Homeless show virus the door
People lacking stable dwelling spared much of pandemic’s fury
SAN FRANCISCO — When the coronavirus emerged in the U.S. this year, public health officials and advocates for the homeless feared the virus would rip through shelters and tent encampments, ravaging vulnerable people who often have chronic health issues.
They scrambled to move people into hotel rooms, thinned out crowded shelters and moved tents into designated spots at sanctioned outdoor camps.
While shelters saw some large COVID-19 outbreaks, the virus so far doesn’t appear to have brought devastation to the homeless population as many feared. However, researchers and advocates say much is unknown about how the pandemic is affecting the estimated half-million people without housing in the U.S.
In a country that’s surpassed 5 million identified cases and 169,000 deaths, researchers don’t know why there appear to be so few outbreaks among the homeless.
“I am shocked, I guess I can say, because it’s a very vulnerable population. I don’t know what we’re going to see in an aftermath,” said Dr. Deborah Borne, who oversees health policy for COVID19 homeless response at San Francisco’s public health department. “That’s why it’s called a novel virus, because we don’t know.”
More than 200 of an estimated 8,000 homeless people in San Francisco have tested positive for the virus, and half came from an outbreak at a homeless shelter in April. One homeless person is among the city’s 69 deaths.
In other places with large homeless populations, the numbers are similarly low. In King County, which includes Seattle, more than 400 of an estimated 12,000 homeless residents have been diagnosed. In Los Angeles County, more than 1,200 of an estimated 66,000 homeless people have been diagnosed.
It’s slightly higher in Maricopa County, which includes Phoenix, where nearly 500 of an estimated 7,400 homeless people have tested positive, including nine who died.
Health experts say the numbers don’t indicate how widespread the disease is or how it might play out long term. It’s unknown how many people have died of conditions indirectly related to the virus. While the coronavirus may dissipate more easily outdoors than indoors, living outside has its own risks.
With public libraries and other places closed, homeless people say they’re short on food and water, restrooms and cash. In San Francisco, 50 homeless people died over an eight-week period in April and May — twice the usual rate, said Dr. Barry Zevin, medical director of the public health department’s street medicine program.
The official causes are pending, but Zevin notes that fentanyl overdoses are rising and stay-athome orders may prevent people from getting help quickly. He knew isolation could result in more overdoses.
“I think that’s happened, and whether it’s more or less than I would have expected, I don’t know,” he said. “It’s frustrating to be able to forecast something as a problem, do everything you can to prevent it as a problem, but it’s absolutely a case of competing priorities.”
Good data is difficult to get on the homeless population because hospitals and death certificates don’t track housing status, says Dr. Margot Kushel, director of the Center for Vulnerable Populations at the University of California, San Francisco.
She was hesitant to draw conclusions about how the pandemic has affected homeless people overall but said “this may be an example where being outside and unsheltered, just in terms of COVID, maybe let people be at lower risk. But again, part of that is that we just don’t really know.”
New York City has reported more than 1,400 infections and 104 deaths among homeless residents out of more than 226,000 positive cases and 19,000 deaths. Roughly 60,000 people live in shelters, unlike in West Coast cities where many more are unsheltered.
But because New York’s shelters have more children than the general population, when deaths are adjusted for age, the mortality rate for homeless people is 67% higher than for the overall population, said Giselle Routhier, policy director for the Coalition for the Homeless.
“That’s extraordinarily high, in our opinion,” she said.
While advocates push for private hotel rooms for homeless people, a massive 1,200-person shelter at San Diego’s convention center is showing it’s possible to keep the case count low by strictly adhering to 6-foot spacing, frequent cleaning and mask-wearing.
“We have a team of firefighters that walk the floors to put the cots back where they’re supposed to be,” said fire Deputy Chief Chris Heiser, who is incident commander for the shelter.