The COVID-19 pandemic has disproportionately affected the homeless, with many social and logistical factors preventing them from accessing stable healthcare.
The World Health Organization (WHO) defines coronavirus disease (COVID-19, also known as SARS-CoV-2) as a highly transmissible pathogen that travels in the form of airborne aerosol droplets. The coronavirus disease has been shown to cause respiratory difficulty, among many other flu-like symptoms in affected persons.
Since the start of the COVID-19 pandemic, many restrictions have been set in place. Public health protocols have urged people to stay at least six feet apart from each other, avoid large gatherings and to practice self-prevention methods such as wearing masks and promoting good personal health, as outlined by the CDC. Measures encouraging curfews and quarantines have also been set in place in more densely populated areas to minimize spread.
However, one of the populations that remains most at risk of contracting the airborne virus is the homeless population. Homelessness leaves people without stable sources of food, shelter or healthcare especially during the pandemic. Currently, approximately 75% of California’s homeless population of over 151,000 is currently not in isolated shelter, putting them at risk of infection.
The spread of the coronavirus has been proven to spread quickly in homeless shelters. Currently, the pandemic poses a disproportionate risk for communities that live in congregate living conditions and cannot self-isolate. A literature review published in CMAJ states that homeless shelters are prone to increased viral transmission due to congregate living arrangements. People living in shelters are kept in close quarters environments, which rapidly spreads infection among inhabitants and staff workers.
A 2020 study done on the transmission of SARS-CoV-2 in a large homeless shelter in Boston, MA, estimated the virulence of the pathogen from March 28, 2020 to April 1, 2020. Over the course of the study, 36% of the homeless population tested positive for SARS-CoV-2. Another study confirmed the spread of SARS-CoV-2 within 19 homeless shelters from shelter residents to staff members, citing 17% spread in Seattle, 30% in Boston and 16% in San Francisco.
Another issue is the lack of access to healthcare for homeless patients during the COVID-19 pandemic. As per the CDC, changes have been put in place to prevent the spread of COVID-19 in medical facilities, namely the optimization of telehealth. Hospital staff have been instructed to screen patients via telephone or telehealth sessions before they are admitted to hospitals or clinics. However, this technology is often inaccessible for homeless patients if they do not have stable shelter or access to communications devices.
According to a peer-reviewed article by Dr. Bernadette Pauly, professor at the University of Victoria School of Nursing, the homeless are also continually subject to “poverty stigma” in which they are labelled as chronic substance abusers, disease carriers and mentally ill. They are also likely to be assumed to be living in shelters or on the streets, and are generally associated with unclean living habits. These stereotypes create discrimination toward homeless patients in the healthcare field that is often apparent in physician visits. This stigmatization that affects homeless patients in the modern healthcare setting makes it more difficult for them to access opportunities for treatment, especially during this pandemic.
Physician bias also plays a role in this issue. On many occasions, patients have reported instances of physician bias toward homeless patients. A study that completed a 17-part interview with homeless patients about how they felt during medical visits found evidence of bias against patients based on their socioeconomic status. 13 out of the 17 patients cited discrimination and unwelcome attitudes from physicians, and mentioned moments where they were ignored, brushed aside or denied proper treatment.
Fortunately, many efforts have been launched in order to provide healthcare and support for the homeless. Initiatives such as Project Roomkey plan to create isolated living shelters as protection for the homeless, and already established homeless health services like Homeless Health Care Los Angeles (HHCLA) have continued providing care to the homeless throughout the pandemic.
There have also been successful attempts to set up homeless vaccination stations in various locations throughout the nation, which would increase the spread of accessible healthcare. More recently, protocols surrounding CoVID-19 vaccine distribution have been extended to people of higher risk, including the homeless. Regions such as Santa Clara have started vaccinating medically vulnerable persons, such as inhabitants of homeless shelters. And as of March 15, 2021, homeless persons became eligible for the vaccine in Los Angeles.