What Happens When COVID-19 Hits the Homeless?

Half a million people in America cannot wash their hands on a regular basis

They live in tents or under freeway overpasses, cycling in and out of shelters with dense sleeping quarters. To sustain themselves, they must rely on food banks or panhandling. They are overwhelmingly suffering from mental illness, substance abuse, PTSD, and countless other ailments. Many are veterans. And many are elderly. An estimated 13,000 homeless people die on our streets each year. Their life expectancy is 20 years shorter than the rest of us.

As events cancel and bars, restaurants, and schools close all over the nation due to the COVID-19 outbreak, the public has its marching orders: Stay home if you can. Practice social distancing. Wash your hands often for 20 seconds with warm water. All these are useless directives for the approximately 553,000 homeless in America, who lack access to soap and hot water, and who cannot “stay home” if they feel unwell. Social distancing is next to impossible in overwhelmed shelters, clinics, and social-service offices.

The demographic that needs the most help preventing the spread of COVID-19 will get the least. America’s decades of neglect in the form of rising poverty and lack of medical care will come home to roost as this disease infects more communities across the nation. It will be a catastrophe for all of us, and our societal failings with regard to the poor and the elderly will come into ever-sharper relief over the next few months.

The states with the highest homeless populations—California, New York, and Washington—have already declared a state of emergency in response to COVID-19. Washington state has the third-largest homeless population in the nation, and its non-profit organizations that provide shelter and healthcare are struggling to maintain sanitary conditions in light of the cluster of lethal cases there.

New York is fighting to get basic preventative information to its homeless population, but it’s swimming upstream against a tide of misinformation. Outreach workers and officials are reporting hearing many misplaced fears and ineffective home remedies.

In Sacramento, California, which had its first reported death on March 10, homeless outreach workers were administering a screening process to identify those with possible coronavirus symptoms, but the protocol was quickly abandoned since so many on the street have symptoms consistent with the illness. There are roughly 150,000 people living in shelters, cars, or homeless encampments in California alone. Sacramento County saw a 19 percent increase in its homeless population in 2019.

Even before COVID-19 hit U.S. soil, Los Angeles was already completely overwhelmed with illnesses that haven’t been seen in the public sphere since the Middle Ages. Typhoid, Tuberculosis, and Hepatitis A have re-emerged and spread to the general population within the last year.

“We’ve been encouraging communities to include the homeless in planning around the response,” says Megan Hustings, managing director for the National Coalition for the Homeless. “Because so many of these folks have chronic illnesses, communities should have dedicated spaces where people can recover and have access to food.” The organization is also recommending that municipalities declare moratoriums on sweeps, where law enforcement forces homeless encampments to relocate. “Cities spend millions on things like this, and they only make the health crisis worse,” says Hustings. Recent reports on sweeps show that life-saving medicines and critical paperwork end up in the garbage.

We tend to think of this segment of society as different and separate from ourselves, but more working and professional people are slipping into homelessness. The housing crisis means that for many Americans, one eviction or tragic life event is all it takes, and already the economic hit from event cancellations, school closures, and lost wages will hit working people hard. The elderly with fixed incomes and health issues are living on the razor’s edge. There are an estimated 40,000 people on the street over the age of 65, and that number is expected to triple in the next decade due to rising rents and housing scarcity.

Part of the problem is that public housing has become privatized. “Public housing has been defunded since the 1990s. It’s all private, and we’ve lost over a quarter of a million units of public housing in 25 years,” Hustings explains.

The main determinant with COVID-19 severity and mortality is the responsiveness of the government and its healthcare system. At a time when China was building new hospitals in a matter of days, and South Korea developed drive-thru coronavirus tests, the Trump administration sat on its hands for fear that an increase in reported cases would hurt his reelection. Clinging to its obdurate anti-science stance, the White House did next to nothing until the stock market tanked. The CDC rejected tests approved by the World Health Organization, opting to develop its own initial batch of kits that turned out to be flawed. The U.S. has still only conducted 11,000 tests, where South Korea has conducted twice that with a population less than a quarter of the U.S.

Deep cuts to CDC funding over the last three years left big holes in its ability to respond to infectious diseases. Hospitals and medical offices are left without the necessary protective equipment and protocol. “If people call with symptoms, we tell them not to come in,” says Dr. Laura Popper, a pediatrician at Mt. Sinai in Manhattan. “Otherwise, we’ll get shut down. These were the kind of things that should have been worked out months ago. Everyone in my office has a mask but you can’t get more, and that all goes back to Trump. He is the worst public health menace that exists.”

The unique “bootstrap” mentality of American culture tends to blame the individual, in this case, the poor, for systemic failures. The second but no less threatening consequence to this already scapegoated population is the possibility of backlash in the form of violence, human rights violations, and more neglect. “I took a call today from someone who was basically blaming the homeless for the virus,” says Hustings. “We’re also worried about ‘patient dump’ when the hospitals become inundated, they might just kick people out.”

In a recent interview with the Secretary of Housing and Urban Development (HUD), Ben Carson discussed the “uncuffing” of law enforcement in order to deal with the homeless crisis. Axios reporter Johnathan Swan asked him, “You’re saying that if you, the federal government, can provide those places, it’s legal for the police to, against their will if necessary, take them off the streets and put them in these places?”

“Correct. It must be done,” Carson replied.

As far as immediate actions that should be taken to combat community spread like hygiene stations, rapid scaling up of testing, and allocated clinical and respite space for homeless patients, Hustings is not seeing large-scale developments, but she also notes that this new threat happened so fast that it’s colliding with decades of inaction.

An aid package to prevent more people under the poverty line from slipping into homelessness as a result of this virus—like paid sick leave, food assistance, and emergency unemployment—passed the House last week after much confusion, but it will go before the Senate today. Despite much bipartisan grappling and Trump’s statement that he would sign it, Majority Leader Mitch McConnell referred to the bill as an “ideological wish list.”

Some states are taking independent action. In California, Governor Gavin Newsom is working on commandeering state-owned spaces and contracting with private motels to provide shelter for the homeless. There are plans to distribute hand sanitizer.

Washington’s Governor Jay Inslee has gotten into a legal dispute over the use of a motel in King County as a quarantine center. Seattle’s first homeless person who was moved into quarantine last week after exhibiting virus-like symptoms.

If the virus has already reached the encampments, these triage measures will likely result in more community spread, even in the best of circumstances. There is also the question of how much ongoing care the relocated population will receive when so many of them have mental health and substance abuse issues.

On the federal level, there couldn’t be more hypocrisy. The bizarre evolution of Trump’s statements on the virus indicates that the administration will continue to mud-sling and leverage fear in order to further restrict basic civil rights around quarantine, HIPAA, healthcare workers’ rights, and free speech.

Where homeless populations are getting a modicum of attention, detention centers at the border have made virtually no contingency plans, according to Reveal reporter, Aura Bogado. The “Remain in Mexico” policy has led to tent cities just on the other side of the Rio Grande with no bathrooms, no cooking facilities, and no medical care.

Some questions we should ask ourselves before our most vulnerable people start dying in large numbers:

When the homeless are blamed for the rising numbers of cases and continual community spread, how many more of their basic human rights will be stripped away?

Who will test them and treat them when the hospitals are full of insured people?

Who will make arrangements for their bodies and track down their loved ones?

Federal, state, and local governments have failed to mobilize around these giant systemic failures. So far, the only solution offered to the public is to “wash your hands.”