How do you stay at home if you don’t have a home? This most basic of questions is one public health workers and charities are grappling with as they try to apply government advice to the homeless people they work with. Shelters have had to deal with turning people away and reducing services in an attempt to contain the spread of coronavirus.
Government guidance, issued on 16 March – the same day people were advised to work from home – were that hostels do not need to close for now, and that if a resident of a hostel becomes unwell they should stay in their room, and if someone becomes unwell in a day centre they should self-isolate there and staff should contact the authorities.
But those providing services to the community say it does not go far enough, and that the population is highly vulnerable and needs more support. They are calling for a coordinated government response to make sure homeless people are not disproportionally affected by the pandemic.
Some charities and shelters have already reduced services to stop the spread of the disease. “Clearly we are the canary in the mine,” said Samatha Dorney-Smith, a public health nurse and fellow at homeless health charity Pathway who is worried as the UK has entered the second “delay” phase of its plan to deal with the crisis.
A large proportion of the estimated 320,000 homeless people in the UK (including 8,000 rough sleepers) have health issues that leave them vulnerable to contracting the virus and put them at higher risk of death. Dorney-Smith says she has heard of at least four cases of homeless people testing positive for Covid-19 in London. The NHS could not confirm her report without more details. She also said she had heard of “another concerning case of a client with clear symptoms who will not self-isolate. In view of the close contact nature of night shelters, day centres and shared facilities in hostels infection is likely to spread”.
Dorney-Smith has been fielding calls from nurses across the UK who are trying to get councils to help house homeless people with symptoms. The government needs to use hotels to provide shelter for homeless people while allowing them to self-isolate, undergo screening, and receive treatment, she said. “Accommodation for this group was already in short supply, but now we are in a situation of needing accommodation for people to self-isolate.”
On top of this many homeless people suffer from complex health issues, from poor mental health to addiction, that would also need to be supported. “We are all waiting for Public Health England to take the lead,” she added.
Before the government guidance was announced, a spokesperson for Mayor of London Sadiq Khan said he “is deeply concerned at the lack of specific government advice on coronavirus to protect people living on the street, those in assessment services and in hostels and urges ministers to engage with the charity sector and to provide official guidance as a matter of urgency”.
At a conference for homelessness professionals organised by Pathway, Dr Al Story and Professor Andrew Hayward of University College London said agencies should stop bringing people off the street and into shared spaces, and that supporting people on the street may be more effective at halting the disease. Instead, they called for opening more places and even outdoor spaces where homeless patients can be “cohorted” (divided into: people with symptoms, people at risk, and people who do not appear to be at risk) and cared for.
Concerns have also been raised about the 86,000 people living in temporary accommodation. Homeless Link, a charity, has issued advice to members that, where residents of temporary accommodation are believed to have contracted coronavirus, “service providers should consider establishing a ‘safe zone’ within the accommodation for those individuals”. This could be separate floor in a hostel or a set of bedrooms. They also suggest moving out unaffected people from buildings where the majority of residents are believed to have the illness.
“Obviously the situation with coronavirus is serious and developing all the time,” said Polly Neate, chief executive at Shelter. “We’ve reached out to the government to provide official guidance for homeless people sleeping rough or living in shared hostel or shared temporary accommodation. We will provide an update as soon as we know more. In the meantime, advice on the use of shared spaces can be found on Public Health England’s and Homeless Link’s website.”
Newham in East London, where there has so far been one case of coronavirus, has one of the highest numbers of people living in temporary accommodation in the UK. A spokeswoman for Newham Council said they have been working with providers to ensure they are responding in line with guidance. “We have contacted each of our nightly-paid accommodation providers asking them to explain how they plan to secure continuity of service, minimise transmission of the virus, and what provision is being made to advise clients of this, particularly those whose first language may not be English,” the spokesperson added.
Living conditions in some temporary accommodation can put residents at risk. Ms. J, wh did not wish to give her full name, was placed by Hackney Council in temporary housing with her partner and two children. The mould problem in their home has always been source of concern. “Since moving here my kids, my partner and myself have been more prone to chest infections, we assume because of the mould in the property,” she said. “My concern is with our persistent coughing that we get because of our living conditions we are in, and my kids getting on-and-off fevers, how are we to know if the symptoms that we have were of Covid-19?”
Ms. J’s partner was recently off work for three days because of a cough and headache, she says. “He was deliberating this morning whether he should go to back work or not but also worried if he has the virus, we are constantly paranoid as we won’t know the difference”. The mould in the bedroom also made it difficult for him to self-isolate, as it was making his coughing worse. In the meantime, homeless charities and some local councils have been trying to put measures in place.
This week homeless organisations including Streets Kitchen and the Museum of Homelessness, together with Islington Council, called for the government to support a specialist clinic in London in providing care for homeless people affected by the virus. The Mildmay and Bart’s Clinic has a long history of treating people who are HIV positive and with a weakened immune system. On 12 March, the signatories and several other organisations launched a Covid-19 task force to help homeless people in the borough. Elsewhere, several homeless services have announced service reduction or closure to prevent the spread of the virus, or are planning to do so.
Glass Door, which runs London’s largest network of shelters, was forced to turn away a rough sleeper due to fears of coronavirus. He slept in a railway station and a coach station and was later found not to have had the virus, according to a report in Inside Housing. The Northampton-based Hope Centre has restricted access to their day centre to rough sleepers only, providing food on a takeaway basis to other vulnerable people. The statement on their website says, “We hope that by reducing the number of social interactions we will be in a position to offer a continuing Day Centre service for a longer period.”
In Kettering, local charity Accommodation Concern has stopped drop-in services and moved to appointments only. CEO Jo Moore explained that local homeless charities and food banks are dependent on volunteers who are mostly over 70 and at high risk from coronavirus. As such they have come together with other organisations to ensure daily food services continue for the time being. On 13 March, they had their first case of a homeless person showing symptoms and were advised by the NHS’ 111 service to self-isolate. Accommodation Concern were able to work with Kettering Council to find them temporary accommodation and basic items like a mattress.
The concern for Moore is whether this is going to happen for everyone, for how long and who pays. “There’s no clear guidance from anybody on what we should be doing or how we can help this group of people,” she said.