People Experiencing Homelessness Are Vulnerable When It Comes to Coronavirus

Bay Area public health officials and advocates for the homeless are scrambling to figure out how to shield a potential spread of novel coronavirus from reaching some of our most vulnerable populations: people living in shelters, cars or in encampments.

Homeless people are at high risk if they contract the virus, say health professionals, because they often suffer from underlying health conditions, get limited medical care and lack access to running water while sometimes living in close quarters.

“They have all the same health concerns that a general person would have,” said Dr. Danielle Williams, a family physician at Roots Community Health Center. She often treats people living in encampments who have high blood pressure, diabetes, wounds and suppressed immune systems — not to mention insecure shelter.

“They're worried about shelter, food and to have to think about another thing," Williams said. “So keeping hands clean is going to be very difficult.”

California state officials at the Department of Public Health are not currently concerned with a potential spread of the virus to homeless populations, but say they are continuing to monitor the possibility. In a statement, the agency said “persons experiencing homelessness are not likely to have any particular risk for COVID-19 related to international travel or exposure to recent travelers.”

California, which declared a state of emergency Wednesday, is also home to the nation’s largest population of homeless residents. And while there have been no confirmed cases among homeless individuals in the U.S., health officials stress the need to have a plan in place.

The U.S. Department of Housing and Urban Development released an infectious disease toolkit report this week, advising local counties on best practices for preventing and managing the spread of disease within encampments.

“Whether encampments are sanctioned or unsanctioned, developing and enforcing sanitation guidelines is essential to prevent disease spread,” the report says.

But the hand washing strategy, which is a critical part of prevention, is hard to maintain at encampments, said Joshua Bamberger, associate director of the UCSF Benioff Homelessness and Housing Initiative.

“What these emergencies highlight is our basic failure of our system to serve the most vulnerable amongst us,” said Bamberger.

Isolating people without a home to quarantine themselves in could present the most challenging task, said Bamberger, who suggested armories as a possible place for patient isolation.

“We need to be preparing now because when it does, it's not going to leave us much time to develop the resources,” said Bamberger. “We have to have the protocols in place, the materials in place and the physical structures in place so that homeless people can be adequately housed during this epidemic, if it comes to pass.”

Although some county public health officials say guidance from the Centers for Disease Control and Prevention on how to protect homeless populations isn’t coming in fast enough, it hasn’t stopped some from preparing for the worst.

“They are a more vulnerable population and it makes sense to plan for them,” said Peter Beilenson, director of health services for Sacramento County.

Beilenson has instructed shelter and outreach staff to identify clients who are showing significant lung disease symptoms, and bring them to local hospitals to be tested for COVID-19. If they test positive, Beilenson said the county will use local motel rooms for quarantine, though that hasn’t happened yet, he said. Beilenson said his health department has also ordered additional hand sanitizer to be passed out at shelters and encampments.

In San Francisco, which has two reported coronavirus cases, city staff has begun outreach to shelters and navigation center staff to share prevention guidelines on coronavirus. On Tuesday, the city’s Department of Public Health canceled Project Homeless Connect, an event that would provide social and health services to hundreds of homeless residents “out of an abundance of caution” from coronavirus.

In Berkeley, which announced its first case of coronavirus, Mayor Jesse Arreguin said 20 additional hygiene stations have been added to some encampments.

“The people that will be most impacted are the people that just don’t have access to basic sanitation,” Arreguin said.

Oakland set aside $500,000 in June to set up mobile bathrooms for people living outside to use, but those have not yet been deployed.

In a statement Monday, Oakland City Council President Rebecca Kaplan urged the city and Alameda County to take action amid growing concerns about public health and the risk of spreading an infectious disease, like coronavirus.

“We ask the County, which has authority over public health, to provide expanded hand-washing and sanitation facilities throughout our communities,” Kaplan wrote.

Homeless service providers across the Bay Area are ramping up sanitation efforts, providing additional hand sanitizer and face masks, when available.

“We’re treating it like we would a flu outbreak,” said Marcell Lloyd with St. Vincent de Paul, a shelter in Alameda County that serves up to 100 residents a night.

Other homelessness advocates are working to get the word out to people living at encampments.

“Well I think the general feeling is one of just confusion,” said Dayton Andrews, an organizer with the Wood Street encampment in West Oakland. “Folks that don’t watch the news aren’t actually aware there’s a coronavirus epidemic going on.”

Andrews said he recently held a community meeting on the topic at the encampment, and said Wood Street residents want the city to provide proper sanitation stations to protect them from coronavirus.

While there have been outbreaks of diseases like hepatitis A in encampments, UCSF’s Bamberger said there’s little precedent for an infectious airborne respiratory virus like COVID-19.

The closest comparison, Bamberger said, may be when severe acute respiratory syndrome, or SARS, moved into cities with larger homeless populations. A Toronto study highlighted the need to develop an outbreak preparedness plan that accounts for unique issues related to homeless people.

“If we can use these emergencies to improve the long-term health of our vulnerable populations, then it can be a wake up call,” Bamberger said.