For the last month, the coronavirus (COVID-19) epidemic has been the topic of the hour, every hour.
COVID-19 rests on the tip of everyone’s tongue, escaping in periodic intervals into egregious, gaudy and occasionally nonsensical opinions that linger in the air we breathe. Everyone is on high alert, watching the news diligently for the latest regional information on COVID-19 in an attempt to gauge personal risk and enact any and all precautionary measures required to keep themselves out of harm’s way.
As a result, disinfectants like hand sanitizer and ammonia are all but obsolete in pharmacies and supermarkets. The stock market has risen and fallen rhythmically like an electrocardiogram to waves of mass, impulsive removal of investments. New enterprises have emerged from the dark yielding avant-garde personal hygiene solutions and protective equipment pieces, like fashionable respirator masks.
It seems the whole world is up in arms in their fight against the virus. But in protecting only ourselves we’ve forgotten the crowning principle of both infectious disease transmission and humanity’s resilience: we are only as strong as our weakest links.
As a shelter worker in an infectious disease outbreak, I witness first-hand how our ignorance toward society’s weakest links—homeless people, who are incredibly vulnerable to the world’s economic, political, ecological, and in this scenario, biological shocks— threatens us all.
Exploring Our Weakest Link
Pre-Existing Health Conditions
Homeless people have pre-existing health conditions that make them vulnerable not only to contracting COVID-19, but also to becoming an extremely ill, if not fatal, case.
Homeless people carry a disproportionate amount of society’s disease burden. This is oftentimes caused by unmet social determinants of health, like income, housing, intersecting oppressions, and access to social services. This relationship is a two-way street: experiencing homelessness can contribute to health issues, while health issues can contribute to homelessness.
Some of the diseases that homeless people are notably at risk for include: cardiovascular disease, diabetes, and lung disease — all of which have been identified by the Center for Disease Control as risk factors for falling extremely ill from COVID-19. Many homeless people check all of the risk factor boxes and more.
Inaccessible Medical Goods and Treatment
The CDC lists a number of measures to take if you suspect you’ve caught the coronavirus. Cathy Crowe brilliantly critiques these by mapping them alongside frontline realities and organizational capacities.
The CDC highlights a number of strategies that aren’t remotely accessible for homeless people, such as isolating oneself from others during the illness by avoiding public areas and public transportation by staying at home. What about people who don’t have homes, who exist is in public spaces? There’s no such thing as tucking yourself into bed when you have no home.
The CDC also recommends purchasing a face mask, sanitizing products, and a visit to the family doctor; all of which require an income and/or health insurance. In my work, I support individuals who cannot afford health goods as basic as canes and over-the-counter medications. How can they be expected to foot the bills for medical goods and treatment for a COVID-19 infection?
Add on top of this homeless “sweeps” that discard personal property and aggravate traditional barriers to accessing medical support, like missing identification. Now you’ve made it nearly impossible for homeless people to access treatment, should they contract COVID-19.
Reduced Space and Brutal Housing Realities
Overcrowding in housing is a brutal reality, whether that is in affordable housing units, emergency shelters or outdoor encampments. People experiencing homelessness exist in tight quarters. In some emergency shelters, more than 100 community members can sleep in the same room. On Skid Row in Los Angeles, nearly 5,000 people live adjacently on the street, with nothing but plastic tents and makeshift shelters separating each individual dwelling.
Socio-spatial theory observes that the space homeless people occupy is under constant threat. Therefore, the space they are both socially and legally permitted is significantly smaller relative to people who are housed.
This is a brutal social reality that as a society, we have accepted. However, it is deadly in the face of an outbreak. All it takes is one infected individual to access these spaces and the virus spreads like wildfire. The case-fatality ratios for a COVID-19 outbreak among homeless people would undoubtedly be harrowing.
How Weak Links Corrode the Chain
Homeless people may be invisible, but they are not isolated. They interact with dozens of people every day within the community, from other homeless individuals accessing public services to the staff and volunteers that serve them.
All of the people from the community-at-large that homeless people interact with have families and friends that they go home to. The six degrees of separation rule does not apply when it comes to outbreaks at the community level. Three degrees is all it takes for an outbreak to spread from a homeless sub-population to a housed general-population under circumstances such as these.
By virtue of not having a private dwelling space, their existence is restricted to public space. Soup kitchens, churches, community centers libraries, parks, and resources are where individuals connect with the general population. And with the exception of frontline healthcare staff, many of these community organizations are not supplied with equipment nor intel to prevent and manage an outbreak— although there are some excellent resources that have adapted public health strategies to the shelter context that can aid frontline workers.
Reframing COVID-19: Opportunity to Reinforce the Weak Links
A former street nurse named Barb Craig once said: if the first person with the SARS infection in Canada had walked into a downtown Toronto hospital instead of a suburb, the infection would have had a different path and it would have been catastrophic for the homeless population.
I believe it would be catastrophic for the general population, too.
Homeless people are like the seams of a quilt; they may not be explicitly visible, but they are intently woven into the fabric of our society. Outbreaks like coronavirus jostle the fabric of our society, testing the robustness of the social safety net we’ve stitched together.
There are holes in the fabric of our society. There are weak links on our chain.
For a long time, we have neglected to reinforce these weakening links; we’ve turned our backs on the failing social structures that lead people to fall through the cracks.
In the spaces between those links lie the invisible people. Our negligence in protecting them may, in the end, be our greatest downfall. COVID-19 is deadly— but our ignorance kills.
Let’s use the COVID-19 outbreak as an opportunity to reset our mental circuitry. Remind ourselves of a lesson that homeless people and their allies have been shouting for a long time— that humanity is stronger when we reinforce our weakest links.