Homelessness, Children, and COVID-19: A Looming Crisis

Abstract

Coronavirus disease 2019 (COVID-19) created unprecedented changes in our society. Millions of people have been called to shelter in place (avoid nonessential travel outside of the home) and social distance (keeping space between yourself and others outside your home) to reduce the transmission of the novel coronavirus, which causes COVID-19. However, these and other public health measures require a level of privilege: a home to live in, access to hygiene supplies, and control over your movements. They require the ability to stay home from work, avoid public transportation when travel is necessary, and stock up on items to reduce trips to the store. Homeless and unstably housed people, including children, are not able to access these privileges, likely placing them at higher risk of exposure to the novel coronavirus. In many ways, the ability to practice social distancing has become a social determinant of health during this crisis.Homelessness is not just living in a shelter or on the street; people experiencing homelessness, especially children and families, are often couch surfing, "doubling up" with friends or relatives, or living in motels, hotels, or campgrounds. 1,2 Fifty-nine percent of people experiencing homelessness are children aged ,18 years who are either unaccompanied by an adult or are homeless as part of a family unit. 2 Within a 12-month period, 4.3% of 13-to 17-year-olds and 9.7% of 18-to 25-year-olds report homelessness unaccompanied by an adult. 3 Additionally, ∼58 000 families, including .100 000 children, experience homelessness on any given night. 2 That is roughly the equivalent of 1400 school buses full of children, enough to stretch 12 miles end to end.The relationship between housing and child health, including COVID-19, is bidirectional (Fig 1), and homelessness results in increased morbidity and mortality. 1,4 Children who are homeless are more likely to experience developmental delays, asthma exacerbations and admissions, obesity, dental and vision problems, and mental health problems, and they are more likely to be a victim of both accidental and nonaccidental injury. 1,4 They are at higher risk of many infections, including otitis media, gastroenteritis, and viral upper respiratory infections.

Viral time capsule: a global photo-elicitation study of child and adolescent mental health professionals during COVID-19

“…Mental health professionals from around the globe shared some of the unique contributions they have made during the pandemic, from utilizing social media as an educational tool to promote emotional wellbeing, to supporting colleagues caring for COVID-positive patients, to providing direct care under new virtual paradigms, to reorganizing entire systems of care. It is vital that the resourcefulness, collaboration, and ingenuity demonstrated during the pandemic be carried forward, scaled, and accompanied by funding so we that can respond to what has already been deemed a “looming mental health crisis.” [ 55 , 56 ].…”

The effect of eviction moratoria on the transmission of SARS-CoV-2

“…Existing data suggest that historically the majority of evictions have led to doubling up (e.g., Fragile Families Study 52 ) and we, therefore, chose to focus our modeling on this outcome. However, the current economic crisis is so widespread it is unlikely that other households will be able to absorb all evicted families if moratoria are revoked, and thousands of people could become homeless, entering the already-over-capacity shelter system or encampments 6,7,[53][54][55] . Shelters could only increase the impact of evictions on cases of COVID-19.…”

“…We have not considered the effects of foreclosures and other financial impacts of the epidemic which will likely also lead to doubling up and potentially homelessness. There are likely more complicated interactions between COVID-19 and housing instability that we have not modeled, such as the possibility that COVID-19 infection could precipitate housing loss 55 , that eviction itself is associated with worsening health 70,71 , or that health disparities could make clinical outcomes of COVID-19 infection more severe among individuals facing eviction or experiencing homelessness 57,72,73 . Finally, we note that our model is not meant to be a forecast of the future course of the epidemic, nor the political and individual measures that might be adopted to contain it.…”

Youth Experiencing Homelessness During the COVID-19 Pandemic: Unique Needs and Practical Strategies From International Perspectives

“…YEH are particularly vulnerable during the COVID-19 pandemic [4,5]. Common upstream factors, including racism, homophobia, poverty, structural violence, and civil unrest, simultaneously place youth at risk for homelessness, poor underlying health, and exposure to the SARS-CoV-2 virus, outcomes which, in turn, compound each other [1,2,6,7]. Globally, public health guidelines recommend physical distancing, sheltering at "home," hand hygiene, and, in some countries, wearing a mask.…”

“…Globally, public health guidelines recommend physical distancing, sheltering at "home," hand hygiene, and, in some countries, wearing a mask. Adherence to these guidelines is nearly impossible for YEH who are rough sleeping, couch-surfing, or in temporary shelter/refuges (Figure 1) [4,7]. Those residing in shelters/refuge settings or couch-surfing are at high risk of viral exposure associated with congregate living and multiple residences [4].…”