Homeless in a Pandemic: Why It Is Critical to Protect the Most Vulnerable

By Bechara Choucair, MD, Chief Health Officer at Kaiser Permanente, and Bobby Watts, Chief Executive Officer of National Health Care for the Homeless Council

As we’ve adjusted our lives around social distancing, self-isolation and quarantine, we can easily list uncertainties wrought by the COVID-19 pandemic. What if one of us becomes ill? How can we keep our jobs or maintain some kind of income? How do we cope with the stress brought by isolation and lack of social connection? What do we do if we run out of supplies?

Now ask yourself what you would do if you did not have a home.

Even under relatively normal conditions, living on the street or in a temporary shelter takes a toll on health. But in the era of COVID-19, challenges faced by homeless populations are intensifying rapidly, creating an urgent need that requires concerted action on the local, state and federal levels to care for those currently without stable shelter and to prevent more individuals from landing in a similarly devastating situation.

Homelessness is already bad for one’s health. Poor nutrition, stress from constant transience and sleep deprivation all weaken the immune system. For sheltered populations, crowded conditions raise the risk of droplet transmission infections. And for people who are unsheltered, the lack of handwashing or bathroom facilities makes it all but impossible to follow recommendations for reducing the risk of contracting or spreading COVID-19.

As our nation continues to mobilize efforts to contain and mitigate the spread of the novel coronavirus, the increased risk to people experiencing homelessness is self-evident. Crowded living conditions, limited access to proper hygiene and sanitation, an inability to isolate or recover from illness and a higher prevalence of chronic disease all conspire to create a dangerously risky environment – one that is absolutely counter to the actions we must take to slow the spread of the outbreak.

There is already tremendous stress on our state and local public health departments. In normal times, homeless shelters and other housing service sites play an essential role in keeping the communities they serve healthy. But now, these workers are at an increased risk of transmission, while their much-needed efforts are threatened by breakdowns in critical infrastructure and limited staff. While there are steps shelters can take to reduce the risk of transmission, these frontline staff are not medical providers. Nevertheless, they are dealing with a serious health issue that requires them to respond.

Health systems must do their part to prevent, test for and treat COVID-19. And we must stand side by side with public health workers and our partners working with our most vulnerable communities on the frontlines because they are both the most impacted and the best positioned to make a positive difference. Organizations and individuals are stepping up and committing financial resources, equipment and expertise to assist. But so much more is needed, now and in the uncertain days ahead.

As Congress debates what to include in the next economic stimulus package, we join calls for funding state and local homeless systems across the nation. These dollars are urgently needed to prevent vulnerable people from becoming homeless; house as many homeless people as possible quickly so they neither contract nor spread the coronavirus; support prevention practices in shelters for those who are not housed; and provide stimulus to the economy.

Millions of Americans are just one paycheck away from homelessness. We must respond to this public health crisis in a way that saves lives and prevents an exponential increase in homelessness that an economic downturn could bring.

To turn the tide against COVID-19, direct financial support is necessary. And so is sustained, smart policy development and implementation. We are rapidly approaching the point in our response where policymakers can exert enormous positive pressure on how well and quickly we make it through this crisis.

Lawmakers are already providing quarantine facilities to house homeless individuals who have been exposed. They are offering temporary housing with an opportunity for social distancing to individuals in shelters who have pre-existing conditions. They are providing handwashing stations and hygiene facilities to encampments and placing a moratorium on dispersing encampments during this emergency. And they are preventing more people from falling into homelessness during this outbreak by placing restrictions on rental evictions and providing rental and mortgage assistance to those in need.

Schools are closing. Families are weighing how to safely care for elder and at-risk loved ones while still earning a living. People are sheltering in place for weeks on end – they feel besieged.

We recognize that each of us living through this global pandemic has been asked to sacrifice and that for many of us the hardest part of the response and recovery is still ahead. It is no easy task to cope with the uncertainty this public health crisis has created. But we also know that we must weather this storm. If we are willing to prioritize the needs of the most vulnerable among us now, we will help ensure greater safety for us all.