By Dr. Joe Jarvis
This post was originally published in the Salt Lake Tribune on March 16, 2020.
In the 1930s between 1 and 2 million homeless Americans resided in shanty towns all over the United States. These makeshift housing areas were commonly called “Hoovervilles” after President Herbert Hoover, who was in office from 1929 to 1933. The reason so many Americans were without adequate housing at that time was, of course, the Great Depression. During that historic economic downturn, the unemployment rate rose to be as high as 25%.
We are currently facing another economic downturn in the United States. It remains to be seen whether the country will slide into a recession, and, if so, how severe it might become. [UPDATE: It now appears almost certain that we are already in a recession, and signs point to it being very severe, with an unemployment rate that could exceed that of the Great Depression.] But before any “Trump Towns” ever appear, we should remember that there are already more than 500,000 Americans who are homeless already. Because this economic downturn is driven by the novel coronavirus pandemic, we should pause and consider the impact of this viral outbreak on the homeless population, and how that might affect the rest of us.
Since there is no specific medication to treat COVID-19, nor any vaccine to protect us against this infection, public health authorities are stressing the importance of hygiene and self-isolation to slow the spread of the virus and flatten the epidemic curve. Schools, churches, sporting events, and gatherings of other kinds have been cancelled. People with known infections or known exposure to infected people are being asked to self-isolate. And we are all asked to wash hands frequently, use hand sanitizer, and cover our faces while coughing or sneezing.
With the exceptions of covering faces and avoiding travel, these recommendations are not really possible for the homeless. They congregate in shelters with nowhere else to go, making self-isolation impossible. Hand washing facilities and hand sanitizing solutions are often not available. If the homeless become ill, they may have no clinic available at a price they can afford.
Thus, we have perfect conditions among the homeless for widespread infection with a contagious virus: group living with poor sanitation and no consistent method to identify the ill. If COVID-19 were to be confirmed in a homeless patient, where can he or she self-isolate? With that in mind, we should expect high rates of infection among the homeless. And, the homeless live among us, we will all be at greater risk if the coronavirus spreads among our homeless population.
We must seek serious solutions for this problem now. Surely we can find the means to improve personal hygiene among the homeless. Let’s invest in improved homeless facilities, reduce crowding, and find ways for these men and women to self-isolate should that becomes necessary. (Increasing appropriations for the public health agencies that serve the homeless population will pay dividends in the long run anyway.) And perhaps we can expand Medicaid for the duration of the pandemic to make health care financing a reality for them.
Or we can wait to see what happens if we again have 1 or 2 million homeless Americans, this time in the middle of a viral outbreak.