Homelessness and Health in the Time of COVID-19

Homelessness and Health in the Time of COVID-19

Housing and health have always been inextricably linked– but never has that been more apparent than during the COVID-19 pandemic. At a time where a key prevention measure is to stay home, more than 500,000 people are experiencing homelessness and have no home to stay in.

Due to the United States’ failure to end homelessness, these individuals– who are disproportionately Black, Indigenous, and People of Color (BIPOC) and people with disabilities– are at an increased risk of illness and death.

People Experiencing Homelessness are at Increased Risk from COVID-19

People experiencing homelessness are at disproportionate risk of contracting COVID-19. Many people experiencing homelessness sleep in shelters, which often have dozens of people in the same room, making it impossible to physically distance. These congregate settings can spawn huge outbreaks: for example, at a shelter in San Francisco, 66% of residents became infected.

People sleeping outside may have difficulty accessing hygiene measures such as frequent handwashing. Moreover, people sleeping outside in encampments are also at increased risk of infection when police forcibly require the encampments’ residents to move– these “sweeps” can cause spread of COVID-19 and are in violation of CDC guidelines.

Other people experiencing homelessness may “double up” with friends or family, also exposing them to new people and potentially increasing infection risk.

Once people experiencing homelessness get COVID-19, they are also at disproportionate risk of severe disease. A recent study estimates that when people experiencing homelessness are infected by COVID-19, they are twice as likely to be hospitalized, two to four times as likely to require intensive care, and two to three times as likely to die than the general population.

People experiencing homelessness are disproportionately prone to severe disease due to several factors. For example, people with disabilities are more likely to experience homelessness, partly due to reduced income if a person’s disability impacts their ability to work. Many disabilities increase the risk of severe illness from COVID-19.

Additionally, because of racism in housing and other systems, people experiencing homelessness are more likely to be BIPOC. BIPOC are more likely to experience severe illness from COVID-19, due to factors like structural and environmental racism that increases the risk of chronic conditions, and from racial discrimination in health care.

Moreover, the experience of homelessness in itself worsens many chronic conditions. In general, older adults experiencing homelessness have a higher prevalence of health conditions associated with aging than housed people who are 20 years older—a worrying fact given the impact COVID-19 has on older adults with chronic conditions.

Without Rapid Action, Homelessness Will Increase

Unfortunately, without significant intervention the crisis of homelessness is poised to soon become drastically worse. Even before the pandemic, the U.S. had an enormous affordable housing crisis; many low-income renters were forced to pay far more than they could afford for housing. BIPOC are far more likely to be low-income renters than Whites, due to racial disparities in income and generations of racist housing policies.

The tremendous economic toll of the pandemic is disproportionately hitting these same people. One in five adult renters were behind on rent for the week ending July 7– including 30% of Black and 23% of Latinx renters. Without relief, many of these families will become homeless.

While many people are presently protected from eviction by eviction moratoriums, in many cases those moratoriums are expiring, even though the economic and public health crisis is still worsening.  In addition to increasing homelessness and hardship, this will worsen the epidemic– research indicates that lifting moratoria against evictions and water and electricity disconnections significantly increases the growth rate of COVID-19 infections.

Policy Changes Can Prevent Homelessness and Help House People Experiencing Homelessness

To reduce risks for people currently experiencing homelessness, federal, state, and local governments should fund placing people in non-congregate settings, such as hotels. Priority should be given to people at the highest risk, including older adults and people with chronic conditions, as well as people with COVID-19.

Even more than temporary hotel rooms, people experiencing homelessness should be moved into permanent housing, using evidence-based approaches like rapid re-housing. The CARES Act provided some funding to support people who are currently experiencing homelessness and to get them into housing, but far more is still needed.

Drastic action is also needed to prevent an increase in evictions and homelessness. As in the HEROES Act that was passed by the House of Representatives, Congress should fund at least $100 billion in emergency rental assistance, and implement a 12-month moratorium on evictions and foreclosures.

While many problems have complex solutions, the solution to homelessness is simple: house people who are experiencing homelessness, and prevent more people from entering homelessness. For far too long, our country has done far too little to address homelessness—and much of our inaction has been rooted in racism and ableism. Acting is a moral imperative, and a public health necessity.

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