For Homeless People, Covid-19 Is Horror on Top of Horror

“There is nothing,” a desperate poster writes, and a dozen others agree. Online communities dedicated to homelessness, like Reddit’s r/homeless, were already places to vent about unlivable living situations, but as the Covid-19 outbreak continues, the challenges they face have only gotten more extreme. Shelters are full, or closed, or too fraught with coronavirus risk to consider sleeping in. They have no access to toilets, much less toilet paper. They’ve been laid off, and there’s nobody on the street so they can’t even panhandle. Common places to find shelter and a bathroom—libraries, gyms, fast food restaurants—are closed. Soup kitchens are closing, out of food, out of workers.

The forums have become literal survival guides: How to set up a safe shelter in the forest; where to find an electrical outlet; how to clean yourself with dry leaves, newspaper, and isopropyl alcohol. “For everyone else this is ‘quarantine and chill,’” Reddit user UNTGaryOaks tells WIRED. “When you’re homeless there is no quarantine, or chill. Unless you’re the type that is comfortable laying on the ground in public.”

Homelessness is incompatible with health. Experts like Margot Kushel, a professor of medicine at UC San Francisco who studies homelessness, have been saying so for decades, but, in the midst of the coronavirus pandemic, it’s never been truer. “It’s a calamity. It’s our worst nightmare,” Kushel says. “It’s an enormous crisis superimposed on an existing crisis.” Unhoused people are already among the most sick in society, and now they’re physically incapable of following the Centers of Disease Control and Prevention’s most basic virus-fighting directive: stay home.

It’s nearly impossible for homeless people to maintain social distance. Their needs are met en masse. The CDC recommends 110 square feet per person for people housed together during the outbreak. Most homeless shelters simply don’t have that kind of space. “There has always been an increased risk of communicable diseases like tuberculosis, hepatitis A, and influenza,” Kushel says. Covid-19 is just the newest addition to the list. Some shelters are rearranging the furniture to house people further apart, but those adjustments inevitably mean fewer beds, and leaving more people outdoors. In Las Vegas, people are sleeping in parking lots, confined to white painted rectangles spaced six feet apart.

Even before the outbreak, many homeless people were left totally unsheltered. In California, where Governor Gavin Newsom estimates some 60,000 homeless people could end up infected with coronavirus, two thirds of the unhoused population lives outdoors, which is about twice the national average. Unsheltered people still rely on congregate settings to meet their basic needs, like food and hygiene, though the latter often goes unmet. “These mass feeding events, they have very good intentions, but they often don’t think about the public health side of things,” says Drew Capone, a water sanitation and hygiene researcher at Georgia Tech. “We saw in our research in Atlanta that most open defecation happens within 400 feet of a soup kitchen. Not a lot of handwashing goes on. They’re not opening toilets to folks.” According to a Reddit user who wished to remain anonymous, “Having nowhere to poop is the worst part.”

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The conditions of homelessness would leave a healthy person vulnerable to catching a disease like Covid-19, and unhoused people tend not to be healthy. “Your first needs are finding food and a place to sleep,” Kushel says. “Healthful behaviors come next.” In addition to not being able to maintain good hygiene or a good diet, unhoused people disproportionately suffer from lung disease, heart disease, hypertension, and cancer, which are all risk factors for experiencing Covid-19’s more severe and deadly symptoms. They also tend to be older: half are 50 years old and up. “They also age prematurely,” says Kushel. “If they’re 50, physiologically, medically, their bodies act more like they’re 70 or 80 because of the incredible challenges of being homeless.” For unsheltered people, matters tend to be even worse. According to Nan Roman, president and CEO of the National Alliance to End Homelessness, many unsheltered people—including about 80 percent of unsheltered women—suffer from a serious medical condition, poor mental health, and drug addiction all at once.