be the last places where testing might take place. 

According to NBC News’ Laura Strickler and Suzy Khimm, “In Los Angeles, members of the City Council are calling for local authorities to install hand-washing stations at homeless encampments, and the city Health Department is meeting with representatives of all homeless shelters to determine how to isolate sick patients.”

Strickler and Khimm reported that “In Seattle, King County officials say no homeless people have required testing so far, but they plan to set up modular housing for homeless people who become infected, and they are buying a local motel for those who cannot quarantine themselves at home. City workers also have been handing out sanitation kits to the homeless, according to the Seattle mayor's office.”

As reported in the Queens Daily Eagle, in New York City, “homeless service agencies have begun issuing basic guidance about the coronavirus to nonprofit providers, but with uncertainty and false reports spreading far faster than the actual illness, accurate information often fails to reach the New Yorkers who actually live in shelters.”

New York’s Picture the Homeless community organizer Nikita Price aid that people are confused by the misinformation that’s flowing their way. “People are talking antiquated methods and home remedies for dealing with things.”

Price added: “This is a population that’s probably going to be neglected in a lot of the conversations around this,” he said. “Everyone needs to be put on notice about this.”

WHYY in Philadelphia reported that shelters are preparing for a possible coronavirus outbreak. “Project HOME, which manages a number of residences across the city, is taking most of its cues from the Centers for Disease Control and Prevention and the Health Department, said Monica Medina McCurdy, vice president for health care services,” WHYY reported.  

Project HOME is going beyond CDC guidelines, McCurdy said. “CDC is recommending routine cleaning and not advising anything more than that, but our staff are doing extra cleaning, particularly around disinfecting services [for] frequent ‘high-touch’ areas like doorknobs, handrails, things like that,” McCurdy said.

Community health centers and public health clinics that are the primary providers of health services to homeless and economically marginal populations are already stretched beyond their means.

A March 7th article in the NY Times by John Eligen describes the challenges that these frontline health providers face in addressing the treat of corona virus:  an outreach provider, Ms. Allen met with one of her patients…”to administer a nebulizer to help with her coughing and wheezing, (who said that she) had only just started hearing about the coronavirus. While living on the streets, she said, she had little access to news media. She has heard enough to know to use hand sanitizer a lot. (Though she doesn’t have access…) But she does not have the luxury of staying away from people — she needs public transit to get around and sometimes sleeps in homeless encampments.”

Although there are no reports to date about COVID-19 outbreaks among homeless people, it is only a matter of time. As ill-prepared as the US is to address the virus among the general population, it is likely to become a tragedy among people without access to housing and stable health care. In addition to a lack of access to services, a significant portion of people living on the streets are struggling with mental illness and addiction and are unable to provide basic self-care, let alone follow disease precautions.  And, beyond these concerns, there is also a historically well-founded and deep distrust among poor and minority populations of treatment that may be provided by the medical establishment.

Nearly 200,000 people in U.S. have no places to wash their hands, have significant health problems, and gather together in unsanitary conditions. While some communities are starting to grapple with what could be a disaster of major proportions, according to ABC News, “few communities … have rolled out plans to protect the homeless and give them a place to recover in isolation, which would prevent them from passing it on.”