Growing population at risk of immediate illness

By Merdies Hayes, Managing Editor, Our Weekly News

The potential for an outbreak of the coronavirus disease (COVID-19) among the nation’s homeless population is increasing daily. Public health officials in Los Angeles County and statewide are concerned for this unsheltered population because of the susceptibility of illness, particularly the flu and other concerns that can begin small and rapidly become a life-altering event.

In Sacramento recently, A Solano County woman came down with a suspected viral infection and needed treatment. She was taken to the hospital, not knowing that she would become the first person in the nation to be diagnosed with the novel coronavirus without a known cause. The hospital’s emergency room is often filled with homeless patients, whose immune systems have become significantly weakened from living in filthy encampments on riverbeds, in alleys and on city sidewalks.

New cases of virus through community spread

This week, Los Angeles County witnessed its first two cases of coronavirus through community spread. While the sources are unknown, the danger of contracting the virus by living in a homeless encampment has received the attention of county officials. Los Angeles County Supervisor Mark Ridley-Thomas has called for extra precautions for this especially vulnerable population.

“While this is a challenging issue for everyone, people experiencing homelessness are particularly vulnerable and we must do everything we can to help them,” Ridley-Thomas said. “LA County is being proactive and collaborating with stakeholders. The board urges everyone to be calm, cautious, mindful and empathetic as we work together to prevent the spread of coronavirus.”

In addition to voting for a motion presented by Supervisors Kathryn Barger and Hilda Solis in declaring a local emergency, Ridley-Thomas asked LA County Public Health Director Dr. Barbara Ferrer about the need to roll out sanitation stations and other measures to prevent any outbreaks among people living on the street. Ferrer said the ordinary safety precautions for the general public can be all but “impossible” to instill among the homeless population of which—taken on an individual basis—are never in the same place twice from day to day.

Homeless often ‘sicker than general public’

“[The homeless] cannot stay home when they’re sick. They cannot wash their hands often,” Ferrer said.  “Many times, they don’t have a medical provider that they’re in contact with.” Ferrer further explained they are aware of many people experiencing homelessness are “sicker than the general public” and already have heightened mortality rates.

“We are very concerned that novel coronavirus can disproportionately devastate people who are experiencing homelessness,” she added.

Throughout the county, members of Ferrer’s department are visiting hundreds of interim housing facilities (mostly homeless shelters) to ensure each has adequate facilities and links to medical providers. The Public Health department has also met with leaders of several departments and agencies—including LA County’s Homeless Initiative and Office of Emergency Management—as well as the Los Angeles Homeless Services Department—to better identify locations where homeless persons who show symptoms of coronavirus can be safely placed to monitor their health.

“If we do start seeing cases among people who are experiencing homelessness, we need to be prepared to house people who have mild illness and don’t require hospitalization,” Ferrer recently told the Board of Supervisors. “These folks will require…a place where they can be isolated and other folks who are (their) close contacts will require a place where they, too, can be quarantined.”

Greater risk of serious complications

Dr. Jeffrey Klausner, professor of medicine and public health at UCLA, concurs that people living in crowded, unsanitary conditions are at increased risk of an infectious disease like coronavirus.

“This is definitely a population…with other chronic medical conditions, so should they acquire coronavirus, they are potentially at risk for more serious complications,” Klausner said.

People living outdoors often do so in close quarters and lack the ability to maintain basic hygiene, including precautions such as hand washing. They may also face more danger from serious infection because existing illnesses or frequent use of drugs or alcohol all factor to make a case of COVID-19 illness more severe.

With an unprecedented number of people living on the streets of LA County, and large encampments now more common in urban areas, coronavirus has created a situation unlike that of previous outbreaks of communicable disease. This has led to an uncertain scenario in which planning is happening as the outbreak evolves. Local public health officials, therefore, are dealing with the possible complexities of managing a pandemic in the middle of a homelessness crisis.

Klausner believes it is a good idea for county health officials to reach out to homeless people to inform them about the coronavirus and screen them for infection.

Flu more prevalent than coronavirus

“It would be useful to be more proactive about giving out flu shots to homeless people,” Klausner said, adding that the flu remains more prevalent than coronavirus, and preventing those cases in the homeless community has the dual benefit of improving overall health and keeping flu cases out of emergency rooms. “On a day-to-day basis, they are at much greater risk for influenza,” he said.

The homeless are more vulnerable to ill health, including contracting an infectious disease. Last year, there was an outbreak of typhus in the squalor of skid row in Downtown Los Angeles. In other places, including San Diego, homeless persons have seen cases of hepatitis A. In Santa Monica early this year, there were a few cases of trench fever, which is transmitted by body lice.

Los Angeles City Council members Mitch O’Farrell and Monica Rodriguez presented a motion recently to direct the city to install sanitation stations at homeless encampments big and small in an effort to protect an estimated 36,000 persons against the coronavirus outbreak.

“While the coronavirus is mainly affecting travel and tourism, it is imperative we have a lens focused on (its) potential to imperil those experiencing homelessness,” O’Farrell said. “I want to ensure we have the necessary hygiene stations and resources available from our local, state and federal partners to address this rapidly moving urgent public health issue.”

Spreading from person-to-person

Experts believe that coronavirus is spread mainly from person-to-person in the following ways:

• Between people who are in close contact with one another (within about six feet);
• Through respiratory droplets produced when an infected person coughs or sneezes;
• These droplets can land in the mouths or noses of people who are nearby or possibly inhaled into the lungs;
• It may be possible that a person can contract coronavirus by touching a surface or object that has the virus on it and then touching their mouth, nose or possibly their eyes. Experts don’t believe that this is the main way the virus spreads.

Health practitioners nationwide believe that people are most contagious when they are most symptomatic (the sickest). Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed COVID-19 cases. Symptoms may appear anywhere from two to 14 days after exposure and include: Fever, cough and shortness of breath.

People who believe they have been exposed to coronavirus should contact their healthcare provider immediately.

Many longtime homeless persons do not have a doctor nor healthcare insurance. This is primarily why the LA City Council is debating the installation of sanitation stations along skid row and at the growing amount of homeless encampments citywide and, possibly, throughout the county.

The risk for homeless seniors

Homeless seniors are at particular risk of coronavirus. The immune system naturally weakens as you age. If an older adult contracts the disease, they tend to have a higher amount of the virus because they can’t get rid of it and it tends to infiltrate deep into their lungs.

In effect, persons with the most robust immune systems have a better chance of warding off the infection—if detected early. Homeless seniors, however, often have pre-existing co-morbidities (simultaneous presence of two chronic diseases). Anyone who has a lung disease is at very high risk. Anyone with Type 2 diabetes is more susceptible to infection—especially from the aforementioned lung infections. Additionally, there a myriad of health concerns (i.e. heart disease, high blood pressure) for elderly homeless persons that can be exacerbated by the cononavirus.

There are many ways to protect yourself and others from coronavirus. First of all, stay at home if you’re sick. Limit close contact with people who are sick. Wash your hands often with soap and water for at least 20 seconds. Clean and disinfect frequently touched objects and surfaces. Always cover your cough or sneeze with a tissue. And get a flu shot to prevent influenza.