As medical practitioners, public health professionals, and social scientists who are members of the UC Berkeley School of Public Health Community Action Team, we are committed to bridging the gap between scientific evidence and the community in an effort to ensure the health and wellbeing of people experiencing homelessness (PEH) during the COVID-19 pandemic.
In our report, based on a review of a wide range of evidence, we summarize the relevant public health principles and knowledge about SARS-CoV2 and its associated illness, COVID-19. We then highlight the reasons for the greater rates of illness and mortality of PEH before the pandemic. We link these causes to their higher vulnerability to SARS-CoV2 infection, severe disease and mortality. We then provide an overview of the latest policy developments in the COVID-19 response to homelessness in the San Francisco Bay Area and in 6 other cities. We conclude with recommendations regarding testing and housing to protect society’s most vulnerable people and the broader communities in which they live from preventable morbidity and mortality.
Some of our key conclusions include:
1. The public health requires that all of us physically distance/shelter in place, practice good hygiene and wear masks. However, it is clear that PEH cannot follow these directives in encampments, on the street, or in large congregate shelters.
2. We recommend that all PEH be given access to housing and support so they can safely shelter in place, quarantine, or medically isolate. For most individuals this will require low-barrier hotel rooms or single-occupancy units. For others, this will require resources and supports to safely shelter in place in their current housing.
3. Hotels rooms or other forms of single-occupancy units should be employed as prevention to prevent viral spread, not just for quarantine or isolation. Similarly, housing should not depend on test results.
4. Provide hotel rooms with accommodations to make them appropriate for PEH, including safe transportation, storage of personal belongings, accommodations for pets and/or families, trauma-informed protocols, and adopting a low-barrier approach.
5. We recommend expanded testing, not only in shelters, but also to unsheltered PEH. Surveillance testing is urgently needed to guide our policy.
6. Communities’ response to COVID-19 must urgently address the needs for all PEH. This response should include families, unaccompanied minors and youth, and post-secondary students, as well as single adults. Similarly, the response should include individuals who are living outside, in tents, in encampments or in cars, as well as people in shelters. It should incorporate adequate access to sanitation and harm reduction principles.
7. To allow PEH to shelter in place and to keep non-violent offenders out of jail and the courts, enforcement of laws that criminalize PEH, such as laws regarding panhandling and sit/lie, as well as property confiscation, ticketing and towing of cars where people are sheltering need to be suspended.
8. Staff caring for PEH are first responders, who should have access to support to be able to perform their job in ways that will keep both them and their clients safe.
Ensuring that all PEH can properly shelter in place will:
· further “flatten the curve”;
· decrease the demand for services from hospitals;
· protect our healthcare workers and first responders;
· allow us to lift shelter-in-place orders sooner than if PEH are not sheltered-in-place; and
· make it safer for those who are not infected to resume normal activities with minimal risk of infection when shelter-in-place orders are lifted.
Dr. Colette Auerswald. firstname.lastname@example.org
Kamran Abri Lavasani. email@example.com
Haruna Aridomi. firstname.lastname@example.org