COVID-19 and the Most Vulnerable: The Homeless

Written by Katia Bannister, Sowing Seeds of Change and Member of the CMHA Open Door Youth Advisory Group

While the law and advice dictated by our governments is to stay at home and physically distance, these activities are not possible for everyone. Some of the most vulnerable people in our general population, namely the homeless, have no home to self-isolate in. Not only this, but homeless people are more at risk of contracting infectious diseases or developing chronic diseases, disorders and respiratory illnesses. Vulnerabilities such as these, in conjunction with immune systems that may be compromised due to poor nutrition, inability to maintain hygiene, insufficient sleep, high stress levels from living on the streets, as well as possible loneliness and use of substances, are factors that combine to put homeless people at a high risk of being more severely affected by a COVID-19 infection.

Photo by Jean Delisle on CBC

The true pathogens are discrimination and stigma

While scrolling through FaceBook yesterday, I found a post that gave me pause and made me feel rather sick. One of the current “hot topics” in my Vancouver Island community is the short-term tenting sites with “family clusters” of campers that are going to be set up for homeless people in the community.

This project is being spear-headed by the regional COVID-19 Task Force for Vulnerable Populations, which received $220,000 from the Rapid Relief Fund and $172,000 from B.C. Housing to fund the project. Six to ten sites with up to 12 people allowed to stay in each site for up to 30 days, will be established under the plan, which was approved by B.C. Housing. The main goal of the initiative is to support the provincial mandate to provide “shelter-in-place” options in order to adhere to social-distancing guidelines and keep people safe.

However, a significant number of homeowners in the area surrounding the proposed tenting site in Chemainus are now citing their safety as having been overlooked. This is the general sentiment of the FaceBook post that I stumbled upon. Sometimes I am in awe of the lack of compassion and empathy people can have for each other. And not only the lack of these emotions, often I am dumb-founded by the sheer magnitude of fear and hatred that is ingrained in people’s views about our most vulnerable.

“Get guns. It’s the only way proven over and over again.”  Anonymous FaceBooker

Most of the hateful, stigma-filled and discriminatory comments centre around ideas like homeless populations causing inevitable theft, vandalism and other crime, and these phenomena creating unsafe spaces for other community members. However, this idea is an overgeneralization and only seeks to perpetuate long-standing stereotypes about homeless people.

Cultivating a compassion that is contrary to popular opinion

A fact that seemed widely overlooked in the FaceBook comments of the aforementioned post, was that the homeless people who so many were opposed to having in the small tent sites, are already members of the Chemainus community. The homeless are residents of Chemainus despite not having residences to call their own. In fact, many homeless people are not homeless at all, they find their home in the communities they live in. They are simply houseless, lacking houses not homes.

Those of us who do have homes, who have clean water to drink, nutritious food to eat and a warm bed to sleep in at night, often overlook our own privilege. Many of the people in the comments section seemed unable to realize that their own safety relies on the safety of their fellow community members, even those who are not homeowners. Compassion for others, particularly the most vulnerable is key. We, as humans, are created equal, with no one’s needs basic human rights being any more important that anyone else’s.

Challenge yourself to cease to look through the lens of stigma. Put aside your preconceived prejudices and notions, and view homeless people for who they are. Not drug addicts, not burdens to tax-payers, not vandals and thieves, but as people. People who deserve compassion and support to get through the difficult times caused by the pandemic.

Vulnerabilities due to addictions

While not all homeless people suffer or have suffered from addictions, unfortunately there are many who do. For some, substance use makes living on the streets a more bearable experience, and for others it may have been a struggle with addiction that helped create the circumstance that they are in.

Addiction is a powerful thing. It can alter brain chemistry through the release of dopamine, consequently beginning to change one’s personality, memory, and bodily processes that most of us take for granted. Additionally, addiction to substance use can take devastating tolls on one’s health and immune system function. Substance abuse can result in abnormal heart rates and heart attacks, and injecting drugs may lead to collapsed veins and heart valve infections. Some drugs even prevent proper bone growth, while others cause severe muscle cramping and general weakness. Using drugs over a long period of time will eventually cause serious kidney and liver damage.

