COVID-19 and people experiencing homelessness: Responding to the crisis

Thanks to Matt Kellway, RNAO Director of Policy, currently seconded to Inner City Health Associates (ICHA) to assist with protecting Toronto homeless persons from COVID-19, for writing this report.

In our collective response to this pandemic, it is the vulnerable that need to go to the top of our list for care and safe keeping.  And, in that, we are failing the homeless because they have been relegated to the bottom. 

This needs to change - urgently. Governments – all three orders – need to move with lightning speed to provide housing and care for people experiencing homelessness.  The epicenter of this pandemic in this province – and in particular in the City of Toronto – threatens to be in homeless shelters where, still, residents are jammed in, face-to-face with each other and the deadly threat of this virus.

The response to this pandemic has ignored the vulnerabilities of this population.  It is said that this virus doesn’t discriminate.  But it most certainly does.  It finds the cracks in our society – the ones so many people have fallen through – and it attacks there.  It is said that this virus attacks the elderly. But this virus doesn’t know chronology – doesn’t know old from young. It only knows vulnerability. 

A recent report out of the US estimates that homeless individuals will be twice as likely to be hospitalized, two to four times as likely to require critical care and two to three times likely to die from this virus.  These estimates recognize that homeless individuals have age-related impairments typical of housed individuals 20 years older in addition to a susceptibility to this virus enhanced by challenges maintaining hygiene, respiratory distress and a mental weathering resulting from exposures to multiple challenges.

The COVID-19 crisis has created an untenable situation. The public is urged to implement social distancing and yet we have a shelter system that forces thousands each night to be in breach of those measures. The government has issued COVID guidelines for shelters that recommend social distance when that, as well as effective measures for infection prevention and control, are impossible to achieve.

As a solution, the province has funded Inner City Health Associates to roll out a nurse-led program to care for people experiencing homelessness in Toronto, where half of the provinces homeless reside. The plan is to convert city owned and/or leased properties into COVID persons-under-investigation (PUI) isolation centres and a COVID+ isolation centre. ICHA has relied on RNAO’s ViaNurse program for its RN/NP nursing complement. We are proud of the RNAO members who have stepped forward to help us all through this pandemic.

From RNAO’s standpoint, before these facilities become operational, the fullest measures must be taken and the highest standards must be in place to protect all healthcare workers. To achieve this, the province and the city must move urgently to provide the requisite health protections for clinical staff including PPE supply, and Infection Prevention and Control (IPaC) policies, protocols, training, and direction.

The request was placed a number of days ago and we are eagerly waiting to move forward. As I advised Minister Elliott and Mayor Tory, the population becomes more at risk with every passing day. One of the most vulnerable populations in Toronto keeps waiting for immediate and urgent action from the province and the city.