COVID-19 Testing for Homeless Populations

I. Why are homeless populations at greater risk for COVID-19?

Officials estimate that approximately 575,000 people in the U.S. meet the U.S. Department of Housing and Urban Development’s definition of homelessness, which is living in a homeless shelter or a place not fit for human habitation.

Among the groups that are at higher risk for contracting COVID-19 or suffering from more severe complications of the disease, individuals experiencing homelessness face a complex web of risk factors, including:

Living conditions: By definition, homeless shelters are congregate settings, in which large groups of people come in close contact with each other in enclosed spaces. Being in these types of settings increases the risk of exposure to COVID-19 because it is an airborne disease transmitted through microscopic particles that can easily travel through rooms.

While being outdoors is safer, much of that safety comes from maintaining physical distancing. This kind of distancing may not be possible for groups of homeless individuals living together in encampments.

Because of the nature of homelessess and unstable housing, quarantining and isolating, which are key to preventing the spread of COVID-19, are generally not possible for homeless individuals who are infected with the virus.
Lack of proper hygiene: Experts recommend frequent hand-washing, and regularly sanitizing high-touch surfaces to prevent the spread of COVID-19, but these practices may not be possible for homeless individuals, especially if they are living outdoors without access to clean water and cleaning supplies.
Underlying medical conditions and poorer health: A significant number of homeless individuals have underlying medical conditions. This puts this population at a higher risk for severe disease than the general population. Preliminary studies have found that people with comorbidities are 12 times more likely to die of COVID-19 than otherwise healthy individuals.
Historical data: Evidence shows that people experiencing homelessness are usually more likely to be hit hard by infectious diseases, including tuberculosis, hepatitis, HIV, and pneumonia, primarily because of the factors outlined above. Although exact rates of COVID-19 infection among homeless populations are still unknown, a Centers for Disease Control and Prevention (CDC) study from late March through mid-April showed that 25% of residents in 19 homeless shelters in four major U.S. cities tested positive for COVID-19.

How can homeless individuals protect themselves from COVID-19?

Despite the challenges of keeping people experiencing homelessness safe from COVID-19, the CDC has offered some recommendations that can help protect these populations.

While acknowledging that homeless individuals may not be able to avoid crowded locations such as shelters, the CDC encourages them to try to stay away from other crowded public settings, including public transportation. If using public transportation is unavoidable, individuals should follow the CDC’s guidelines for safely using mass transit.

The CDC also recommends using take-out options for food whenever possible, maintaining a distance of six feet from others, covering coughs and sneezes, and washing hands with soap and water for at least 20 seconds as much as possible.

Many individual cities have also taken steps to assist homeless individuals and improve hygiene and safety during the pandemic, including installing portable toilets and hand-washing stations, expanding homeless shelter capacity, and housing homeless individuals in hotels.

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II. What should homeless individuals do if they experience COVID-19 symptoms?

According to the CDC, homeless individuals who have COVID-19 symptoms should alert a service provider, such as a case manager, homeless shelter staff, or other care provider in their community. These staff members can assist the individual with assessing their symptoms, isolating, and receiving testing and medical attention as needed.

If a homeless individual experiencing COVID-19 symptoms does not have access to a service provider or homeless shelter, an alternative is to visit a hospital emergency room or urgent care center.

Where can homeless individuals get tested for COVID-19?

Criteria for diagnostic testing is determined by state and local health departments and local healthcare providers. Service providers like case managers, homeless shelter staff, or social workers can connect homeless individuals with healthcare providers to determine their eligibility for testing, and arrange a COVID-19 diagnostic test, if necessary.

The federal government has established programs to help uninsured individuals, including people experiencing homelessness, get tested for COVID-19. Additionally, some cities with significant homeless populations, such as San Francisco, are holding testing events specifically for people experiencing homelessness.

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III. Why COVID-19 testing for homeless populations is important

Overall, diagnostic testing for COVID-19 is critical for several reasons. It helps to slow and prevent the spread of the virus, encourages individuals to seek medical treatment, and allows for a safe re-opening of the economy.

For people experiencing homelessness, testing is essential because of how vulnerable this population is, and how easily the virus is transmitted among homeless individuals. COVID-19 outbreaks among homeless populations can have a severe impact on the individuals themselves, and spread the disease throughout the wider community.

Continued efforts must be made for outreach and testing among homeless populations as a way to control and contain the spread of the disease.

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IV. Additional Resources

Name	Website	Summary
Centers for Disease Control and Prevention (CDC)	https://www.cdc.gov/coronavirus/2019-ncov/index.html	The CDC is the United States’ leading national public health organization. Its mission is to protect public health and safety through the control and prevention of disease, injury, and disability in the U.S. and abroad.
World Health Organization (WHO)	https://www.who.int/	A specialized agency of the United Nations, WHO is responsible for international public health. Headquartered in Geneva, Switzerland, it has field offices worldwide.
Association of Public Health Laboratories (APHL)	www.aphl.org	The APHL is a nonprofit organization in the United States that represents laboratories that protect public health and safety.

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V. Sources

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