The major metabolite in alcohol, acetaldehyde, impairs ciliary function in the lungs, making them more prone to bacterial and viral infection. Acetaldehyde is also considered a probable human carcinogen by the World Health Organization. In addition, alcohol impairs the body’s processes of attacking and breaking down bacteria and viruses, which puts people who abuse alcohol at higher risk for infections.

Nicotine also has extremely detrimental effects on the immune system, effects that are experienced regardless of whether someone smokes traditional cigarettes or e-cigarettes. Nicotine increases cortisol levels, while simultaneously reducing B cell antibody formation and the T cell response to antigens. Vapour from e-cigarettes damages the lungs, thus making them more susceptible to infection.

From substance abuse alone, it is easily visible how homeless people are more susceptible to infectious diseases, chronic diseases, disorders and respiratory illnesses, and having a pre-existing condition makes an individual all the more susceptible to severe consequences from catching COVID-19.

The causes of pre-existing conditions in homeless populations

However, not all homeless people have substance abuse problems, and substance abuse is not the only precursor to larger underlying diseases and conditions that many homeless people suffer from.

Many homeless individuals suffer from malnutrition due to not having enough opportunity to find nutritious food, not knowing where to find the social services that will help them get food to eat, or feelings of embarrassment or shame that prevent them from seeking help.

Malnutrition is one of the contributors to the development of respiratory illnesses. Along with crowding while living in groups, and environmental stresses, poor nutrition is observed to predispose homeless people, particularly those living in shelters, to developing infections in their lungs and upper respiratory tract. Respiratory diseases like Tuberculosis are common in many homeless populations; Catching the disease is associated with frequent exposure (due to overcrowding in shelters), alcoholism, poor diet and other previously developed illnesses that can cause decreased immune functioning in the host. 

Chronic diseases like diabetes can not only be developed as a result of homelessness, but they make life as a homeless person infinitely harder. To control and treat diabetes, an individual must be taking medicines at certain times or with meals. This allows them to regulate their blood sugars. However, many homeless people do not know when their next meal will be, and even if they do, they may be eating food that will only make them sicker. In serious cases of diabetes, an individual may need to take insulin shots. Even if a homeless person is able to purchase or access the medications they need, they are still likely to inject themselves in unhygienic conditions, possibly making them even sicker.

COVID-19 and the homeless

Members of the CMHA Cowichan Valley Youth Advisory Committee passing out food at Our Place Society – Photo by Ray Anthony

Homeless people are already more at risk of contracting infectious diseases or developing chronic diseases, disorders and respiratory illnesses; Having a pre-existing condition and a consequently weaker immune system makes homeless people even more likely to contract COVID-19. According to the Centre for Disease Control and Prevention, individuals of any age who already have serious underlying medical conditions may be at a heightened risk for severe illness from COVID-19. Conditions cited by the Centre for Disease Control and Prevention as increasing the likelihood for severe COVID-19 infection include: Serious heart conditions, HIV or AIDS, diabetes, asthma, and liver disease. Many of these conditions are common in homeless populations, and coupled with substance abuse, they make homeless people especially vulnerable to COVID-19 infection.

Especially in these times of hardship, it is essential that we come together as a community and find resiliency within each other. We must take measures to protect our most vulnerable, and allow the houseless to feel at home.


It’s been 34 days since I touched my daughter...

By Stacy Middlemiss, Shelter Manager, Warmland House

It’s been 34 days since I touched my daughter, 34 days since I’ve felt her skin on mine. If you’re a mother you’ll understand the absolute torture of having to deny the only person who has heard your heart beat from the inside, the snuggles that they want, need, and crave during our distanced visits. At the same time, I’m so unbelievably proud of her as her five-year-old self knows me well enough to understand the importance of mommy’s work. I am also very grateful to have parents that are willing and able to take on the responsibility of caring for my child.

