Across California, Two Public Health Challenges Converge: Coronavirus and Homelessness

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As the coronavirus alters daily life for many Californians, state leaders are facing the confluence of two public health challenges: the virus and homelessness.

Standard advice for helping to prevent the spread of COVID-19, the respiratory infection caused by the novel coronavirus, includes staying home as much as possible and washing your hands. But for California residents who don’t have a home—or even a sink—that advice is difficult to implement.

“What you are seeing is two crises—homelessness and the virus—collide,” says Margot Kushel, director of the Center for Vulnerable Populations at UCSF.

Service providers and health experts are gearing up to get supplies and quarantine rooms ready for the 150,000 people in California who live on the streets or in shelters. The California Department of Public Health released guidelines for homeless assistance providers on March 11 and said it is coordinating with local health departments and organizations to deploy aid.

“The state of California is committed to preparing and protecting all Californians, including our most vulnerable,” Business, Consumer Services and Housing Agency Secretary Lourdes Castro-Ramírez said in a statement.

A significant number of Californians who are experiencing homelessness are over 60 and have chronic health problems, which puts them at higher risk of dying from the virus, said Brandon Brown, an associate professor in the Center for Healthy Communities at UC Riverside.

“A lot of the measures being recommended to help prevent the virus, such as social isolation, easy access to soap and water and calling a primary care doctor if you have symptoms, are just not easily available to people who are homeless,” Brown said.

Across the state, facilities that serve homeless residents are working to stop the spread of the virus. At the Union Rescue Mission in Los Angeles, for example, new hand-washing stations with soap and water are now outside the building. Staff members, residents and visitors who come for health services are all encouraged to wash hands before entering.

“We’ve also set up quarantine rooms for single men, single women and families in case they are needed,” said Rev. Andrew Bales, the shelter’s CEO.

An apprentice staff member who identified himself only by his first name, Ryan, 27, said signs reminding people to wash hands and cover their coughs are “everywhere in the building.” After years of substance abuse, Ryan said he now calls the mission home.

“I’m scared of the virus,” he said, “but grateful there’s so much inside and outside of the building to protect me.”

Public health officials are also trying to offer specific advice to people experiencing homelessness. Alameda County issued guidance last week urging health care workers to remind homeless residents to not to share drinks and cigarettes. They should also consider sleeping head to toe in shelters and on streets, rather than head to head, to help avoid contracting the virus, the advisory said.

Statewide care for those experiencing homelessness during the outbreak isn’t uniform, but Kushel and Brown say cities are learning and borrowing from each other. San Francisco has released $5 million to help marginally housed residents. The funds can be used for expanded cleaning in shelters, homeless resource centers and single room occupancy residences. The money may also go toward additional meals if there is an increase in people who become homeless because the virus caused them to lose income.

Many clinics that serve people experiencing homelessness are staging triage tables outside to assess patients before they enter the building and give them masks if they show possible signs of the virus, said Louise McCarthy, president and CEO of the Community Clinic Association of Los Angeles.

Barry Zevin, medical director of Street Medicine and Shelter Health, a program under the San Francisco Department of Public Health, said additional precautions his agency is recommending include reminding clients to wash their hands before meals and opting to have staff serve food, instead of having clients serve themselves.

“We’re getting the message out that the clients can be part of the solution, such as letting providers know if hand sanitizer supplies run out or they think too many people are handing food.”

Roselie, 52, who requested to be referred to by her first name only, is doing her best to limit the spread of the virus, despite living in her car. Roselie works as a custodian at an L.A. hotel but doesn’t earn enough to afford rent. For the past four years, she has been living in her car, often in a McDonald’s parking lot.

At a routine pap smear at a health clinic in L.A. this week, a staff member reminded her about precautions to take and symptoms of the virus.

“I’ve been paying attention and wipe my car’s door handles every time I get in,” Roselie said.

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