While the law and advice dictated by our governments is to stay at home and physically distance, these activities are not possible for everyone. Some of the most vulnerable people in our general population, namely the homeless, have no home to self-isolate in. Not only this, but homeless people are more at risk of contracting infectious diseases or developing chronic diseases, disorders and respiratory illnesses. Vulnerabilities such as these, in conjunction with immune systems that may be compromised due to poor nutrition, inability to maintain hygiene, insufficient sleep, high stress levels from living on the streets, as well as possible loneliness and use of substances, are factors that combine to put homeless people at a high risk of being more severely affected by a COVID-19 infection.

The true pathogens are discrimination and stigma

While scrolling through FaceBook yesterday, I found a post that gave me pause and made me feel rather sick. One of the current “hot topics” in my Vancouver Island community is the short-term tenting sites with “family clusters” of campers that are going to be set up for homeless people in the community.

This project is being spear-headed by the regional COVID-19 Task Force for Vulnerable Populations, which received $220,000 from the Rapid Relief Fund and $172,000 from B.C. Housing to fund the project. Six to ten sites with up to 12 people allowed to stay in each site for up to 30 days, will be established under the plan, which was approved by B.C. Housing. The main goal of the initiative is to support the provincial mandate to provide “shelter-in-place” options in order to adhere to social-distancing guidelines and keep people safe.

However, a significant number of homeowners in the area surrounding the proposed tenting site in Chemainus are now citing their safety as having been overlooked. This is the general sentiment of the FaceBook post that I stumbled upon. Sometimes I am in awe of the lack of compassion and empathy people can have for each other. And not only the lack of these emotions, often I am dumb-founded by the sheer magnitude of fear and hatred that is ingrained in people’s views about our most vulnerable.

“Get guns. It’s the only way proven over and over again.”  Anonymous FaceBooker

Most of the hateful, stigma-filled and discriminatory comments centre around ideas like homeless populations causing inevitable theft, vandalism and other crime, and these phenomena creating unsafe spaces for other community members. However, this idea is an overgeneralization and only seeks to perpetuate long-standing stereotypes about homeless people.

Cultivating a compassion that is contrary to popular opinion

A fact that seemed widely overlooked in the FaceBook comments of the aforementioned post, was that the homeless people who so many were opposed to having in the small tent sites, are already members of the Chemainus community. The homeless are residents of Chemainus despite not having residences to call their own. In fact, many homeless people are not homeless at all, they find their home in the communities they live in. They are simply houseless, lacking houses not homes.

Those of us who do have homes, who have clean water to drink, nutritious food to eat and a warm bed to sleep in at night, often overlook our own privilege. Many of the people in the comments section seemed unable to realize that their own safety relies on the safety of their fellow community members, even those who are not homeowners. Compassion for others, particularly the most vulnerable is key. We, as humans, are created equal, with no one’s needs basic human rights being any more important that anyone else’s.

Challenge yourself to cease to look through the lens of stigma. Put aside your preconceived prejudices and notions, and view homeless people for who they are. Not drug addicts, not burdens to tax-payers, not vandals and thieves, but as people. People who deserve compassion and support to get through the difficult times caused by the pandemic.

Vulnerabilities due to addictions

While not all homeless people suffer or have suffered from addictions, unfortunately there are many who do. For some, substance use makes living on the streets a more bearable experience, and for others it may have been a struggle with addiction that helped create the circumstance that they are in.

Addiction is a powerful thing. It can alter brain chemistry through the release of dopamine, consequently beginning to change one’s personality, memory, and bodily processes that most of us take for granted. Additionally, addiction to substance use can take devastating tolls on one’s health and immune system function. Substance abuse can result in abnormal heart rates and heart attacks, and injecting drugs may lead to collapsed veins and heart valve infections. Some drugs even prevent proper bone growth, while others cause severe muscle cramping and general weakness. Using drugs over a long period of time will eventually cause serious kidney and liver damage.

The major metabolite in alcohol, acetaldehyde, impairs ciliary function in the lungs, making them more prone to bacterial and viral infection. Acetaldehyde is also considered a probable human carcinogen by the World Health Organization. In addition, alcohol impairs the body’s processes of attacking and breaking down bacteria and viruses, which puts people who abuse alcohol at higher risk for infections.

Nicotine also has extremely detrimental effects on the immune system, effects that are experienced regardless of whether someone smokes traditional cigarettes or e-cigarettes. Nicotine increases cortisol levels, while simultaneously reducing B cell antibody formation and the T cell response to antigens. Vapour from e-cigarettes damages the lungs, thus making them more susceptible to infection.

From substance abuse alone, it is easily visible how homeless people are more susceptible to infectious diseases, chronic diseases, disorders and respiratory illnesses, and having a pre-existing condition makes an individual all the more susceptible to severe consequences from catching COVID-19.

The causes of pre-existing conditions in homeless populations

However, not all homeless people have substance abuse problems, and substance abuse is not the only precursor to larger underlying diseases and conditions that many homeless people suffer from.

Many homeless individuals suffer from malnutrition due to not having enough opportunity to find nutritious food, not knowing where to find the social services that will help them get food to eat, or feelings of embarrassment or shame that prevent them from seeking help.

Malnutrition is one of the contributors to the development of respiratory illnesses. Along with crowding while living in groups, and environmental stresses, poor nutrition is observed to predispose homeless people, particularly those living in shelters, to developing infections in their lungs and upper respiratory tract. Respiratory diseases like Tuberculosis are common in many homeless populations; Catching the disease is associated with frequent exposure (due to overcrowding in shelters), alcoholism, poor diet and other previously developed illnesses that can cause decreased immune functioning in the host. 

Chronic diseases like diabetes can not only be developed as a result of homelessness, but they make life as a homeless person infinitely harder. To control and treat diabetes, an individual must be taking medicines at certain times or with meals. This allows them to regulate their blood sugars. However, many homeless people do not know when their next meal will be, and even if they do, they may be eating food that will only make them sicker. In serious cases of diabetes, an individual may need to take insulin shots. Even if a homeless person is able to purchase or access the medications they need, they are still likely to inject themselves in unhygienic conditions, possibly making them even sicker.

COVID-19 and the homeless

Homeless people are already more at risk of contracting infectious diseases or developing chronic diseases, disorders and respiratory illnesses; Having a pre-existing condition and a consequently weaker immune system makes homeless people even more likely to contract COVID-19. According to the Centre for Disease Control and Prevention, individuals of any age who already have serious underlying medical conditions may be at a heightened risk for severe illness from COVID-19. Conditions cited by the Centre for Disease Control and Prevention as increasing the likelihood for severe COVID-19 infection include: Serious heart conditions, HIV or AIDS, diabetes, asthma, and liver disease. Many of these conditions are common in homeless populations, and coupled with substance abuse, they make homeless people especially vulnerable to COVID-19 infection.

Especially in these times of hardship, it is essential that we come together as a community and find resiliency within each other. We must take measures to protect our most vulnerable, and allow the houseless to feel at home.