A Scoping Review of the Health Impact of the COVID-19 Pandemic on Persons Experiencing Homelessness in North America and Europe

Abstract

Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.

COVID-19 Vaccination and Hesitancy among People Experiencing Homelessness in Sacramento, California

“…Early in the pandemic, advocates and researchers highlighted the especially high danger of COVID-19 for people experiencing homelessness and the need for substantial interventions (Routhier et al, 2022). Many people experiencing homelessness have been exposed to COVID-19 in congregate shelters (see Corey et al, 2022;Karabanow et al, 2022;Mohsenpour et al, 2021 for reviews). Meanwhile, many unsheltered people have limited access to sanitation and social distancing.…”

“…Meanwhile, many unsheltered people have limited access to sanitation and social distancing. In addition to challenges from lacking safe and stable housing, people experiencing homelessness tend to be older and have more chronic health conditions, elevating the risk of severe symptoms and death from COVID-19 (Corey et al, 2022).…”

“…The COVID-19 pandemic disrupted many vital services for people experiencing homelessness while also increasing demand for them (Corey et al, 2022;Karabanow et al, 2022;Shi et al, 2020). Some shelters closed following COVID-19 outbreaks, and others reduced capacity to implement social distancing (Jang et al, 2021).…”

“…People experiencing homelessness may encounter many barriers to accessing COVID-19 vaccinations, including lacking access to transportation, primary care physicians, and information (Knight et al, 2021). As in the overall population, safety concerns about the COVID-19 vaccines are common reasons for hesitancy among people experiencing homelessness (Corey et al, 2022;Knight et al, 2021;Liu & Li, 2021;Meehan et al, 2022). Racism and stigma around homelessness foster distrust of health care institutions (Wen et al, 2007) and COVID-19 vaccinations specifically (Knight et al, 2021), which is especially salient given that systemic racism causes disproportionate homelessness for Black and Indigenous people (Shinn & Khadduri, 2020).…”

“…People experiencing homelessness have been at high risk for severe symptoms and mortality from coronavirus disease 2019 (COVID-19) (Corey et al, 2022;Culhane et al, 2020;Leifheit et al, 2021), making widespread vaccination against COVID-19 particularly urgent for this population. Data regarding COVID-19 and housing status are sparse (McFarling, 2021;Routhier et al, 2022), but COVID-19 vaccination rates among people experiencing homelessness lag far behind overall rates in places across the United States (Montgomery et al, 2021) and Canada (Shariff et al, 2022).…”