Wash your hands with soap and water frequently throughout the day, keep a six-foot distance between yourself and others, use hand sanitizer when you’re on the go, mask-up when you’re outside your own house and, most importantly, stay home if you feel sick.
Several months into the COVID-19 pandemic, hearing these repeated CDC recommendations has become the new normal. But what if you don’t have a home? Or much less reliable access to hand soap, travel-sized bottles of sanitizer or adequate face coverings?
For those experiencing homelessness, navigating life during coronavirus brings some unique challenges.
“The fact that the current opiate epidemic isn’t being addressed with the same type of force of any type of epidemic that is killing a particular group of people in of itself sort of speaks to forms of prejudice that is triggered by stigma against those people who may be suffering,” said Jeffrey Schonberg, a lecturer in the department of Anthropology at San Francisco State University
Schonberg is also a fellow at the Berkeley Center for Social Medicine at the University of California Berkeley. He’s co-author of “Righteous Dopefiend”— a book for which he and Phillipe Bourgouis spent several years doing participant observation with the homeless in San Francisco.
During much of that time, both Schonberg and Bourgouis lived and even slept outside along with the homeless population in San Francisco, and experienced a lot of stigma. Schonberg has also witnessed examples of this stigma during the pandemic among healthcare workers.
“I do know of cases where they would be in a homeless encampment and they call an ambulance to come and because of COVID-19, they wouldn’t go into their tent to check them out—but they really needed to be checked out because they might have been experiencing particular COVID related symptoms,” Schonberg said. “And not providing them with the same type of services that someone who was housed would get around COVID.”
Paul Harkin is the director of harm reduction services at Health Right 360 in San Francisco. He says that during times of stress it is particularly crucial that harm reduction services are available.
“We knew that people don’t just stop using drugs because they are in the midst of a pandemic, and so we really prioritize making sure that sterile equipment was available,” Harkin said. “And we also understood that in these times with extra stressors, that overdoses were more likely to go up, which did indeed happen. So there is an extra effort to ensure that we are getting Narcan into the hands of drug users any way that is possible—including a lot of outreach and mobile.”
Without a place to safely quarantine, people in congregate living, including those experiencing homelessness, are far more susceptible to the spread of sickness. Fourth Street Clinic is a community shelter and resource center in Salt Lake City.
“The county health department has worked in creating a county quarantine facility so that any persons that are being tested that are positive for symptoms, they are able to be placed in the county quarantine facility while they wait for those results,” said Lindsay Perry, the lead care coordinator at the clinic.
Once the test results are received, it’s determined if the patient will stay in the facility. However, the availability of quarantining areas means that other resources and scheduling change.
The Utah Harm Reduction Coalition used to be on sight at Fourth Street Clinic every Tuesday, but now that doesn’t happen. The clinic now instructs its patients to go elsewhere for harm reduction services. Access to the Department of Workforce Services has also changed during a time when many jobs are done from home.
“In the beginning [months of the pandemic], some of the resource centers, they were pretty quick to shut down, so patients that hadn’t accessed a shelter or a resourced center by a certain date, they were not able to access that resource center until further notice,” Perry said.
And for those experiencing homelessness, ‘until further notice’ could mean more time without shelter—perhaps on the street, or camping, or in a detox facility.
Fortunately, Fourth Street is available each weekday, and Utah Harm Reduction services are available weekly on Monday, Wednesday and Saturday for syringe exchange and access to naloxone in Salt Lake City, with different days available elsewhere in Utah.
And, we wait.