The spread of novel coronavirus (COVID-19) has drastically changed daily life, both here in the United States and around the world. Many of us are working from home, or are otherwise limiting our interaction with others per the U.S. Centers for Disease Control and Prevention’s (CDC) social distancing guidelines to limit transmission. But for those without homes (or whose homes are unsafe or unsecure) the repercussions of the COVID-19 pandemic are particularly salient. Residents of public housing, people experiencing homelessness, and members of low-income communities may lose access to the critical resources they need to survive. As local and state governments ask people to shelter in their homes to avoid spreading this infectious disease, it is apparent now more than ever that housing is health.
The National Healthcare for the Homeless Council notes that people experiencing homelessness tend towards high rates of chronic conditions such as diabetes and lung disease, both of which increase the risk of severe illness from COVID-19 infection. People living in public housing are also at a greater risk during the COVID-19 pandemic. According to a recent Urban Institute report, “over half of households in public housing were headed by a person who was 62 or older and/or was disabled” - two groups that are especially vulnerable to severe illness.
But clinical risk is only one consideration. Low-wage workers will bear the brunt of the economic downturn caused by the COVID-19 pandemic. This means that families struggling to afford rent each month may now be displaced as a result of lay-offs, wage cuts, or slashed hours. Moreover, those experiencing homelessness may be unable to comply with recommendations to limit coronavirus exposure or prepare for potential quarantine. Where can you quarantine if your home is a public place?
Social distancing is currently the best preventive measure to halt the spread of COVID-19. Yet social distancing has implications for those working in “non-essential” industries, those reliant on public services for essentials like food and medicine, and families with young children no longer able to attend school. While social distancing is the correct public health approach to preventing further spread of disease, economically vulnerable communities are facing immediate, catastrophic losses as businesses across the country close their doors for the foreseeable future. Moreover, for people experiencing homelessness and those with disabilities, social distancing poses a daunting - if not insurmountable - challenge.
COVID-19 hasn’t caused these gaps in our healthcare system and housing landscape, but has exposed them and made the need for solutions more urgent for the public’s health. To solve these issues, communities must find creative solutions that address all aspects - social, economic, and health-related - while being grounded in public health and social justice.
Fortunately, some communities are taking steps to mitigate the pandemic’s effects among vulnerable populations. In Philadelphia, the mayor announced the city’s plan to temporarily halt evictions as the number of cases continues to rise throughout the city and its surrounding counties. Other major cities have also taken this critical step. Federal lawmakers are considering emergency measures to support American families during the crisis. The U.S. Department of Housing and Urban Development is prohibiting foreclosures and evictions for homeowners with Federal Housing Finance Agency-backed mortgages. These steps are crucial, but don’t go far enough to provide much-needed relief for many Americans. In addition to addressing the immediate needs arising from this public health crisis, policymakers must consider implementing long-term solutions to the inequities that persist in the public sphere. Social service and community healthcare providers should be involved not only in actualizing guidelines, but in designing thoughtful, client-centered policies and strategies to address the persistent disparities in under-resourced communities.
To that end, what can healthcare providers do - both now and in the future - to respond to the needs of those at greatest risk?
Justin Gero and MaryGrace Joyce contributed to this blog post.