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Shelters are like a petri dish waiting for COVID-19 to arrive

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A microscopic image that shows the novel coronavirus SARS-CoV-2, the virus that causes COVID-19. Image: U.S. National Institutes of Health

Canadian public health officials repeat reassurances that the risk of COVID-19 in Canada is low or mild, and continue to ignore social conditions that put people at serious risk. We are told that a country with a strong public health system such as Canada is at lower risk for virus spread. Yet this year, 235,000 people will face homelessness, an opioid overdose epidemic remains unchecked and Indigenous communities continue to face inadequate housing and unsafe water supplies.

In all the COVID-19 media coverage I have not heard one mention by the public health experts of poverty, homelessness or the shelter conditions that force people to live in tight quarters with hundreds of people. But public health officials have always ignored these conditions, whether it was during SARS or subsequent dangers.

During SARS we dodged a bullet. As former street nurse Barb Craig once said: if the first person with SARS had walked into a downtown Toronto hospital instead of Scarborough, the infection would have had a different path and it would have been catastrophic for the homeless population.

So, I welcome the expertise of Dr. Michael Gardam, who has been an expert witness in the past at an inquest involving deaths of people who are homeless.

In a recent issue of Maclean's, Dr. Gardam, an infectious disease specialist and chief of staff at Humber River Hospital is quoted as saying:

"Let's say you're on the beach and you can see a tidal wave coming in the distance. It's not here yet. At this very moment, the risk on the beach is low. But we know that's soon going to change.”

Dr. Gardam goes on to add that although the World Health Organization (WHO) won't call COVID-19 a pandemic just yet, it would probably be best for Canada to consider it.

Community health workers, in particular street nurses and outreach workers, have witnessed the tidal wave before: tuberculosis micro-epidemics in the homeless population that killed, group A streptococcus outbreaks and Norwalk virus outbreaks.

Today we are bombarded with a formula of measures to take to protect ourselves from COVID-19.

This 10-point list is from the WHO's director-general Tedros Adhanom Ghebreyesus advising what we should know about the virus and how to diminish the risk of transmission. I have added my reality check in bold to his list.

  • First, as we keep saying, clean your hands regularly with an alcohol-based hand rub, or wash them with soap and water. Touching your face after touching contaminated surfaces or sick people is one of the ways the virus can be transmitted. By cleaning your hands, you can reduce your risk. During SARS in Toronto, there were drop-in centres and public schools without soap and paper towels.
  • Second, clean surfaces regularly with disinfectant -- for example kitchen benches and work desks. Are countries advised to increase cleaning staff? How does this apply to soup kitchens that feed hundreds of people a day?
  • Third, educate yourself about COVID-19. Make sure your information comes from reliable sources -- your local or national public health agency, the WHO website, or your local health professional. Everyone should know the symptoms -- for most people, it starts with a fever and a dry cough, not a runny nose. Most people will have mild disease and get better without needing any special care. Yet, refugee camps, nursing homes and shelters include a populations with compromised health and would be more at risk.
  • Fourth, avoid traveling if you have a fever or cough, and if you become sick while on a flight, inform the crew immediately. Once you get home, make contact with a health professional and tell them about where you have been. What about other travelers: migrants, refugees, people who are homeless?
  • Fifth, if you cough or sneeze, do it into your sleeve, or use a tissue. Dispose of the tissue immediately into a closed rubbish bin, and then clean your hands. Homeless people cannot afford tissues nor can shelters and drop-ins afford to provide enough.
  • Sixth, if you are over 60 years old, or if you have an underlying condition like cardiovascular disease, a respiratory condition or diabetes, you have a higher risk of developing severe disease. You may wish to take extra precautions to avoid crowded areas, or places where you might interact with people who are sick. How does one avoid crowded areas if one is homeless and staying in a shelter with hundreds of people?
  • Seventh, for everyone, if you feel unwell, stay at home and call your doctor or local health professional. He or she will ask some questions about your symptoms, where you have been and who you have had contact with. Home? Phone your doctor?
  • Eighth, if you are sick, stay at home, and eat and sleep separately from your family, use different utensils and cutlery to eat. Home?
  • Ninth, if you develop shortness of breath, call your doctor and seek care immediately. Phone?
  • And 10th, it's normal and understandable to feel anxious, especially if you live in a country or community that has been affected. Find out what you can do in your community. Discuss how to stay safe with your workplace, school or place of worship. I see no direction provided to community agencies on how to prepare.

Meanwhile, those who can afford to will start stockpiling food and supplies, in some cases on the advice of local authorities such as Ottawa Public Health. Poor people, agencies with limited funding will be left behind, unable to afford this measure.  

As long-time homeless advocate Beric German says, "A shelter is like an open wound and if anything happens to an open wound it festers." Shelters are not unlike the petri dish that we understand cruise ships to be except shelters are more crowded, have even worse ventilation, poorer staffing levels and cleaning standards.

Toronto's Shelter and Housing Justice Network (SHJN) has been appealing for Toronto to declare a homelessness emergency for over a year. Last week city council voted for the third time to not enact emergency measures. Mayor Tory called the approach and the campaign "political theatre." It would have been an opportunity to start putting emergency measures in place to protect people, COVID-19 or not.

Here is the SHJN homeless emergency petition. Please sign.

Cathy Crowe is a street nurse, author and filmmaker who works nationally and locally on health and social justice issues.

Image: U.S. National Institutes of Health

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