Among the Nation’s Most Vulnerable Populations, the Homeless are at Heightened Risk for Coronavirus

They are among the nation’s most vulnerable – those experiencing homelessness, whether living on the streets, in a car or shuttling among relatives’ couches. A large percentage have serious health conditions. And they are particularly susceptible to coronavirus and the related COVID-19 disease.

In an online workshop for the National Press Foundation, three experts on the issue detailed the state of homelessness in America, the impact of COVID-19 on the population, and how reporters can best cover it.

Dr. Bechara Choucair, chief health officer of Kaiser Permanente; Bobby Watts, chief executive officer of the National Health Care for the Homeless Council; and Hannah Dreier, a national reporter for The Washington Post, said that reaching the homeless population to help people prepare for coronavirus is both vital and difficult.

“We look at homelessness itself as an epidemic,” said Watts (bio, Twitter). Dealing with that as well as this new threat makes it all the more complex.

Video: Choucair explains how health systems have dealt with past pandemics.

Choucair (bio, Twitter) is a former public health commissioner for the city of Chicago and now oversees efforts to integrate social health and health care services for 12.2 million members of Kaiser Permanente. He described the stages of pandemics, detailed how the homeless population is affected by each stage and discussed how health care workers and journalists can anticipate what will come next.

“We haven’t seen this disease before, but we have seen pandemics,” Choucair said.

The first stage is containment, and in the U.S., coronavirus has already raced past that. Next is mitigation, or the stay-at-home and social distancing steps designed to slow the spread of the virus.

Up next will be suppression, with broader testing and contact tracing – something the U.S. has been slow to adopt. Later will be prevention, hopefully with a vaccine to prevent future outbreaks.

Choucair said that even in the absence of COVID-19, homeless individuals are twice as likely to be hospitalized and two to three times more likely to die than housed populations. His presentation cited the work of researchers from the University of Pennsylvania, UCLA and Boston University that estimated the impact of COVID-19 on the homeless population.

Watts, whose organization brings together more than 200 health care, respite, housing and social service programs, said that people experiencing homelessness are more at-risk themselves than they are a risk to others.  One simple necessity: Government-provided hand-washing stations. (More of the National Health Care for the Homeless Council’s public policy recommendations here.)

The Washington Post’s Dreier (bio, Twitter) was looking for a city with a relatively large homeless population that hadn’t received much media attention. She decided to go to San Antonio to see how social workers were reaching out to the city’s estimated 3,000 homeless people.

Dreier spent time walking the streets of San Antonio with a social worker and got back to Washington just as most airline travel was drying up and businesses were closing. Her resulting story noted the stark realities for the homeless: “Many of these people are sick, many are elderly, some are purposely staying in the shadows because of their immigration status, and a third have serious mental illness such as schizophrenia and paranoia that can make reasoning with them difficult. They are largely uninformed about the virus, and, because of their living conditions, are seen as crucial links in the spread of a pathogen that has the potential to overwhelm the country’s hospital capacity.”

Dreier, a 2019 winner of the Pulitzer Prize, gave tips on how to cover the issue while staying safe and bringing value to readers and viewers. Among them are to treat everything – shoes, clothes, even your notebook – as contaminated.

“The most important thing is to not become a vector yourself,” she said.

She also said reporters and their editors need to talk about whether a story can be done over the phone – or if it really requires going into the field.

“If there is a story that could be done over the phone, it should be done over the phone,” she said.

This program was funded by Kaiser Permanente. NPF is solely responsible for the content. 

Bechara Choucair, MD
Senior vice president, Chief health officer, Kaiser Permanente
Hannah Dreier
Reporter, The Washington Post
Bobby Watts
CEO of National Health Care for the Homeless Council
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