As our community slowly emerges from several months of staying home to stay healthy, we are following the science and data to make sure it is done safely. We are all eager to see our friends, support businesses and restaurants, and share our public spaces. But as we leave our homes, we must also have a public-health plan for those who could not stay at home — those experiencing homelessness.
For the past three years, we have served as family physicians in King County’s Downtown Public Health Center. In that time, we have provided person-centered care for anyone who walked through the doors, including many patients who are experiencing homelessness and housing instability. We have seen firsthand the toll homelessness can take on physical and mental health, and how access to safe housing can improve both short- and long-term health outcomes.
At least 11,000 people are without a safe place to live in King County every day, a number that has almost certainly increased because of the pandemic. As the county and City of Seattle take care to prevent further spread of COVID-19, these efforts must extend to people living in tents, shelters, hotels, cars, doorways or anywhere outside.
These patients are our neighbors. They are students, veterans, and parents with whom we share our community spaces: our parks, libraries and sidewalks. Many are older with underlying health conditions. Many may be newly homeless. But what we have learned from watching this pandemic unfold throughout the world is that this virus affects everyone. If we as a community are vulnerable to infection anywhere, then we are all vulnerable everywhere.
We can learn a cautionary tale from Singapore, where authorities had forgotten about the approximately 200,000 workers who live in cramped quarters with 10 to 20 men packed into a single room. A virus outbreak in these dorms represented 85% of the country’s total COVID-19 cases in April and put the rest of the country at risk of a resurgence. This illustrates the dangers of overlooking vulnerable communities that lack access to clean facilities and space to social distance.
In King County, welcome steps were taken to reduce the crowding at homeless shelters by moving more than 600 people into small hotel and motel rooms. With a few exceptions, as a result of this work, we’ve contained COVID-19 outbreaks and seen an important change — the effects of moving people into safe, private, clean rooms with a bathroom, a roof and a door of their own, have been profound, both physically and psychologically.
We have heard directly from our patients who have benefited from this program. One reported that he was able to sleep easier knowing he was at decreased risk of catching the virus, as he was especially worried about his underlying lung condition. Others reported that, before moving into a motel, it was difficult to maintain good hand hygiene due to closed public restrooms, and nearly impossible to social distance in their regular shelter beds. As physicians, we are grateful for the work of this initiative to keep our patients safe.
However, while impactful, this is not a silver bullet. Thousands of people, including many of our patients, remain living on the street without shelter or access to sinks and bathrooms for hand washing and hygiene. And for the hundreds of people who have been thriving in the safety and stability of hotel rooms, their leases are almost up and their futures are unclear — even though the coronavirus threat has not ended, and even though homelessness itself is its own public-health emergency.
Our region is full of smart, compassionate people who have proven their willingness to do whatever it takes to address the global pandemic. As part of that effort, we must also ensure the long-term safety and health of people without permanent housing and seek permanent solutions to the epidemic of homelessness. For the dignity and safety of more than 11,000 of our neighbors, we urge elected officials and decision makers to offer socially distant housing with clean air and clean surfaces for those among us living homeless.