As of Monday, March 23, there are 16 confirmed cases of coronavirus in West Virginia. Medical professionals are worried about what may happen if an outbreak occurs amongst one of the state’s most vulnerable communities: those experiencing homelessness.
Some of the advice that’s been given to smooth the curve of coronavirus infection has been to stay home, reduce the amount of time spent in large groups, and increase handwashing, but for those without permanent housing, all three of those tips can be nearly impossible.
Because of this, keeping those experiencing homelessness safe during this pandemic could prove to be quite the public health challenge, according to Wheeling-Ohio County Health Department Administrator Howard Gamble.
He said the challenges are multi-pronged, and include challenges ensuring those experiencing homelessness receive both testing and treatment.
“One, they could become infected and finding out if those individuals are positive or not can be extremely difficult one, how do you get them into testing? Two, how do you track them back down to say you’re positive or negative?” Gamble said. “If you ever move to a pharmaceutical intervention, how do you make sure that population gets that intervention? Whether that’s a medicine or a vaccination.”
There’s sometimes a stereotype that people who are experiencing homelessness struggle with their mental health or are in active addiction.
Crystal Bauer, Project HOPE director and nurse , said homelessness is caused by a variety of factors such as job loss, house fires, and domestic violence situations. One of the fastest growing segments of the homeless population is families with children. According to the 2018 point in time study on homelessness conducted by the United States Housing and Urban Development, 33 percent of those experiencing homelessness were families.
Project HOPE is a street medicine team based in Wheeling made up of medical professionals who make “street rounds” by traveling to different camps and shelters where those without permanent housing may be staying to offer medical care.
The organization is assembling kits with hand sanitizer, masks, disinfectant wipes, and cough drops to give to those they see on rounds in hopes that these items, along with handwashing demonstrations, will help slow the chances of an outbreak.
The team conducts rounds two times a week.
But even if the group can help successfully slow down an outbreak, Bauer is worried about what may happen when someone experiencing homelessness gets the virus.
Concerns of Quarantine
“I would say the biggest concern once someone has been identified as being diagnosed with coronavirus or COVID-19, what are we going to do with them?” Bauer said. “They do not have the luxury of having some place to quarantine themselves for 14 days.”.
There are options being considered for community medical quarantine and treatment spaces. One option brought up by Wheeling Mayor Glenn Eliott is to use the Ohio Valley Medical Center, which shut its doors in late 2019. The city has expressed interest in purchasing for other purposes.
Even with this possibility, advocates say that still doesn’t address the problems that self-quarantine and social distancing can have in regards to how those suffering from homelessness find jobs, or even get their meals. Sefan Perdue has been homeless for two months. He said he spends a lot of time during the day traveling around town applying for services, which often require in-person interviews.
”How can I self quarantine? I can’t. Like I said, I'll go stir crazy. I don’t want to sit inside of a tent all day long self quarantining,” Perdue said. “Can I stay away from people when that’s the only way helping me survive?”
Then there are the concerns over how the disease will affect the already weakened immune system of someone who is experiencing homelessness, Gamble said.
”You have an infectious disease that has mortality/morbidity rates that's of concern [and] that does not have a vaccine or pharmaceutical treatment. You have to consider this as a real threat to society and to public health,” he said.
While everyone should take the virus seriously, public health experts say this is especially pertinent for those without housing. Chronic homelessness has been shown to reduce someone’s life expectancy by about 17 years.
Dr. Thomas Wack, a volunteer with Project HOPE, said as many states move to close non-essential businesses, many Americans may find themselves closer to experiencing homelessness than they might expect.
“Many of us are just a paycheck or two from being homeless ourselves these days,” he said.
A 2018 Federal Reserve Report on household economic well-being has shown around 40 percent of American households would have a hard time paying for a $400 emergency expense. And the coronavirus pandemic is taking a major economic toll on the U.S. economy.
Bauer hopes this experience will show the need for proper planning in case there’s another emergency like this.
“We’re learning as we go. Let us use what we learn from this experience to create a plan for the future. Unfortunately, the homeless population is getting bigger and bigger, and unfortunately the homeless population is including more and more children,” Bauer said. “ So, we really have to be thinking collectively as a community about ‘what is a plan?’ We have to have a disaster plan that includes the most vulnerable in our community. Because if we don’t, shame on us because what will happen is people are gonna die.”
In the meantime, she says, Project HOPE is going to keep making rounds.