We are currently living unprecedented times. If we are lucky enough to survive this scourge, many years or even decades from now we will be able to talk about those immemorial times to our grand-children, perhaps great grand-children and explained to them how we survive the scourge with stay-at-home order, shelter-in-place order, social distancing and all those other terms that are now part of our lexicon. For the majority of us, not a day passes by without referring to at least one of those terms. Our lives will have been for ever changed in a significant major way. We will be obliged to leave in 2019 all those habits or gestures that are believed to promote the spread of Coronavirus Disease 2019 (COVID-19). Besides handshake that I mentioned in an earlier post, I have been thinking of how in Europe people enthusiastically kiss each other on the cheeks when they meet. Sometimes Italians or French people get lost in the number of kisses that they should give each other ( is it one kiss, two or three?). Myself, I usually get lost in the number of kisses when visiting family members in Europe: when I think it’s just a kiss, they would say oh no, one more or even two more.
In order to considerably limit the spread of COVID-19, in many parts of the world the governments have been very firm and strict on preventing people from being in the streets if they are not essential workers. Depending on where you are living, the orders have been enforced with various degree of rigour. That observation in itself can explain to some extent the difference that we see in the data coming from various countries, cities, and counties reporting on the pandemic.
While in several parts of the world, many are respecting the stay-at-home orders and others have the responsibility to enforce these orders, we need to recognize and acknowledge the fact that for some of us the stay-at-home orders do not apply. In the midst of the complete chaos caused by COVID-19, there is an homeless population that is fervently and ardently fighting to stay away from the virus, stay alive, and stay warm. For those individuals, the home is a sidewalk or a space under a bridge. They are way less likely to get access to healthcare services if they were to be infected with the coronavirus.
In the USA, in New York particularly there is approximately 70,000 homeless people (including children). While there are some shelters trying their best to serve this population, every night there are about 5,000 to 6,000 people who sleep literally in the streets. At the onset of the COVID-19 outbreak in New York many shelters that were serving the homeless population closed their doors because there were a couple of cases diagnosed in those shelters. Therefore, there is now a higher number of homeless people sleeping in the cold, on the sidewalks or under the bridges every night. The stay-at-home order definitely do not apply to those amazing human beings. Besides the shelters being closed which cause more homeless to be in the streets, there is also the fact that in the USA 70% to 80% of people are just one of two paychecks away from being homeless. The economy has been hit severely by COVID-19, millions of people have lost their jobs, they don’t have any savings, and are forced to get to the streets. The stay-at-home orders do not apply to those folks either.
In my work implementing harm reduction programs in New York to serve people who use drugs, and those who are involved in sex work, I have come across some really interesting, very smart, and compassionate human beings who just happened to be homeless. Despite everything that is going on in their lives, despite all the negativity that constantly surrounds them, they always find the strength to put a great, beautiful smile on their faces if a provider is kind enough to make a nice joke.
I find it mind-boggling that in a state as rich as New York, in a country as wealthy as USA there are that many people without a place to call home. I find it despicable that in a nation considered the wealthiest in the history of the world there is such a high proportion of workers who are literally just one or two paychecks away from being homeless. Those are major issues that should be talked about more and more and ultimately addressed. I do not understand how many folks can be proud to talk about how strong the economy was before COVID-19 whereas those major issues have been around for too long. How do you define strong economy when there are so many that cannot even satisfy their basic needs. Those without a place to call home are not less human than the rest of us. They deserve quality healthcare services like anyone else so that they can tested and treated for COVID-19. Any plan being discussed on re-opening should include them. What are the steps that will be taken to re-open the shelters that are closed. On a larger scale, what is the plan to address the housing crisis that the “wealthiest” nation in history is currently facing. As states will be re-opening one major component of the public health approach to continue combating COVID-19 will be contact tracing in order to identify all the people that someone who is tested positive for coronavirus might have been in contact with. However, the conundrum is: how do you contact trace homeless people who, in the majority of the cases do not even have a phone whey they can be reached.
It is clear that the stay-at-home orders do not apply to the homeless people, nevertheless any plans to apply the lessons that will have been learnt through this overall situation should apply to them. Quality healthcare services apply to them. Having a place to call home is such an important determinant of health. To my knowledge, health is still a human right. Right?