People experiencing homelessness: Their potential exposure to COVID-19.

BACKGROUND: Insufficient housing quality is associated with stress and mental health impacts. Crowding, pollution, noise, inadequate lighting, lack of access to green spaces, and other environmental factors associated with slums can exacerbate mental health disorders, including depression, anxiety, violence, and other forms of social dysfunction.
METHOD: The studies were identified using large-sized newspapers with international circulation.
RESULTS: Experts say that people who sleep in shelters or on the streets already have lower life expectancy, suffer from addiction, and have underlying health conditions that put them at greater risk should they develop the virus. There are just so many competing and unmet needs, which makes it much harder for homeless to contend with all of this. If exposed, people experiencing homelessness might be more susceptible to illness or death due to the prevalence of underlying physical and mental medical conditions and a lack of reliable and affordable health care. Nevertheless, without an urgent solution, people experiencing homelessness will remain in limbo.
CONCLUSIONS: Many people living on the streets already have a diminished health condition, higher rates of chronic illnesses or compromised immune systems, all of which are risk factors for developing a more serious manifestation of the coronavirus infection. Those suffering from mental illness may have difficulty in recognizing and responding to the threat of infection. Homeless people have less access to health care providers who could otherwise order diagnostic testing and, if confirmed, isolate them from others in coordination with local health departments.

About one billion people live in slum-like conditions, making up 30% of the world's urban population. These housing facilities tend to have very little ventilation, drainage and sewage facilities; therefore, diseases spread easily (BBC, 2020). These individuals are much more susceptible to contracting COVID-19 because of cramped quarters, utensil sharing, and lack of proper sanitation facilities (The Daily Star, 2020). It is known that depression and stress weaken our immune systems. Individuals of low incomes are disproportionately likely to suffer from poor mental health. As the coronavirus continues to unleash mayhem, we could be on an economic precipice (The Guardian, 2020a). Mental-health issues can be exacerbated by the kind of uncertainty that has been happening across the world (The Philadelphia Inquirer, 2020).

Insufficient housing quality is associated with stress and mental health impacts. Crowding, pollution, noise, inadequate lighting, lack of access to green spaces, and other environmental factors associated with slums can exacerbate mental health disorders, including depression, anxiety, violence, and other forms of social dysfunction (WHO, 2020). Experts say that keeping hands clean is one of the easiest and best ways to prevent transmission of the new coronavirus, in addition to social distancing. However, homeless and urban poor populations that live in thousands of slums across major cities and towns, maintaining good hygiene, are nearly impossible to notice (International News, 2020). In addition to the public health implications there are deep concerns about violations of human rights (Health Affairs, 2020).

Homeless organizations have been sounding the alarm for weeks. They have been warning that the coronavirus could cause catastrophic harm to unhoused communities amid the absence of a coordinated strategy to aid people already struggling to survive in tents and overcrowded shelters (The Guardian, 2020b). Experts say that people who sleep in shelters or on the streets already have lower life expectancy, suffer from addiction, and have underlying health conditions that put them at greater risk should they develop the virus (CTV News, 2020). There are just so many competing and unmet needs, which makes it much harder for homeless to contend with all of this (Aljazeera, 2020).

While some people experiencing homelessness have found refuge in local shelters, more are spread across the state, sleeping on sidewalks and under tunnels. Many have also erected makeshift homes. Experts say the chronically ill homeless have a unique vulnerability to the new coronavirus. A number that is expected to exponentially rise in the coming days. If exposed, people experiencing homelessness might be more susceptible to illness or death due to the prevalence of underlying physical and mental medical conditions and a lack of reliable and affordable health care. Nevertheless, without an urgent solution, people experiencing homelessness will remain in limbo (The Texas Tribune, 2020).

In the midst of all the conversations about social distancing and sense of entitlement, the mental health and well-being aspect has been relatively less discussed, though it remains one of the foremost challenges for public health in these times of a new ‘normal life’. It is very important for people to maintain a ‘healthy’ mind at this point of time and help those who are particularly vulnerable to mental health challenges. Individual with mental health disorders are by and large vulnerable to day-to-day stressful events; their ability to cope with such stressors is generally not always adequate. This may result in them having a difficult time to cope with such situations (Citizen Matters, 2020). One of the causes here is everyday life stress. Humility, not certainty — less accusation and panic — should be the order of the day (City Journal, 2020).

Over half a million people are homeless in the US. Their living conditions and poor health may place them at higher risk for contracting the disease. Many homeless people who do not stay in shelters may sleep in train or bus stations, ride subways or buses or go to the waiting room of a hospital emergency department in the evening. These are places where an exposed person could contaminate doors and bathroom fixtures, chairs or other objects, providing opportunities for spreading the infection to others. Once exposed, homeless people may have a mortality risk due to other health conditions they may already have, such as diabetes, hypertension, cardiovascular disease, and increased age. Many people living on the streets already have a diminished health condition, higher rates of chronic illnesses or compromised immune systems, all of which are risk factors for developing a more serious manifestation of the coronavirus infection. Those suffering from mental illness may have difficulty in recognizing and responding to the threat of infection. Homeless people have less access to health care providers who could otherwise order diagnostic testing and, if confirmed, isolate them from others in coordination with local health departments (Next City, 2020).

People experiencing homelessness are increasingly older and sicker. Many have underlying health conditions but lack access to primary-care physicians or preventive health screenings. They struggle to find public bathrooms to maintain their basic hygiene. Those who live in tent encampments or crowded shelters might be unable to keep their distance from others or self-isolate if they show symptoms (The Washington Post, 2020). They have only been invalidated by bad luck and social injustice. COVID-19 is likely to serve up even more injustice for them. Finally, it is noteworthy that this needs proper attention from a high level [in social psychiatry] (Ham & High, 2020).

Funding

Suicidology Research Group from Universidade Fderal do Ceará (UFC) and the Brazilian National Council for Scientific and Technological Development (CNPq) – institution linked to the Brazilian Departament of Science, Technology and Innovation to encourage research in Brazil.

CRediT authorship contribution statement

Nádia Nara Rolim Lima: Conceptualization, Data curation, Writing - original draft. Ricardo Inácio de Souza: Supervision, Validation. Pedro Walisson Gomes Feitosa: Supervision, Validation. Jorge Lucas de Sousa Moreira: Supervision, Validation. Claudio Gleidiston Lima da Silva: Validation, Visualization. Modesto Leite Rolim Neto: Conceptualization, Data curation, Writing - original draft, Writing - review & editing.

Declaration of Competing Interest

The authors declare that they have no competing interests.