Homelessness and the Response to Emerging Infectious Disease Outbreaks: Lessons from SARS

Abstract

During the 2003 severe acute respiratory syndrome (SARS) outbreak in Toronto, the potential introduction of SARS into the homeless population was a serious concern. Although no homeless individual in Toronto contracted SARS, the outbreak highlighted the need to develop an outbreak preparedness plan that accounts for unique issues related to homeless people. We conducted key informant interviews with homeless service providers and public health officials (n = 17) and identified challenges specific to the homeless population in the areas of communication, infection control, isolation and quarantine, and resource allocation. Planning for future outbreaks should take into account the need to (1) develop systems that enable rapid two-way communication between public health officials and homeless service providers, (2) ensure that homeless service providers have access to infection control supplies and staff training, (3) prepare for possible homeless shelter closures due to staff shortages or high attack rates among clients, and (4) plan for where and how clinically ill homeless individuals will be isolated and treated. The Toronto SARS experience provided insights that are relevant to response planning for future outbreaks in cities with substantial numbers of homeless individuals.

Mobile Phone Technology: A New Paradigm for the Prevention, Treatment, and Research of the Non-sheltered “Street” Homeless?

“…Information about influenza vaccinations and other infectious disease outbreaks could also be disseminated in this manner with obvious public health ramifications. 31,32 Regarding health care practice, technology could be used to enhance communication between homeless clients and their health care providers. Providers could potentially check in with their clients via voice or text message.…”

Public Health Emergency Preparedness and Response Communications with Health Care Providers: A Literature Review

“…However, formative studies, though useful in the planning and early development phases of a system, need to be followed up with an evaluation focused on identifying changes in outcome or performance measures, results, or effectiveness criteria that can be confidently attributed to the system rather than other factors and conditions. While reports of retrospective evaluations of ProMED, a global outbreak surveillance system [23,24], the messaging tools used in conjunction with a TOPOFF exercise [26], and a survey of homeless service providers during the SARS outbreak in Toronto [20] identify problems and propose measures to counteract problematic communications issues between public health and HCPs, the reports lacked the detailed methodology or results that are needed to assess the rigor of these evaluations. One of the most widespread strategies in the U.S. for public health agencies to communicate to HCPs on both national and local levels is through the CDC's Health Alert Network (HAN) program which communicates information about infectious disease outbreaks and public health implications of national disasters within its health alerts, advisories, and updates [14,29,30].…”

COVID-19: a potential public health problem for homeless populations

“…Some lessons can be learned from the response to severe acute respiratory syndrome among homeless service providers nearly two decades ago. 10 Testing kits and training on how to recognise COVID-19 should be widely disseminated to homeless service providers and deployed in shelters, encampments, and street outreach. Alternative spaces might be needed to quarantine and treat people experiencing homelessness.…”