Hamilton has confirmed cases of coronavirus, the World Health Organization has declared a global pandemic, and yet what are we doing to protect our city’s most vulnerable citizens?
Widespread public health and media reports have focused on specific strategies to mitigate the spread of COVID-19, including hand washing and self-isolation. What remains elusive in the public health messaging is the impact of COVID-19 on individuals who experience homelessness. Some of our sickest patients rely on emergency-drop in centres and overcrowded shelters — the realities of which make it very difficult to contain the spread of something so dangerous.
Given Hamilton’s high rates of homelessness and huge inequalities highlighted by the Spectator’s Code Red Series, it begs questioning what kind of contingency plans exist for the roughly 3,000 individuals who use shelters yearly in Hamilton. As noted in both the series and a growing body of literature, the burden that poverty places on someone’s health is immense and cannot be ignored.
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Individuals experiencing homelessness are especially vulnerable to the impact of COVID-19 because of several added complexities. Shelters and drop-in centres are overcrowded and have cramped sleeping arrangements. Dining areas and washrooms are shared, and proper hygiene is difficult at the best of times. Shelter networks operate on limited funding making it difficult for staff to access appropriate personal protective equipment.
Those who experience homelessness are also often forced to migrate between facilities as some drop-in-centres only operate during the daytime while some shelters are only equipped for short-term stays. For those who sleep on the streets, accessing a place to wash their hands is most often non-existent.
Ultimately, if the goal of prevention or ‘flattening the curve’ requires social distancing and self-isolation, how is that possible for someone who lives in a shelter or on the streets?
These factors create a perfect storm for the transmission of a potentially deadly virus. Additionally, individuals who are homeless may also be at greater risk of experiencing significant complications from COVID-19. This population has higher rates of pre-existing health conditions, are more likely to have respiratory illnesses, and have fragmented access to health care services. They are, in fact, some of the sickest members of our society.
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If global trends continue and critical care capacity in our hospitals becomes overwhelmed, how will the allocation of health care resources impact those who quite often fall through the cracks of
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our health-care system? Further, as clinicians who provide palliative care, how will we ensure adequate compassionate care for those who succumb to this devastating pandemic, particularly those who have inconsistent access to health care?
If Hamilton wants to develop a COVID-19 contingency plan that is all-encompassing, it must not forget those who are most vulnerable in our city. Suggestions for such a strategy could include:
The development of a communications and contingency plan specific to the homeless population, including screening and isolation protocols that are uniquely tailored by public health agencies.
Ensure emergency funding allocation to shelters and drop-in community sites so that they can increase sleeping space (decrease crowding), implement more extreme cleaning protocols, ensure access to protective equipment, and plan for increased staffing requirements.
Declare homelessness as an emergency and work toward prioritizing Housing First initiatives to not only contain the spread of COVID-19 but to protect our vulnerable from future outbreaks.
As physicians, we are trained to understand how the burden of disease affects our patients. But what happens when the burden of poverty makes it near impossible to mount a defence against a pandemic? Like so many other terrible things, COVID-19 will disproportionately impact those who live below the poverty line. Perhaps it is time to consider how much we really care about our city’s most vulnerable.
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Dr. Jacqueline Carverhill is a resident physician at McMaster Family Practice and has an interest in inner-city health and palliative care. Twitter: @jcarverhill. Dr. Naheed Dosani is a palliative care physician and Assistant Clinical Professor in the Division of Palliative Care at McMaster University. Twitter: @NaheedD
