How Do You 'Self-Isolate' at a Homeless Shelter?

How Do You 'Self-Isolate' at a Homeless Shelter?

By Carly Stern

Cots are arranged in a room at a shelter and soup kitchen run by the Missionaries of Charity, a group founded by Mother Teresa, in Gallup, New Mexico.
SourceSpencer Platt/Getty


A coronavirus outbreak could be devastating for people with no place to call home.

By Carly Stern

For Americans with a place to live, the recommendation to start practicing aggressive social distancing to contain the spread of the coronavirus is difficult enough. But for Americans experiencing homelessness, it’s impossible. 

Experts are warning about the risk of contracting this virus in high-density environments. One has to look no further for a place where people are forced into close quarters than a homeless shelter — where residents live in crowded conditions and sleep in immediate proximity to one another. People living in shelters have the lowest degree of social distancing, says Dr. Nima Afshar, an emergency physician at the San Francisco VA Medical Center and associate professor at the University of California at San Francisco (UCSF). They could also face prolonged exposure and are less likely to get care for early symptoms. In terms of acquiring the virus, “it’s safer to be living outside, from a public health standpoint,” if people can tolerate it, Afshar says.

Then, of course, there’s the added element of who experiences homelessness, which has significant overlap with groups for whom the coronavirus could be most dangerous: the elderly and immunocompromised. Research from UCSF shows that more than half of the people living unhoused are over age 50. Even for those who aren’t, the physical stress of being unhoused and experiencing poverty can cause people in their 50s to display accelerated aging and geriatric conditions typical of those in their 70s and 80s. People experiencing homelessness also tend to have untreated chronic diseases, such as heart or lung conditions. It’s difficult, after all, to refrigerate or regularly take medicines — not to mention get adequate sleep — without a place to live and safely store supplies. 

Taken together, all of these factors could make a coronavirus outbreak in homeless communities particularly devastating. But cases or data to pore over from other countries to foreshadow what’s soon to come in the U.S. are not available — because homelessness at this scope and scale is a distinctly American phenomenon. “They’re in the groups we already know are higher-risk groups related to this virus,” Afshar says. “Are they going to be disproportionately vulnerable? … We don’t have the answer to that.”

Amid all of this, the sobering reality becomes clearer: Many American cities have been in a state of crisis long before coronavirus. 

But what we do know is that self-quarantining won’t be feasible for many. “Homelessness is going to impact how we care for them,” Afshar notes. Current coronavirus tests have a turnaround of between two and four days in a lab, but doctors won’t want to discharge patients who can’t effectively self-isolate during the wait time. This could lead to more hospital admissions in cities with significant homeless populations: Seattle, San Francisco and Los Angeles.

Others point out that even if shelters could be petri dishes for virus transmission, sleeping outside makes practicing the hygiene being urged by the Centers for Disease Control and Prevention nearly impossible. And, of course, those living close to others in tent encampments face exposure risks. “If you are living outside, your sanitation needs are not being met,” says Colleen Echohawk, executive director of the Chief Seattle Club, a Seattle-based nonprofit that serves Native American and Alaska Native people experiencing homelessness. To start, people living outside can’t frequently wash their hands and lack access to proper toilets and showers. 

Amplifying cause for concern is the fact that states with the highest number of coronavirus cases — Washington, New York and California — are also places where the homelessness crisis is most dire. Chief Seattle Club, like other providers in Seattle, has been implementing precautionary measures, while the city has also brought in modular units — like tiny homes — to house people at risk. The New York City Health Department has released interim coronavirus guidance for homeless shelters, and San Francisco plans to put $5 million toward reducing exposure for the more than 25,000 people living in shelters, Navigation Centers and single-room occupancy hotels. More people live unsheltered on the West Coast compared to places like New York City. But in another twist of events, San Francisco is expected to experience unseasonably cold weather and rain in the upcoming weeks, which could put even more strain on the shelter system if an outbreak were to occur.

Amid all of this, the sobering reality becomes clearer: Many American cities have been in a state of crisis long before coronavirus. Seattle even declared a homelessness state of emergency back in 2015. But a public health outbreak of this proportion now makes it painfully evident that the well-being of any American person — not just those in our school system, living on our block or in our social networks — has the capacity to impact another stranger’s health. It’s those who stand on society’s ground floor, not those who reach the penthouse, who shape the story. And all of those emergency dollars flowing now? One must wonder why, exactly, those funds couldn’t have been flowing before.  

What to watch in the coming days? Whether cities can create emergency housing that protects some of its most vulnerable residents and introduce effective regulations to increase distance and keep the number of cases down. “It could be a factor that limits our success in containing this epidemic,” says Afshar. After all, these are the same cities where people fight so bitterly — in times of relative peace — over how to house people in the first place. Now, what’s always been true is spelled out: Our shared fates hang in the balance.