Written by Yusuf Samimi, Edited by Maura McDonagh, Justin Nguyen, and Courtney Coleman
It is no secret that the unhoused population is at a greater risk of being vulnerable to diseases because of their inaccessibility to proper health resources, as well as unsanitary conditions. When COVID-19 hit the world, and much of the United States underwent stay-at-home orders in early 2020, the unhoused population spiked from 567,000 in 2019 to 580,000 in 2020 from COVID-19, creating a larger demand for shelter and quarantine locations for sick unhoused individuals. Members of the unhoused population who are unaware of the dangers of SARS COV-2 virus and may not have access to safety measures are likely to contract it, especially if they are in shelters or packed communities. Without information on social distancing, resources such as masks, and facilities for sanitation, the unhoused population has increasingly suffered severe health impacts during the pandemic, with 84% of the unsheltered population experiencing physical health problems. The COVID-19 outbreak emphasizes the importance of housing and the need to re-evaluate our nation’s current approaches to addressing homelessness.
Given the risk factors in unhoused populations, unhoused individuals are at an increased risk of contracting COVID. These risk factors include such unhoused individuals experiencing a difficult time following CDC guidelines, such as social distancing, isolation/quarantine, and other safety measures because of their circumstances. A combination of limited resources and crowded conditions makes it easier for airborne infections to spread. Given the risk factors, a potential peak infection rate of 40% is expected among the unhoused population, with an estimate of 4.3% needing to go to the hospital.
These health centers that receive 330(h) funding have closed during the pandemic because of costs. 330h funding comes from section 330 of the Public Health Service Act that allows health administrations to make grants to health centers to provide health care to homeless populations. Additionally, four hundred health centers have closed from the months of April to October of 2021.
From the graphic, note that positive test rates among the unhoused population are high in health centers, so closing so many of such centers will only lead to a spike in cases. In fact, according to the nonprofit organization, National Health Care for the Homeless Council, the COVID positivity rate for unhoused individuals was between 9-12% during the months of June to October, compared to the rest of the United States’ average of 7.8% positivity. Making matters worse, there are older folks among the unhoused population who are immunocompromised.
The pandemic has shown how important it is for public health agencies and other organizations to make a coordinated effort in disease surveillance and infection control, especially among the unhoused population. In April 2020, California launched Project Roomkey, which secured 1,300 trailers and 15,000 hotel and motel rooms to isolate and quarantine sick unhoused individuals in an effort to provide self-isolation for unsheltered immunocompromised elderly individuals, quarantine those who are unhoused and infected, and shelter those who are sick but do not require hospitalization. In addition to this project, California implemented Project Homekey to fund public entities to purchase housing stock that would serve as permanent long-term housing to support residents while tending to their health needs, much similar to Project Roomkey. The big difference here is that unsheltered people will be able to have secure housing while maintaining safety measures. As California and America as a whole push through the pandemic, it will be even more important to invest in these collaborative efforts to protect and preserve the health of the unhoused population.
COVID-19 has proven to be a greater health risk to people experiencing homelessness because of their inability to live in sanitary conditions, making it difficult to follow safety guidelines. Measures are currently being taken to use facilities as quarantine areas for unhoused people for both temporary and permanent housing as well as producing isolation sites for unhoused people who have been infected with COVID-19. However, with limited resources, infection rates are still high, and the unhoused population is still in danger. With more focus on collaborative public health efforts, pooling of resources, and implementation of effective policies, the health impacts among the unhoused population will greatly be reduced.
This post is not a substitute for professional advice. If you believe that you may be experiencing the symptoms of COVID-19, please contact your primary care physician, or go to the nearest Emergency Room. Results from ongoing research and the current understanding of COVID-19 are constantly evolving. This post contains information that was last updated on April 20, 2023.