Stuck between a virus and a cold place: A choice for homeless Americans awaits

Imagine having lost your sole source of income in June in the midst of a global pandemic. This is not a unique situation; after all, the COVID-19 pandemic has wrought havoc on many families. And in the United States, life has irrevocably changed. But the worst is yet to come. Illinois is seeing exponential growth of patients with COVID-19, and winter is coming. With it, the homeless population faces challenges on multiple fronts: the challenge of finding shelter that can provide warmth and safe enough to avoid high rates of transmission of a silent virus. With an already unstable economy adding to the growing homeless, it will be a long and hard winter.

The COVID-19 pandemic worsened the dilemma that homeless shelters combat every winter. Due to close living conditions and large numbers of people circulating in and out of homeless shelters on a regular basis, it is inevitable these places will become COVID-19 endemic zones once winter arrives.

If new residents are accepted at the start of the cold months, it will increase the risk of COVID-19 spread due to exterior exposure. If homeless shelters adopt similar protocols to this past summer, meaning people may only exit but not enter, then the homeless populations on the streets will be more at risk of dying from hypothermia. There are no easy options, but there may be a solution appropriate for each city with an understanding of what shelters across the country are doing.

At the onset of the COVID-19 outbreak, Chicago homeless shelters had reported increased cases among their staff and residents. The CDC/CDPH risk factor assessment shows that the shelters with greater resident flux on a regular basis presented with higher rates of COVID-19 infection. However, planned interventions can be effective as described in a September 24, 2020, NPR article that highlighted community efforts from the Chicago Homelessness and Health Response Group for Equity and the Chicago Coalition for Homelessness. These organizations have managed to mitigate the numbers of infected individuals with frequent testing and strict rules regarding handwashing. Adopting these variables during the winter months could prove useful.

However, such protocols may not be as sustainable as winter approaches. As reported in the Seattle Times, the combination of COVID-19 restrictions limiting bed space, the coming winter, and low federal funding makes for poor prospects. A strict lockdown has been successful in creating a COVID-19 free zone from March to October, but the staff at Mary’s Place homeless shelter is unsure of what to do when federal funding runs out, and more people are asking for shelter. One option may be to partially reopen the bed space but allow for indoor tenting. Careful risk mitigation, such as social distancing, mask-wearing, and regular handwashing with soap and water would be essential in this case.

Effective strategies were implemented in Springfield, Massachusetts, where shelters were able to plan ahead for a COVID-19 winter and opted for a different option – installing HVAC ventilation and organizing bed expansion to allow for social distancing. The city of Springfield also built three massive fully equipped tents outside of Friends of the Homeless shelter to prepare for COVID-19 case surges in their homeless populations. While expensive, these precautions may be viable options for shelters with larger sources of funding.

Not all risks to the homeless population this winter season are unique. Annually, cold temperatures kill 1,330 people in the U.S. This number is an underestimate, as not all cold-induced deaths are reported as such. Cold can worsen heart diseases and respiratory illnesses, leading to hospitalizations and deaths from those conditions. Cold conditions also lead to increased emergency room visits, which can be costly relative to adequate safe housing. To prevent hypothermia deaths among the homeless population, Washington, DC homeless shelters change their working hours to allow their residents to stay inside for longer during cold weather. The city also offers emergency shelter in churches and community centers and free transportation to those shelters. These precautions may prove to be useful in northern states during the cold winter months.

To be sure, the biggest hurdle for any shelter is financial in nature. HVAC installation is expensive, lockdowns require infrastructure in place with staff and resources, and community involvement, be it financial or in person, are vital for success. However, as has been shown by the examples above, solutions are possible. However, they require intentional planning, effective allocation of resources, and solutions should be individualized, taking into account each specific community’s needs.

What form the incoming winter will take depends on the location and status of the COVID-19 pandemic. Each city must find a method that will provide the most relief and assistance for their homeless population. Analyzing the results of the measures already taken by shelters in the country will prove vital to developing individualized intentional plans for others. Finances will have to be the deciding factor on whether a shelter will install an HVAC system, engage in strict lockdowns, tap into the community, or develop a hybrid solution. Whatever the choice, shelters and the cities best act fast, because after all – winter is coming.

Miracle Diala, Christopher Llerena, and Marina Lentskevich are medical students. Garth Walker is an emergency physician and can be reached on Twitter @garthwalkermd. Shikha Jain is a hematology-oncology physician who blogs at her self-titled site, Dr. Shikha Jain.  She can be reached on Twitter @ShikhaJainMD.

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