There is only a small window of time in which we can prevent widespread transmission of Covid-19 among people who are living on the streets or in shelters. Once the disease begins to spread in these groups, it will likely accelerate rapidly and be uncontainable, creating a crisis for the homeless and the entire community. This will undermine all efforts to slow the pace of the epidemic and will increase the disastrous consequences of Covid-19.
We offer a radical solution: Use suddenly empty and available living spaces — empty dorm and hotel rooms, abandoned offices — to provide safe, private housing for individuals and families who are living on the street or in shelters.
Many communities are working to prevent the spread of Covid-19 among homeless individuals by employing the same principles that are used for housed individuals: social distancing, hand hygiene, and covering a cough. They are trying to rapidly implement screening of shelter residents. If someone screens positive for symptoms of Covid-19, they need to be isolated during the often-lengthy process of being evaluated, tested, and awaiting test results; if a test is positive then they need to be quarantined. Many communities are taking steps, such as erecting tents or converting auditoriums and warehouses, to create spaces for screening, testing, isolation and quarantine of people who do not have housing.
While these are important steps, they are destined to fall far short. Homeless shelters are typically overcrowded and have little ability to create space between beds or chairs. Sleeping areas are usually wide-open spaces with no dividers between beds. Even the process of screening people before they enter a shelter often creates a situation in which many people must stand close to each other while waiting in line. Shelter staff follow protocols regarding cleaning and disinfecting surfaces, but it is impossible to prevent the spread of illness among large numbers of closely packed adults.
Preventing the spread of Covid-19 among people who live on the street is even more difficult. They have inadequate access to basic hygiene facilities. Now that many food sites are closing their dining rooms, they are also closing access to bathrooms and sinks. Too few hand sanitizing stations (with dwindling supplies of sanitizer) are available to allow adequate disinfecting.
On the street, social distancing is impossible. People who are homeless have little choice but to congregate for safety; for shelter; and to share information, food, and consolation. And those who have untreated addiction often use substances together to prevent overdose death.
Mental illness is also common among those living in shelters or on the street. For them, remembering to stand far apart and to cover a cough are often difficult.
As most Americans shelter in place, colleges and universities have closed, sending students home and leaving millions of dorm rooms sitting empty. Likewise, offices have also been shuttered, since employees have been asked to work from home. We have plenty of space to provide every homeless person with a private room. The city of Boston and the commonwealth of Massachusetts are taking steps in this direction, working with community partners to move the most medically vulnerable individuals out of shelters and off the street, and using dorms and vacant medical facilities to provide safe, individual housing.
Doing that would, of course, pose challenges, but it is a more humane solution that will be far more effective than our current efforts.
One particular challenge that must be tackled in tandem with this plan is effective treatment of addiction. America’s epidemic of overdose deaths from opioids and other drugs has not stopped in the face of the Covid-19 epidemic. If we fail to adequately treat withdrawal and provide effective maintenance medications, such as buprenorphine and methadone, then people will be unable to adhere to measures to limit viral spread, including isolation, quarantine, or housing.
The federal government has been moving quickly to loosen restrictions on medication treatment for addiction, but additional emergency action is needed to improve access. For instance, all licensed medical providers should be authorized to prescribe buprenorphine, even if they have not obtained the special federal waiver to do that.
We will succeed in preventing epidemic spread of this terrible virus only if we shift our focus. This pandemic has laid bare that we not only have to prevent the spread of infection, we need to end homelessness and addiction. These problems can’t be overlooked or set aside as we grapple with Covid-19.
Miriam Komaromy, M.D., is the medical director of the Grayken Center for Addiction at Boston Medical Center. Michael Botticelli is the center’s executive director; he served as director of the White House Office of National Drug Control Policy from March 2014 until January 2017.
This is very good. Thank you.
I am on methadone in palm springs CA. At first, there were no changes made to the manner in which the clinics were run… I’m we were packing into a tiny waiting room and having people cough in us and sneeze and the staff wasn’t making any changes whatsoever despite my and many others complaining, I begging for changes. Before this
It wasn’t until after I emailed the mayors office that they finally implemented change. Made now they’re keeping patients 6 feet apart and all but still making a bunch if addicts travel to the clinic either ABC wry day or every other day. They my husband and I travel over an hour each way to and from the clinic just so we can stay clean of heroin use… I’m I don’t think we should be made to out our health at risk just to remain clean. No it’s unfair and morally reprehensible!
