It is with great relief (and bated breath) that many of us are watching declines in the number of new reported diagnoses, hospitalizations, and deaths due to COVID-19. Many are eager to dispense of the masks in indoor spaces, the checking of vaccinations, and welcoming a return to public spaces. But I don’t think we are going to return to “normal.”
This week marks two years since the National Alliance to End Homelessness closed its office space. As we walked out the door, most of us anticipated returning within two weeks, after the health crisis passed us by. This week, we will begin the formal re-entry process to the office, but it will different.
There is so much that the homeless services field has learned and accomplished over the past two years. And one of the essential lessons is the importance of attending to the intersection of health and homelessness. As we envision a return to something closer to normalcy, it is critical that we continue to integrate an equity-based public health lens within our efforts to end homelessness (among other changes!).
Continuing Focus on Vaccinations and Precautions for High-Risk Groups
While COVID-19 cases may be declining overall, the virus will remain present and deadly to many of the people that we serve in our programs. The field should continue to maintain a strong focus on keeping people safe from acquiring or transmitting COVID19, and getting vaccinations and boosters delivered, especially due to disproportionate risk many people in homeless service programs face.
- Pregnant women are at particularly acute risk of severe illnesses due to COVID-19, especially Black and other women of color. Acquiring COVID-19 during pregnancy can also endanger the baby, increasing the risk of babies being born pre-term or still-born. CDC has developed infographics (available at the link above) specifically designed for pregnant women to educate them about COVID-19 risks.
- Young children. Research indicates that children age two or under, Black and Latino children, and children with other underlying medical conditions are at greater risk of severe consequences from acquiring COVID-19. Children age five or under comprise half of the children served in homeless shelter programs each year, a vastly disproportionate number of whom are Black. Vaccinations for children under five has not yet rolled out, but is anticipated soon. These efforts will need to be conducted strategically to ramp up vaccinations in a more equitable way than has been achieved for other populations.
- Older adults. Older adults with COVID-19 are at higher risk of severe illness or death, but vaccinations can reduce risk of severe hospitalizations or death among older adults by 94%. Older adults experiencing homelessness will likely have other risk factors putting them in danger of acquiring COVID-19, including underlying health conditions and/or being Black or Latino – groups that have been disproportionately impacted by COVID-19.
- People with Certain Medical Conditions. CDC also highlights underlying health conditions and factors that put people at greater risk of severe consequences of acquiring COVID-19, including dementia, asthma, cancer, mental health disabilities, chronic liver or kidney disease. Behavioral issues, including substance use and current or former smoking, can also increase the risk of poor outcomes.
So, while we all may be beginning to see the light at the end of the tunnel, our work is not yet over. Given these disproportionate impacts of COVID-19 on the people we serve, there is still much more to do.
Looking Forward
Very early in the pandemic, public health researchers were able to point to the disparate toll COVID-19 was having on people of color. Yet the rollout of vaccinations has not happened equitably. There is still a lot more to do to make sure that all people, particularly those highly vulnerable to severe consequences of COVID-19, are vaccinated. It is not only the right thing for their own safety, but for the people they reside with and the people who serve them. And we have to make sure that this is achieved equitably.
Some anecdotal reports indicate that vaccination rates among people experiencing homelessness lagged behind the larger population – despite people experiencing homelessness having higher risk factors. There are efforts being made to “catch up;” we need to make sure those efforts don’t wane as relief of declining numbers sets in with the larger narrative. Last year, both DC and Los Angeles hired peer ambassadors to help increase vaccination rates. We must continue to test and elevate such innovative and pragmatic efforts to maintain progress in keeping people safe.
Conclusion
There will be many lessons from this pandemic that we are still to fully digest, but the public health learnings give us a strong platform to build from. We need to continue to nurture the bridges made over the last two years to ensure that we can help keep people safe and healthy wherever they are, whether that’s in housing, in shelter, or as part of street outreach. We lost too many people to COVID-19 and other health crises over the last two years. Promoting safety has to be a central tenet of our work ahead.