“Treat Him as a Friend and Save a Life – A Homeless Man is not a Leper.” (Sir Kristian Goldmund Aumann)
By Fayaz Ahmad Paul & Vineesh A
Various Individuals experiencing homelessness are at increased risk of infection with corona owing to their lack of safe housing and are also at higher risk of severe coronavirus disease given the high prevalence of risk factors in homeless populations. People experiencing homelessness often find it difficult to adhere to public health directives such as physical distancing, isolation and quarantine because of shelter conditions and other challenges. Various states and regions have taken measures to provide spaces for people experiencing homelessness, to ensure physical distancing, isolation or quarantine however, service providers must focus on building relationships and rapport, and take a trauma-informed approach to care, to persuade individuals to follow advice.
Closure of regular services may put people experiencing homelessness at risk of other harms, such as those related to unsafe substance use and intimate partner violence. Covid-19 pandemic disparity is particularly relevant for individuals who experience homelessness. Homeless shelters are an ideal environment for transmission of coronavirus because of shared living spaces, crowding, difficulty achieving physical distancing and high population turnover. People who are homeless also have a high prevalence of chronic health conditions that increase the risk of poor outcomes if they develop Covid. Homeless individuals are at increased risk of infection with pandemics owing to their lack of safe housing and conditions in shelter and drop-in facilities.
The risk of severe Pandemics is increased for people experiencing homelessness owing to the high prevalence of medical co-morbidities including heart disease, respiratory conditions, liver disease and high rates of smoking in homeless populations. In one of the research findings it shows that mortality rates among individuals experiencing homelessness range from 0.4% to 1.7%, which is higher than population averages. Mental and other health professionals that provide services for people experiencing homelessness have identified the following challenges like lack of timely and ongoing public health communications, difficulties in maintaining adequate infection control measures because of limitations in staffing and physical facilities, lack of sufficient personal protective equipment, and challenges to achieving effective screening of patients.
Homeless people represent a group that is particularly vulnerable to pandemics; it is prudent to offer homeless people priority testing for SARS. In keeping with general public health recommendations to prevent the spread of pandemics, shelters, meal programs and other Governmental and nongovernmental organizations that serve individuals experiencing homelessness must create conditions that enable physical distancing.
Various factors such as mental illness, substance use, involvement in Commercial sex work and distrust of service providers may contribute substantially to difficulties faced by individuals in engaging with pandemic-specific guidelines. Screening and treatment services such as primary care clinics may have been less accessible for individuals experiencing homelessness. Persons experiencing homelessness are likely to be at high risk for clinically severe pandemics yet are also unlikely to have engaged in any advance care planning. However, as a result of alienation from the health care system, many individuals experiencing homelessness may resist transfer to hospital if their condition deteriorates. Clinicians caring for this population should be trained and equipped to provide pandemic palliative care, including compassionate and trauma-informed end-of-life care.
Individuals who are experiencing homelessness and have substance use disorders, the added stress imposed by the closures of related services may contribute to increased alcohol or drug use and high rates of substance-related morbidity or mortality. For individuals who are opioid dependent, experiences of physical distancing and the resulting limited supply of opioid products may increase risks of overdose because of intermittent use and loss of drug tolerance. Reduced access to supervised consumption services increases risk of harms associated with unsafe drug use, including acquisition of blood-borne infections such as HIV and hepatitis C. Homeless women and gender-diverse people may be at increased risk of experiencing intimate partner violence during the pandemic. Individuals who experience homelessness are also likely to face criminalization of their daily life. It is difficult, and impossible, for homeless individuals to avoid infractions of physical distancing orders when they line up to enter a shelter or any food program or when they sit on a road or park.
Many health, social, NGO’s and government agencies must collaborate in a coordinated approach when developing and implementing services within the homeless sector. Money is needed to ensure adequate supply of resources such as personal protective equipment, to enhance shelter space and to ensure harm reduction approaches in isolation and quarantine facilities for individuals experiencing homelessness. Covid-19 and associated public health control measures pose particular challenges and increased risks of harm for people experiencing homelessness.
Different Measures have been implemented across the country to increase capacity to allow safe physical distancing for homeless people, including arranging temporary housing, enlarging shelter spaces and creating isolation sites for homeless people with Covid-19.
Fayaz Ahmad Paul & Vineesh A can be reached at paulfayazpaul@gmail.com