Modern Healthcare, April 1, 2020
By Bechara Choucair
The health of our nation and our unsheltered population are inseparably linked. The ripple effects of a COVID-19 outbreak among the homeless in our communities will impact each of us and the health systems already stretched so thin. Across the country, 500,000 people are without a home, with thousands of workers on the front lines serving this population in shelters, encampments and social service agencies. Healthcare workers, emergency shelter staff, street outreach teams and other providers must be equipped to handle the inevitable outbreak of COVID-19 among our homeless populations. To protect our communities, they need clear guidance and protocols to prevent the worst outcomes, assess those who are most vulnerable and ill, and treat those suffering. Homeless individuals have an increased risk of contracting and transmitting COVID-19 because of a higher likelihood of pre-existing conditions and other factors like weakened immunity and barriers to basic sanitation. We're no longer contemplating whether this disease will impact shelters and encampments, but rather when and how severe the consequences will be. Addressing the needs of our homeless neighbors advances health and safety for everyone. In California alone, predictive modeling suggests more than 60,000 of the state's 150,000 homeless could contract COVID-19 over the next eight weeks. Across the U.S., researchers predict at least 21,000 hospitalizations and 3,400 deaths among the homeless population alone. Through a coordinated effort among civic leaders, health systems, homeless service providers and private organizations, we can limit spread, reduce stigma and ensure everyone is cared for with dignity and respect—but we must act quickly and with a unified purpose. Expand screening and testing Handwashing stations, hand sanitizer and bed separation in shelters are important preventive steps to flatten the curve of COVID-19, but ultimately those will not be enough to deter a widespread outbreak without expanding the volume and frequency of screening homeless individuals and front-line workers. Service providers need a standardized checklist for triaging daily screenings of all guests and staff—as well as the proper personal protective equipment, or PPE. Some organizations are already taking the lead. For example, Destination: Home in Santa Clara, Calif., is partnering with the Centers for Disease Control and Prevention and local officials to deploy a model for this process. If an individual presents flu-like symptoms or fever, testing must be available (preferably in an outdoor, well-ventilated space) to ensure proper care and prevent rapid-fire spread. Through targeted testing, communities can begin to supplement strained hospital resources and stem the rising tide. Ensure safe places for treatment Effective treatment protocols differ for individuals with a high likelihood of contracting COVID-19 and those with confirmed cases. Symptomatic individuals awaiting test results (or who will not be tested), require safe transportation to a space to practice appropriate isolation protocols. These facilities, which can range from RVs to motels, require increased resources to meet individuals' total health needs—from nutritious food to follow-up care. Individuals with underlying health conditions or who are 60 and older are considered high-risk and require additional precautions. Those with confirmed COVID-19 disease must be quarantined with appropriate medical care and wraparound services. These measures will require additional funding, clinical staff and PPE for service providers, resources already in short supply. However, if communities do not act quickly, the cost to our health systems and our communities' health will be insurmountable. We must advocate for increased resources to treat the broad spectrum of need for homeless populations. Share best practices and protocols Ongoing communication to share best practices among healthcare and homeless service providers is critical during this time. As the pandemic progresses, we will find effective approaches that can be implemented broadly—and those on the front lines will be eager for information. Webinars and online meetings are effective ways to safely convene and disseminate what we've learned. While addressing the immediate threat of COVID-19 is our priority, it should not take a pandemic to give our government and communities an incentive to care for our neighbors in need. We must leverage heightened awareness and compassion for the unique needs of homeless populations and, with guidance from the World Health Organization, CDC and public health departments, transition emergency measures into long-term affordable, healthy housing solutions. With each day that we don't take quick action to advance housing for health—both in times of crisis and times of calm—we place everyone's health at greater risk. Dr. Choucair is author of "Precision Community Health: Four Innovations for Well-Being," to be published in May.