Seeking shelter: homelessness and COVID-19

Abstract

Those experiencing homelessness in Canada are impacted inequitably by COVID-19 due to their increased exposure, vulnerability of environment and medical comorbidities, and their lack of access to preventive care and treatment in the context of the pandemic. In shelter environments one is unable to effectively physically distance, maintain hygiene, obtain a test, or isolate. As a result, unique strategies are required for this population to protect them and those who serve them. Recommendations are provided to reduce or prevent further negative consequences from the COVID-19 pandemic for people experiencing homelessness. These recommendations were informed by a systematic review of the literature, as well as a jurisdictional scan. Where evidence did not exist, expert consensus from key providers and those experiencing homelessness throughout Canada was included. These recommendations recognize the need for short-term interventions to mitigate the immediate risk to this community, including coordination of response, appropriate precautions and protective equipment, reducing congestion, cohorting, testing, case and contact management strategies, dealing with outbreaks, isolation centres, and immunization. Longer-term recommendations are also provided with a view to ending homelessness by addressing the root causes of homelessness and by the provision of adequate subsidized and supportive housing through a Housing First strategy. It is imperative that meaningful changes take place now in how we serve those experiencing homelessness and how we mitigate specific vulnerabilities. These recommendations call for intersectoral, collaborative engagement to work for solutions targeted towards protecting the most vulnerable within our community through both immediate actions and long-term planning to eliminate homelessness.

population level study of SARS-CoV-2 prevalence amongst people experiencing homelessness in Wales, UK

“…There is a large body of evidence highlighting how communal forms of homelessness accommodation can lead to transmission of communicable diseases such as H1N1/swine flu [ 2 ], MRSA [ 38 ] and tuberculosis [ 39 ]. Furthermore, a recent systematic review concluded that use of accommodation that satisfies basic needs such as a bed and food—as is the case with shelters—can do more harm than no intervention at all [ 40 ].…”

“…Concerns centred upon people who were literally roofless and those in communal forms of accommodation, such as shelters and hostels, where facilities and air space were shared. It was feared these environments could hamper a person’s ability to adhere to public health instructions regarding hand hygiene, maintaining physical distancing, and isolation when symptomatic or following a positive SARS-CoV-2 test [ 1 , 2 ]. The COVID-19 pandemic triggered unprecedented policy and practice responses, with homelessness being reframed as an urgent public health crisis for the very first time [ 3 ].…”

Utility, Limitations and Opportunities for Using Linked Health Administrative Data to Study Homelessness in Ontario

“…Finally, emerging evidence suggests that the experience of homelessness itself has changed since the COVID-19 pandemic. There appears to be greater visibility in rural settings (Devereaux 2021;Schiff et al 2020) where previously homelessness was either not present or hidden, more reliance on temporary hotel accommodations or urban camping in avoidance of emergency shelters or as a result of reduction in affordable housing (Baral et al 2021;Devereaux 2021) and potentially more reliance on hospitalbased care due to reductions in or closures of homeless-serving programs and services (Gibson et al 2020;Perri et al 2020). If these changes persist, the algorithm may perform differently than before the pandemic.…”

Homelessness during the COVID-19 pandemic. Strategies and action plans of the Berlin Senate

“…For isolation or quarantine, several authorities in the U.S. have secured hotels to house people experiencing homelessness temporarily (Fuchs et al, 2021). Likewise, in Canada, isolation units and shelters were set up from hotels or community centers (Baral et al, 2021).…”

“…The risks of SARS-CoV-2 infection and the course of the COVID-19 disease and prevention measures are extremely unequally stratified among socioeconomic groups (Coughlin, Sandel & Stewart, 2020;Baral et al, 2021). Thus, precisely the most vulnerable social groups were hit particularly hard by the COVID-19 pandemic.…”