Opinion

It's time to think of homelessness as a public health emergency

Cathy Crowe: After a homeless person in Toronto tested positive for coronavirus, the government needs to realize that 'self-isolation' for this population is a cruel oxymoron

Cathy Crowe is a long-time street nurse and a visiting practitioner in the Department of Politics at Ryerson University.

Home is essential to protection from COVID-19 in a pandemic. Having one, that is. Only two days ago, it was announced that a homeless person in Toronto tested positive for coronavirus. 

For over two months the World Health Organization and public health experts did not utter the word homelessness in their media briefings. Similarly, the situation of displaced people such as refugees and migrants was rarely given attention. Both groups, by nature of their health vulnerabilities and required search for shelter, place them at risk for this virus.

Yet over the course of this year in Canada, an estimated 235,000 people (including families with children), will be homeless. They are our internally displaced persons. Homelessness is an unprecedented emergency, firmly established in the early 1990s when federal governments withdrew from building social housing. The problem has only worsened each year since. In Toronto, the epicentre of the homelessness crisis, advocates have been appealing for a state of emergency on homelessness to be declared by the mayor and city council since 2018. 

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Across the country, shelters are full and overcrowded, violence against women and family shelters report waiting lists, and new tiers of emergency shelter in the form of soccer-like domes and empty buildings have been opened to house homeless people. In some cases, 100 people sleep in one space with no separation between cots. In addition, for over 30 years, Toronto has relied on faith groups to provide over 700 mats on the floor per week. Each synagogue or church opens its doors one night per week, run by volunteers, many of whom are elderly. That means a homeless person might sleep seven nights in seven different places. Talk about risk for disease transmission. 

While Canadian public health officials deserve some praise for system improvements made post SARS and H1N1, they have clearly not trickled down to the community level.

Who is at risk for contracting coronavirus? We’ve heard the messaging over and over. It’s seniors, people with compromised immune systems, and those with chronic illness such as diabetes, heart or lung disease. That describes a huge percentage of the homeless population. In addition, homeless people are further at risk due to their reduced and fragmented access to health care.

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The public health crisis of opiate overdoses and homelessness remains ignored amid a pandemic.

To date, the public health messaging during COVID-19 presents as uninformed and offensive: “stay at home, practice social distancing, avoid large gatherings, wash your hands frequently.” They spell out exactly what homeless people can’t do. 

Being in a 50- to 500-bed shelter is a large gathering, and I’ve never seen six feet between cots or mats. Imagine a coughing neighbour on the top level of your bunk bed. If a homeless person does practice social distancing and the avoiding of large gatherings by creating an outdoor encampment, they are evicted. Self-isolation for the homeless population is a cruel oxymoron.

As Aaron Orkin, population medicine lead for Inner City Health Associates in Toronto said, “homeless people have a dramatically elevated risk of death.” 

Initial attempts to reduce crowding in shelters, provide screening and testing, and ensure both isolation and quarantine for homeless people have started, but they are far from fine-tuned.

Bottom line is that we have to isolate people. No one is safe until everyone has a room of one’s own. That means using emergency legislation to commandeer rooms. It means thinking outside the box and establishing modes of fast construction of social and supportive housing, with prefab units, for example. 

I’m shocked that we are in the position of struggling to obtain the basics in an acute health crisis: masks, hand sanitizer, ventilators and nasal swabs for testing. These items should never have to be rationed.

Coronavirus shows the weakness in our health care system, including hospitals, home care, long-term care facilities, shelters and social housing. More than ever this is a wake up call for a massive infusion into our social programsand that must include housing. 

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