The COVID-19 crisis has upended most of people's daily lives. The most obvious disruptions have been the stay-at-home orders, social distancing recommendations, and subsequent closing of businesses and loss of jobs, along with mask mandates and hand-washing orders.

But there’s one group whom COVID-19 is impacting especially hard, people who can't stay at home, can't easily find a place to wash hands, and find it impossible to maintain social distance: People experiencing Homelessness.

Fears That COVID-19 is Spreading ‘Under the Radar’

Most Americans have had to grapple with a lack of testing for COVID. And in the homeless community, that lack of testing is magnified. In May 2020, Nature reported that testing was rare in homeless shelters. That lack of testing threatened the lives of people who are homeless, as well as increased the risk of an unmanageable spread.

Because COVID-19 can be spread by people who aren't showing any symptoms, the CDC recommends widespread testing and quick isolation to try and limit outbreaks, according to US News and World Report.

Underlying Factors Lead to More Risk

Although there is a lot about COVID-19 that’s still unknown to scientists and public health officials, some ways the disease spreads are well-known. We know that COVID-19 spreads easily when people are in close contact with each other, or in communal spaces.

According to 'Nature,' about 1.4 million people use homeless shelters or transitional housing in America each year -- and the looming eviction crisis combined with anticipated prison releases to ease overcrowding will only add to those numbers.

Another important factor in the severity of COVID-19 is underlying health conditions, especially pre-existing lung diseases, HIV or AIDS, or malnutrition, according to Invisible People. Homeless people also lack access to many of the methods of reducing risk. In many areas, inadequate sanitation means they can't wash their hands frequently.

Many facilities homeless people have relied on for hygiene in the past - public restrooms, community centers - have closed making maintaining proper hygiene is even more difficult.

Buying a mask or face covering can be prohibitively expensive. Avoiding other people might not be an option - it's impossible to shelter in place at home when there is no home.

And if a homeless person does need to recover, the remedy of 'get plenty of rest' is simply not feasible.

Ways to Prevent the Spread Among People Who Are Homeless

The Centers for Disease Control recommends that shelters screen clients for symptoms. Clients who show symptoms should be housed in a separate space. Shelters should also provide face covering to anyone who needs one, and have an on-site nurse or clinical staff to help with clinical assessments.

The CDC also recommends the classic advice of avoiding crowded public settings and taking care while using public transit, while noting that following that advice is easier said than done for a person experiencing homelessness.

Any homeless person who experiences symptoms should alert their service providers, like a case manager or shelter staff, immediately.

Shelters should also practice enhanced cleaning and disinfection procedures. The CDC recommends shelters increase space between people. While necessary for disease control, Invisible People notes that often means a reduction in capacity, leaving some people without access to shelters.

That can lead to people finding shelter at train or bus stations, sleeping on public transportation, or finding shelter in a hospital waiting room -- All places with increased risk of exposure, the University of Southern California Health Sciences Campus.

In the end, providing one factor may do the most to mitigate the disproportionate danger of infectious diseases that many homeless people face: Adequate housing.

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