I’m sure it’s difficult for some people to understand how a mother could make the choice to work over being with their child, though we don’t often ask this when fathers work away. I accept that not everyone will understand this, and that is ok with me. I know that my daughter is safe and loved with my parents and that this too shall pass and we will appreciate one another twice as much when we can be together.

I also know that, without any uncertainty, I was put on this earth to do the work I do. Every single day is different for me. Some days I am creating behavioural plans to support people to be able to access our services in a way that works for everyone involved. Some days I am tasked with making the call as to whether or not to just clean and bandage someone up or call for an ambulance knowing that our clients aren’t always met with the most compassion or deciding if someone requires a “break in service” for their actions on site and how that might affect them in the short or long term.

Even amongst this pandemic I risk my life to breathe air into people’s lungs, wipe away their blood, clean up their feces and vomit. I sit with people and let them cry and/or yell, I find them clothes and help them shower when they’ve soiled themselves. At the end of every single day I am thankful for the opportunities that each day brought me, I love my job and the people I serve…every single one of them!

It’s easy to only see or get wrapped up in the negative aspects of my line of work, especially if you’re looking in from a distance. What you don’t see is the genuine care and compassion my clients have for me – they notice when I am showing signs of stress, when I change my hair or get new articles of clothing, they complement me often on the work I’m doing and recognize when I have to make hard decisions and they are the first to tell me when something isn’t working for them. There’s no doubt about it, I work closely with some of the most forgotten, criminalized, un-medicated mentally unstable, potentially dangerous people that walk our streets and while I am always aware of my surroundings, I feel safe and protected at all times.

Let’s move ahead to our current situation where we have had to reduce the services we provide at the Shelter as a way to follow the guidelines put forth by our government and, if we’re being honest, keep my staff working and safe. Over the past 35 days, we have only been able to sleep 30 people per night at the Shelter and there are well over 150 homeless people in this community.

We are still providing services during the day (showers, bathrooms, etc.) just for a reduced numbers. Essentially, we have been a gathering place for people to spend their days, allowing people to just sit and be who they are without judgment – but now we’ve had to force people out into the world to spend their days on benches and sidewalks only to be moved along with no place to belong.

I spend a lot of time mentally taking a tally of my clients, asking around if I haven’t seen or heard from someone and that is getting more and more difficult as everyone is scattered around town. We are serving dinner on the street each night at 5pm because we know that our clients need to eat but it also gives me a chance to check in and see people, find out how they’re doing, let them know that as a community we are working diligently to meet their needs through this time and that they have not been dismissed or forgotten.

The truth is, the clients are scared, anxious and many of them are physically unable to comprehend what is happening in the world right now. People are feeling deserted, abandoned and alone and my heart goes out to them as time ticks by while we try to figure out a plan for them through this pandemic.

Being a manager of an essential service that runs 24 hours a day 365 days a year is difficult at the best of times. The decision to close the gates during the day was not an easy one to make. I’ve lost 9, soon to be 10 staff members in the past 35 days and the future is uncertain.   I feel the anxiety of my staff wondering if they are safe and if they are putting their own families at risk by being here – and I don’t blame them.

Many of my staff don’t have extensive training in this line of work but they do have heart, compassion and dedication and no amount of training can provide those skills. I am extremely grateful for my staff and am proud to see how they have stepped up through all of this, not just by showing up for work but my supporting our clients through it as well. Each person on my team brings something special to Warmland House and together we make this place great.

Right now, people are making noise each night at 7pm for “healthcare workers” and rightfully so! I think that a lot of my staff probably don’t feel that they fit into that category. As a nurse who has worked in facilities, I can tell you that the work we do here at Warmland Shelter is just as important and we do it with a higher ratio of clients to staff, we don’t have security, we have less PPE available to us, and our clients are all coming and going around the building, some of whom are psychotic and un-medicated.

So, I ask that you take the time to consider not only the Shelter staff but all of the essential service workers at Canadian Mental Health Association – Cowichan Valley Branch and beyond as we move through the coming days, weeks, and months – because they are all heroes.



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