Coronavirus panic is spreading through the United States, and local and state officials seem helpless at shielding the most vulnerable among us and curbing avenues for transmission. West Coast states are going into this health crisis having failed to truly assist their homeless populations, an at-risk demographic that may serve as a conduit for transmission.
Over the course of the last several years, experts have been warning that the crowding and filth associated with homeless encampments make them ripe for outbreaks of contagious diseases. Epidemics of Hepatitis A, tuberculosis, and typhus have already been flaring up among the homeless. So far, health officials have been able to extinguish them with minimal loss of life.
As six counties in the San Francisco Bay Area have issued shelter-in-place orders (from which the homeless are exempt), the effort to find permanent solutions for a pandemic reaching the homeless remains wanting. Thirty homeless people in San Francisco are being tested for the illness.
Two of the three states most affected by the Wuhan coronavirus are Washington and California, both notorious for intractable homelessness. The authorities are worried the pandemic might get out of hand once COVID-19 makes it into homeless encampments. San Jose Mercury News summarized:
If they are infected, homeless people face a higher risk of getting very sick from the disease, experts say. They tend to be older, and their immune systems already may be compromised by other chronic illnesses, drug or alcohol use, and the harsh realities of street living.
A recent Los Angeles Times study found that drug addiction is three times as prevalent among the homeless than previous research indicated, and entrenched drug addiction may keep homeless people from seeking medical attention because feeling unwell is part of their daily reality. Drug-induced sedation masks the illness, and the flu-like symptoms of coronavirus may be mistaken for flu-like drug withdrawal.
The Likelihood of Virus Spread Among Homeless People
There are two known methods of COVID-19 transmission: oral and fecal. According to epidemiologists, the oral route is the most common, with the disease spread by saliva particles released through coughing and left on surfaces. Both transmission routes put the unsheltered and the rest of us at risk. The homeless live in extremely close quarters in shelters and generally don’t practice social distancing.
Drug dealing is also an obvious plague-spreader. Thomas Wolf, who once lived on the street but is now in recovery, explained how drug transactions often take place:
Many drug dealers in San Francisco hold their drugs wrapped in plastic bindles in their mouth. When someone buys, they spit the bindle out and hand it to them. If one of the dealers has the Corona virus, the entire population of users in SF could get sick.
Fecal transmission of the Wuhan virus has been noted, and one study of children’s excrement found the virus can remain in a person’s gastrointestinal tract for up to 30 days. Hong Kong officials found the infection might have spread through faulty plumbing in a government housing project in Wuhan. In a city like San Francisco, where drug addicts are living unsheltered on the streets without sanitation, and especially in densely populated neighborhoods like the Tenderloin where they frequently take up the entire sidewalk, this could present a serious health risk.
As the Wuhan coronavirus has been spreading through the globe, California Gov. Gavin Newsom sent helpful tweets about how to wash hands. In the meantime, local nonprofits rolled out a plan to enable the homeless to wash and sanitize their hands.
Laudable goal, of course, but simply saying “wash your hands” doesn’t quite cover their needs. That so-called homeless advocates continue demanding to “stop sweeps” — advocacy lingo for police clearing the encampments, including inhabitants’ possessions — seems counterproductive because the items may contain generous samples of diseases.
The Difficulty of Implementing Quarantine
Equally questionable is the decision to put the homeless afflicted with the Wuhan virus but not sick enough to be in a hospital into RVs. To this end, the San Francisco Department of Emergency Management has rented out 30 RVs. How these 30 RVs are supposed to house sick members of the homeless population, which exceeds 17,000, was never clear, but since Newsom has issued an executive order allowing the state to take over hotels for quarantine, shortage of space might no longer be an issue.
A bigger problem is counting on the homeless to self-quarantine. In Seattle, a vagrant man with suspected coronavirus isolated in a hotel left the facility, stole items from a nearby store, and hopped on a public bus. His test results came back negative, but what if they hadn’t?
Kentucky Gov. Andy Beshear sent armed guards to enforce seclusion on a Wuhan virus patient (not homeless) who refused to self-quarantine. During the Sunday night presidential debate, Democratic hopefuls Bernie Sanders and Joe Biden expressed willingness to call in the military, although neither elaborated on what they meant by it. Surely, there is a way to go through a pandemic without imposing marshal law.
The homeless are not the only people who often flout doctors’ orders, but they are uniquely vulnerable and frequently out in public.
The Homeless Crisis Is a Health Crisis
It might be a bit late to effectively enforce sanitary conditions to preempt the spread of the highly contagious Wuhan virus. Unfortunately, California failed to prepare for a pandemic like it failed to prepare during rainy years. Like we don’t collect water when it’s plentiful and store it for inevitable drought, we don’t anticipate public health emergencies by addressing anti-sanitary conditions before pandemics strike.
Making inroads in solving the homelessness crisis before the next epidemic hits should be a priority. Instead of simply trying to house the people who won’t stay housed, we need to focus on addiction and mental illness, extending conservatorship for the mentally ill, and forcing those with drug addiction into rehab.
Some people in this country legitimately can’t help themselves, and society should step in and intervene. Right now we are failing them. The homelessness problem is a matter of public health, and a matter of our society’s moral health.