In the 1930s, between 1 and 2 million homeless Americans resided in shanty towns all over the United States. These makeshift housing areas were commonly called “Hoovervilles” after President Herbert Hoover, who was in office from 1929 to 1933.
The reason so many Americans were without adequate housing at that time was, of course, the Great Depression. During that historic economic downturn, the unemployment rate rose as high as 25%.
We are currently facing another economic downturn in the United States. It remains to be seen whether the country will slide into a recession, and, if so, how severe it might become. But before any “Trump Towns” ever appear, we should remember that there are already more than 500,000 Americans who are homeless already.
Because this economic downturn is driven by the novel coronavirus pandemic, we should pause and consider the impact of this viral outbreak on the homeless population, and how that might affect the rest of us.
As there is no specific medication to treat COVID-19, nor any vaccine to protect us against this infection, public health authorities are stressing the importance of hygiene and self-isolation to slow the spread of the virus and flatten the epidemic curve.
Schools, churches, sporting events and gatherings of other kinds have been cancelled. People with known infections or known exposure to infected people are being asked to self-isolate. And we are all asked to wash hands frequently, use hand sanitizer, and cover our faces while coughing or sneezing.
With the exceptions of covering faces and avoiding travel, these recommendations are not really possible for the homeless. They congregate in shelters with nowhere else to go, making self-isolation impossible. Hand washing facilities and hand sanitizing solutions are often not available. If the homeless do become ill, they may have no clinic available at a price they can afford.
Thus, we have perfect conditions among the homeless for widespread infection with a contagious virus: group living with poor sanitation and no consistent method to identify the ill. If COVID-19 were to be confirmed in a homeless patient, where can he or she self-isolate?
With this in mind, we should expect high rates of infection among the homeless. And, because the homeless live among the rest of us, we will all be at greater risk if the coronavirus spreads among our homeless population.
We must seek serious solutions for this problem now. Surely we can find ways to improve personal hygiene among the homeless. Let’s invest in improved homeless facilities, reduce crowding and find ways for these men and women to self-isolate should that become necessary. (Increasing appropriations for the public health agencies that serve the homeless population will pay dividends in the long run anyway.) And perhaps we can expand Medicaid for the duration of the pandemic to make health care financing a reality for them.
Or we can wait to see what happens if we again have 1 or 2 million homeless Americans, this time in the middle of a viral outbreak.
Joseph Q. Jarvis, M.D., MSPH, practiced family medicine in a community health center located in the Rose Park neighborhood of Salt Lake City. He went on to a career in public health, serving in the federal government, two state health departments and as a public health consultant. He is currently a candidate for Congress in Utah’s 2nd District.
