Homelessness in the time of coronavirus

Data from the 2016 Australian Census of Population and Housing estimated that 116,427 people were counted as experiencing homelessness on Census night, up from 102,439 persons in 2011.
 
The atypical time of society shifting into lockdown to combat the spread of coronavirus has forced people to stay at home, except under specific circumstances.
 
However, the health of those people who do not have a stable home is vulnerable and could be further compromised if they contract COVID-19.
 
According to Victoria’s Council to Homeless Persons, people experiencing homelessness are more likely to have poor health due to exposure to extreme weather and living in substandard accommodation, as well as limited finances to access healthcare.
 
Dr Kate Coles, a GP with Melbourne-based outreach medical clinic cohealth, told newsGP that support services like food kitchens and mobile laundries are now mostly closed due to social-distancing rules, so people who are experiencing homelessness may also be missing out on regular social connections.
 
‘For many people who use homelessness services, contact with workers in those services is the main human contact they will have during the day, and now that has been cut off,’ Dr Coles said.
 
‘I think people are frustrated and lonely, like everyone else, but they don’t have the luxury of a comfortable home or access to entertainment.’
 
On a day-to-day basis, Dr Coles has noticed a drop in the amount of people seeking care via the outreach program since the lockdown, along with closures of the regular homelessness services that usually help to attract patients to the outreach service.
 
‘We have found co-locating with other services, [such as] Centrelink and mobile laundries, helps to attract patients to our service,’ she said.
 
‘But with most of those services shut down, there are fewer people in the places we visit, and one site has completely shut down.’
 
Much like temporary field hospitals or repurposing large venues to be used as coronavirus treatment facilities, temporary accommodation for people experiencing homeless is limited, but available.
 
‘I believe that a nursing home has been commandeered to use for patients with COVID-19, or suspected COVID-19, who don’t have somewhere to isolate,’ Dr Coles said.
 
But Dr Coles is also concerned about the virus’ effect on some of her patients living in short-term accommodation such as boarding houses, where there are shared bathrooms and kitchens.
 
‘How are you supposed to self-isolate? If someone in the accommodation has the virus, everyone will be at risk,’ she said.
 
The Pan Pacific Hotel in Perth is piloting the Hotels with Heart program, in which 20 homeless people who are unable to self-isolate have been housed.
 
If successful, the program will expand to take up 120 rooms at the hotel, opening up to more people experiencing homelessness, as well as victims of domestic violence and those experiencing mental health issues. It is hoped other states will roll out similar services during the lockdown.
 
Perth-based doctor Dr Andrew Davies, who operates out of charity Homeless Healthcare and is providing care for Hotels with Heart, is calling for ‘urgent action’ to move as many people as possible who don’t have a permanent home into accommodation to protect both themselves and the broader community.
 
‘There are a lot of co-existing health problems that put rough sleepers at very high risk of firstly getting COVID-19 infection,’ Dr Davies told the ABC.
 
‘There will be quite an extensive outbreak of COVID-19 among homeless people if we don’t act.
 
‘The last thing we want is any group in society that’s out there, that is particularly susceptible to this infection, being able to spread it to other people.’
 
Dr Coles agrees.
 
‘We will need to start suspecting COVID-19 more in this population, as the pattern of infection changes,’ she said.
 
‘People who are homeless can’t self-isolate so they are going to be [some of] the people in the community most at risk of acquiring COVID-19 from now on.
 
‘Up until recently, the epidemiological criteria meant that none of these patients were eligible to be swabbed for COVID-19  – no overseas travel, no contact with known case – but the epidemiological criteria have expanded to include people working face-to-face in homelessness support and any person in high-risk settings, including aged care.
 
‘They don’t specifically mention homelessness or boarding houses as high risk, although people working face-to-face in homelessness are, but I would consider it to be high risk and think it justifies doing the COVID-19 test.’
 
Dr Coles and her team are following precautions to protect themselves as best they can, which is not always straightforward when providing outreach care.
 
‘At the cohealth centres, a protocol has been developed to help identify any possible cases before they enter the centre, so that the person can be either sent to a fever clinic or they are isolated and adequate personal protective equipment can be donned before the doctor sees them,’ she explained.
 
‘While on outreach it is tricky to maintain precautions, people can just approach us on the street. We have asked the St Vincent’s nurses to screen people who want to see us, and if there is anyone we suspect of COVID-19 we send [them] to a COVID-19 clinic.
 
‘We have gowns, gloves, eye protection and masks, but we are at risk of running out of the good masks.’
 
The RACGP has more information on coronavirus available on its website.
 
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