Might the pandemic be a lifeline for the rich world’s homeless?

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THE ADVICE governments around the world are giving their people has a monotonous consistency: stay at home; shelter in place; maintain social distance; go out only for essential purposes. None of that is much use for people who spend their nights either sleeping rough or in a homeless shelter. To take an extreme example: in a number of cities in France, charities claim, people have been fined for not staying in homes they do not have. And government efforts to help people through the crisis often require fixed abodes. In Japan the government has promised to distribute two reusable face masks to every household in the country—but they will not reach rough sleepers.

Yet charities working at improving the lot of the homeless have seen the pandemic as, perversely, offering a glimmer of hope—it does at least highlight the urgency of easing their plight. For two reasons, the homeless are especially vulnerable to contracting the covid-19 virus and hence to transmitting it. The first is to do with their physical state. They are more likely to suffer from underlying health conditions. According to a paper in the Lancet Public Health, a journal, by Jack Tsai and Michal Wilson, homeless people in America and Canada aged younger than 65 years are five to ten times likelier to die, of any cause, than the general population of the same age.

In England, where a survey one night last autumn found 4,300 people sleeping rough, Pathway, a health-care charity for the homeless, estimates they are 2.5 times as likely to have asthma as the general population, and 34 times likelier to have tuberculosis, conditions that often make covid-19 fatal. Homeless men in England have a life expectancy of 44, half the national average. But in many countries, the homeless tend to be older than society as a whole. This is most acute in the world’s oldest country, Japan, where the government estimates there are over 4,500 rough sleepers, 43% of whom are over 65.

The second vulnerability stems from the difficulty they face in practising social distancing. In the tent encampments and night shelters where they congregate it can be simply impossible. So efforts to move people indoors might even be counterproductive. On the American west coast, where many of the country’s estimated 600,000 homeless people live, officials have tried to add shelter capacity. But Randall Kuhn, a demographer and sociologist at the Fielding School of Public Health at the University of California, Los Angeles, says the guiding principle should be not to endanger people by raising density: “If the choice is between putting someone in a really crowded shelter or leaving them where they are in an unsheltered place, think carefully.”

A shelter built last month in Seattle, intended to reduce density elsewhere, is now home to at least six infections. Kelly Doran, a doctor who treats the homeless in emergency wards in New York, agrees that packing people into shelters cannot be the solution: “Communities need to do everything possible now, immediately, to protect their homeless populations. That means getting them out of congregate settings.”

A group of researchers at several universities estimate that, if 40% of America’s homeless are infected with covid-19, more than 21,000 might be hospitalised and nearly 3,500 might die. And, inevitably, the virus has already reached some clusters of the homeless. On April 10th it was revealed that 68 homeless people and two staff members had tested positive for the virus at San Francisco’s largest homeless shelter. The virus has been detected in other shelters from Los Angeles to New York. Preliminary data from Boston show homeless people contracting the disease at a rate of 46.3 per 1,000 people, compared with 1.9 per 1,000 for the general Massachusetts population. By April 9th 343 homeless people in New York had tested positive, and 20 had died. The total death toll among the homeless from the virus is unknown. Few dying without a home, anywhere, have had access to testing.

Recognising the danger posed by cramped shelters, some governments have opened new facilities. In France, for example, 80 sites have been identified as potential isolation centres. In Berlin, the city government has emergency plans to accommodate 350 homeless people in a former youth hostel and elsewhere. In Denmark, Hus Forbi, the local version of the Big Issue, a magazine sold by the homeless, has reached an agreement with a chain of youth hostels to accommodate rough sleepers. In Melbourne, some care homes for the elderly are being used for the homeless.

Worldwide, of more significance than such ad hoc measures is an immediate, partial and temporary solution that is itself a consequence of the pandemic: the availability of large numbers of empty hotel rooms. Many central and local governments have taken action to match this supply with the need. On March 26th Britain’s government wrote to local authorities asking them to move homeless people “into appropriate accommodation by the end of the week”. Thus did an official target, of ending rough sleeping by 2024, shift, in the blink of an eye, to a goal of within three days. It was not met, but by April 10th, more than 1,000 homeless in London had been allocated hotel rooms. Around England, the number on the streets had dwindled to 500-600.

In America, too, a consensus swiftly formed that hotel rooms offered the best way to stem the spread of the disease among the homeless. Few places were able to provide accommodation for all, so they gave priority to the most vulnerable. Cities across the country—Atlanta, Baltimore, New York, Seattle and others—have been moving people from the streets into hotels, aided by $4bn in the most recent congressional stimulus. Gavin Newsom, California’s governor, promised to acquire more than 15,000 hotel rooms for some of the state’s 150,000 homeless to self-isolate. The Federal Emergency Management Agency will foot most of the bill.

Progressive lawmakers in San Francisco are proposing a more ambitious plan, to place all rough sleepers into hotel rooms if they want one and can care for themselves. Los Angeles, with 58,000 homeless, has promised 15,000 rooms; about 1,300 should be ready this week. “They talk about it, but it takes a long time to deliver it,” says Mike Arnold, of Midnight Mission, which provides shelter and meals in downtown LA. He was told on April 8th that the city had just four hotel rooms ready for the most vulnerable residents. At the top of his list is an 88-year-old woman with emphysema.

Of course, the moves into hotels have not gone smoothly everywhere. John Bird, founder of the Big Issue, a social enterprise working with the homeless, says that some have refused to accept accommodation, sometimes because they were addicts who feared being cut off from their supply of drugs. Others had gone into hotels but had “gone stir crazy and left”. A four-star hotel in Milton Keynes, near London, evicted a group of rehoused homeless people for “bad behaviour”, such as injecting themselves with drugs on the staircases. By then, one had already absconded by jumping out of a window. In New Orleans homeless people were placed in a hotel and left unmonitored. They then gathered in the lobby, defeating the social-distancing object of the exercise. In Western Australia, the state government faced criticism after moving only 20 of its most vulnerable rough sleepers into a five-star hotel in Perth. Campaigners grumbled this was ludicrous at a time when the vast majority of the homeless population was being ignored.

Moreover, simply decanting people from the streets into hotels may open up more problems. Often, health-care provision is lacking. In Britain, according to Crisis, a charity for the homeless, there is no systematic separation of people into those with and without symptoms. In Oakland, in California, by contrast, the city government has secured one hotel for positive cases and those under investigation and another for people who are negative but high-risk. “Normally people just need to be housed,” says Margot Kushel, a doctor in San Francisco. “But these are not normal times. You need extra support.”

So, much is still missing in the official response to the covid-19 crisis among the homeless. But optimists take the opposite message: the speed and extent of what has been done shows how much more could be achieved were homelessness given a higher priority when this crisis passes. Even they, however, have two big worries. First, conditions for those still sleeping rough are becoming harder, as shelters close for lack of staff, soup kitchens and other facilities cannot operate under social-distancing rules, and, for those begging, sources of income dry up. Second, even as some leave the streets for hotel rooms, in most countries, more people are joining the ranks of the homeless every day—for economic reasons but also because women are escaping the increase in domestic violence that the lockdown has caused. As forecasts of the looming global recession seem to grow gloomier by the day, the numbers of the unsheltered may rise, even as the pandemic wanes.■

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