From homeless shelters and low-income neighbourhoods to harm-reduction facilities and prisons, the COVID-19 pandemic has magnified the cracks in our society for the most stigmatized and vulnerable.
While sound public health strategies such as physical distancing work for those with privilege, they are not foundationally plausible for homeless people who don’t have money, physical space or social support.
Housing – a fundamental human right – has been inextricably linked to food security, education, adequate employment and improved overall health and well-being. Despite this, more than 30,000 Canadians experience some form of homelessness each day. Often, those who experience absolute homelessness – meaning they have no shelter whatsoever – have scarce access to health and social services, experience high rates of criminalization and are accustomed to systemic stigmatization.
In addition, the inability of vulnerably housed individuals’ to pay rent or mortgages, accompanied by added healthcare costs, is pushing this group into absolute homelessness.
With infection risk estimated to rise to as high as 56% among the homeless, understaffed and under-resourced front line housing and social service organizations across North America have had to decrease capacity or in some cases shut down.
This means more people are sleeping in the streets than ever before – at the worst possible time in modern history. Services homeless people depend on are dwindling: food banks are experiencing shortages, bathrooms in public spaces are closed and drop-in centres are operating with limited resources. Housing services that have remained open are underequipped, with hundreds of people living in conditions that are not conducive to social distancing or quarantine. In addition, front line workers lack personal protective equipment, which is reflective of a worldwide shortage.
Homeless people have twice the risk of contracting and spreading COVID-19 compared to the general population. Since the first outbreak in a homeless shelter in Canada was identified on March 20, we have seen similar outbreaks in several jurisdictions across the country. What has become clear is that we are seeing two curves: one that is flattening for people with housing and incomes that allow for physical distancing and a second that is not flattening for people who live in congregate settings. The rapidity of COVID-19 transmission along with the vulnerable nature of this population creates the potential for thousands of deaths.
Further, the lack of necessary support and supervised consumption services due to COVID-19 will result in drug-related health consequences long after this pandemic has passed.
To prevent stigmatized people living on the margins from falling through these cracks, a response is needed at individual, community and policy levels. Strategies implemented in some Canadian cities have included moving homeless individuals into hotels along with the development of isolation sites where groups can undergo testing and quarantine appropriately.
But what happens after COVID-19? Are we really going to ask people to leave temporary accommodations they obtained during the pandemic and go back to the streets?
Clearly, we have the potential now, more than ever, to commit to housing as a human right through investments in programs such as housing first and subsidized housing and supports such as a universal basic income.
Housing first – a model that provides housing without the prerequisite of completing mental-health and substance-use programs – has been a proven homelessness solution for years. Globally, the model has been found to increase long-term housing maintenance, address physical and mental illnesses and be cost effective.
Subsidized housing, otherwise referred to as rent-geared-to-income, is another potential solution. It caps rent at 30% of an individual’s monthly income, addressing a common contributor to homelessness.
Finally, solutions must be focused on addressing the primary cause of homelessness – poverty. Improving social supports and implementing policies such as a universal basic income that provides all individuals a set amount of monthly income will allow those who experience poverty to improve their living conditions while simultaneously preventing occurrences of homelessness.
Every COVID-19 solution focused on those experiencing homelessness must address systemic barriers through a consideration of providing universal health care, decriminalizing drugs, implementing paid sick days and health insurance, supporting those with debt and ultimately providing housing for all.
To support society’s most vulnerable among us, all levels of government, public health authorities and our communities must respond to this pandemic now and after this crisis is over.