They should be quartered with Ivy League equity czars.
For the homeless with drug addiction, is where the focus needs to be set upon the root cause. If each one that gets caught with drugs instantly had a jail sentence of a year(for all not just homeless). But if you give up the dealer, then they get rehab and no jail time. I’m not sure how many are aware once a user takes meth or these other drugs the user’s life is turned upside down and usually will have instant addiction from that point forward. The more focus is placed on the removal of drugs is the solution. But the main issue is, it was either Netflix or Amazon, but I think Netflix, U.S does not have the jail capacity to jail all the dealers. There are too many of them, but you need to start somewhere.
The other homeless they really need good mental health care setup and new laws passed based on those mental health checks. I think more importantly they are human as much as some many see them differently.
The fact is these are hard core rule breakers which is why they are on the streets in the first place. This population will not be confined to hotel rooms no matter how much magical thinking you conjure up. Already the price of meth and heroin is sky rocketing and they will be crawling all over town search for their self medications.
While I appreciate the humanitarian sentiment behind this post, and agree with using temporarily vacant infrastructure to house people seeking shelter, the author makes a fundamental mistake in her characterization of the problem. Here in California, in particular, the burgeoning homeless population can in great part be attributed to politicians and NGOs promotion of the homeless’ “right” to live on the street. Provision of safe, semi private living conditions would doubtless reduce the homeless population by some percentage. However, many people living on the streets— including many with mental health and addiction problems— remain on the street by choice. Placement in any sort of housing requires rules and restrictions that many homeless and their self-proclaimed advocates view as an abrogation of their rights. Are we willing to force people to take their meds? Will we restrict access to alcohol? Will we enforce social distancing? Insist on residents maintaining personal hygiene? The problem has been with us for a while, but no one with political power to date has been willing to accept that the solution to much of homelessness may involve compelling people to do what’s right for them and the community. During a pandemic, the consequences of not making this difficult choice become profoundly more serious.
In my opinion, it is more complicated than just the promotion/misinterpretation of the so called “right” (Boise v Martin) for the homeless addicted to live in the street, which is interpreted in vastly different manners depending on the jurisdiction in California. There are many underlying legal causes unique to California that exacerbate all of the well meaning organizations in their attempt to truly help the addicted homeless and mentally ill. There is a terrible amount of unnecessary suffering in the streets here in California because of the lax laws. The most urgent item to start getting the legal right to help the homeless at this hour in March 2020 in the midst of the Covid-19 crisis, is to urge our California Assemblymen to pass AB 1946 (Santiago. Mental health services: involuntary detention) http://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200AB1946 It would reform California’s extremely restrictive and outdated Lanterman-Petris-Short Act (LPS). “It is the intent of the Legislature to enact legislation to reform the Lanterman-Petris-Short Act, including expanding the definition of “gravely disabled” to add a condition in which a person is unable to provide for their own medical treatment as a result of a mental health disorder, and emphasizing the necessity to create policies that prioritize living safely in communities.” It would allow Californians to identify addicted homeless and mentally ill that are unable to care for themselves and get treatment for them even if they do not agree to treatment. Part of the underlying diagnosis and definition of addiction in this population is that they are going to refuse treatment in order to feed their addiction and or not recognize their need for treatment due to mental illness. They are treatment resistant as part of the diagnosis of what ails them and they need our help. This is one of the many reasons to reform LPS. Another is that there are many family members who love their homeless mentally ill relatives and they cannot compel them to take their medication without some kind of conservatorship oversight that would allow treatment involuntarily. This is not a draconian measure but a lifesaving one because it would be done with court oversight and have safeguards in place such as medication oversight via supervision alumni programs. Please look into AB 1946 and join me in pressuring the California Assembly to get it out of committee and to vote it into law. A number of things could be done to set up temporary treatment villages to help the huge population of homeless and addicted, but we cannot even start without a change in this outdated LPS Act. If you have scientific studies that would be useful to a think tank on how to treat the homeless and addicted mentally ill, you may contact me via Be Lifted Organization on Facebook to provide a link. We will need a monumental effort of specialists, volunteers and an all hands on deck response to really help end this unnecessary suffering.
Product of the subprime crisis