Homeless populations are among America’s most vulnerable to the coronavirus

More than half a million people living in the United States are experiencing homelessness. Every one of them is at a dramatically increased risk in this pandemic. This is true across the board: They’re more likely to catch the virus, to experience complications, and to die from it. The scope of the interventions needed to make sure this doesn’t happen is difficult to fully define, but experts say the need is immediate, and likely to get larger as we weather this crisis and the economic downturn that’s come with it.

As COVID-19 sweeps across the country, forty percent of America’s homeless population could become infected with SARS-CoV-2, the novel virus that causes COVID-19, according to a recent report. This percentage would put more than 20,000 of these individuals in hospitals and kill thousands. The findings are based on limited data from federal and local government agencies and predict that homeless people could be in a much worse situation than the general public, especially if local and federal administrations don’t produce a plan to address the problem.

Getting everyone indoors is a key first step, researchers say, as that would prevent potential contact with people who might be infected with the virus. The report estimates that the total cost of getting everyone indoors would be $11.5 billion annually. That money is urgently needed, the authors note, as it will significantly lower the national public health burden and make a huge difference to people experiencing homelessness.

“Folks experiencing homelessness are an incredibly vulnerable population,” says Thomas Byrne, a professor in the department of social welfare policy at Boston University. “From a humanitarian and moral perspective, there’s a real urgent need here.”

People experiencing homelessness can’t self-isolate to avoid catching or transmitting the virus, which means it could spread through their communities quickly. Beyond that, they are more likely to be experiencing other chronic health issues that would make them more vulnerable to the virus. As a result, “I would be very worried about someone who’s 50 [and homeless] in the same way I might be worried about somebody who’s 70 in the general population,” says UCSF professor of medicine Margot Kushel.

Since Black and Indigenous Americans are significantly overrepresented in the population of homeless people, the vulnerability of people experiencing homelessness also means that racialized Americans are also going to be disproportionately impacted by COVID-19, she says.

Meeting this challenge would require jurisdictions across the country to find 400,000 extra indoor spaces, and ones that are much more spread out than currently available shelters, for people to live and in some cases totally self-isolate.

Because homelessness looks very different in different states and even different neighborhoods (in some areas it means living on the streets and in others, people exclusively living in shelters), local authorities would need to prioritize the push to get everyone indoors. Some places are already attempting this, like the San Francisco Bay Area, but with limited financial resources and a lack of push from higher levels of government, says Dennis Culhane, a professor of social science who studies homelessness at the University of Pennsylvania. So the overall response has been patchy,

“There has not been, I think, a sufficient push from the federal level telling communities they have to do this,” he says. Culhane and Byrne, together with other researchers from the University of Pennsylvania and UCLA, produced the report on a tight deadline to provide context for debates about the federal relief bill that was signed by the president last week.

“There really was no information available for how this might impact homelessness,” Culhane says. The bill included $4 billion to address homelessness, which would be distributed through existing programs. “It’s not enough to shelter everyone,” he says, but it is a start.

With those funds, communities could start putting in place some measures like offering 24/7 shelter services, helping the most at-risk or people who have contracted COVID-10 to isolate, and providing infrastructure like handwashing stations to existing encampments of people. The National Alliance to End Homelessness and the CDC have called for these and other measures.

But the process of distributing these resources and what may happen down the road is still uncertain. Further funds through FEMA or other agencies might provide additional help, Culhane says, although interagency logistical issues abound. But COVID-19 is spreading fast through these communities right now, and the need is immediate.

About two thirds of the homeless population—500,000 people—are single adults, many of them are aging baby boomers, with a total mean age of about 55, Byrne says. They also have much higher rates of chronic health issues than the general public. This is bad news as people with chronic health issues as well as older folks are more at risk for COVID-19 complications.

UCSF’s Kushel has read the report produced by Culhane and his colleagues. “There are a lot of unknowns, and so they obviously had to make assumptions” using the data available, she says. That data includes federal data and some from Los Angeles County and New York City. A national 40 percent infection rate for homeless people, in the worst-case scenario, isn’t outside the realm of possibility, but “I really hope we don’t get there,” she says.

The other third of the homeless population is made up of families with small children. The report excluded them, because they look very different, demographically, from single homeless people, and they aren’t captured by the Department of Housing and Urban Development numbers the report relies on (they come from a specific set of educational statistics).

They’re also really vulnerable to COVID-19, Kushel says. Like single homeless people, homeless families are likely to have underlying health issues. They may also be splitting housing with numerous others. “If there are eight people in a one-bedroom apartment, that becomes like a homeless shelter’s density,” she says.

All of this adds up to a huge public health issue in the context of COVID-19, and one that requires swift action. Both Kushel, Culhane, and Byrne all agree that things are going to get worse in the coming months, as the economic downturn puts more people out of work and makes it harder to find new work, or jobs that pay enough. This instability is likely to make more people homeless, Byrne notes, which will increase need in a system that’s already unable to provide appropriate services to meet this pandemic.

And given that SARS-CoV-2 isn’t going anywhere, it’s likely that we’ll need to socially distance in waves over the coming years—which will be difficult for people on the streets, living in the shelter system, or sharing housing with many others. “If we’re getting people into emergency accommodation, this shouldn’t be the end of the story,” Byrne says. “We want to make sure that people have a stable place to go back to.”