Coronavirus: What does self-isolation look like if you sleep rough?

By Liam Geraghty, The Big Issue (UK)

The coronavirus outbreak is intensifying across the world. In the UK, the guidance remains the same – intensive hand washing to prevent catching the virus and 14 days of self-isolation if advised by NHS24.

But that’s all very well when you have a place to stay. For rough sleepers, there is no such luxury and often the only protection from the elements, especially at this time of year, can be in a homeless shelter.

But that means sharing a small space with a large number of people, carrying an obvious risk of catching the virus.

Lucy Abraham, the chief operating officer of homelessness charity Glass Door which runs a network of shelters, said that it is still unclear how self-isolation will work for their guests, with up to 35 people staying in each night shelter.

“We identified quite early that we need to get ahead of the curve and understand what we needed to do,” she said. “So we issued guidance to all of our shelter staff asking them to reiterate the message to guests and volunteers on the importance of washing hands per the NHS guidance. We also issued a set of questions asking our staff to ask to all volunteers and guests. It started off being in relation to having travelled from Hubei province in the last 14 days and as the guidance has changed we have amended the questions. But, basically, the idea is that we are not allowing anyone who could potentially be at risk into the shelters.”

Dubbed a “social crisis” by Big Issue founder Lord John Bird on Question Time last week, 85 Brits have been diagnosed with the virus known as Covid-19 at the time of writing, including the first patient to catch the disease in the UK without travelling to affected areas abroad.

Glass Door has already sought advice from authorities on one guest who returned from northern Italy, allowing them into the shelter after assessing the risk of infection.

Abraham insists that the charity have considered setting up taxi accounts to transport rough sleepers to facilities where they can self-isolate but abandoned the idea after guidance warned against infected people using public transport or attending A&E or GP surgeries.

“We had actually already identified that the guidance to self-isolate and call [the NHS number] looks very different when you sleep on the street because where do you go?” she said. “You might not have access to a phone. It’s not appropriate to be on the streets when ill. So quite early on we wrote to various authorities to ask some of the questions – the main one being: what does self-isolation look like if you are street homeless?

“At the moment it is still fairly unclear. The thing for us is that we are deliberately an open access shelter and we don’t want there to be any barriers to accessing our service.

“We want to respect everybody’s inherent dignity, but we also understand the importance of maintaining public health. This means we will potentially have to turn people away from the shared space of our shelters – and then it’s a question of working out how that person can self-isolate and what their next steps might be.”

The charity has brought in posters to emphasise the importance of washing hands as well as boosting the stock of hand gels kept in their vans that move between shelters.

The Big Issue has also taken the same steps to protect vendors in sales and operations offices all around the UK where they buy their magazines.

“We had actually already identified that the guidance looks very different when you sleep on the street because where do you go? You might not have access to a phone. It’s not appropriate to be on the streets when ill.”

Housing Justice issued specialised advice to homeless shelters earlier this week and that has formed the basis of the response from Museum of Homelessness (MoH) in their weekly Solidarity drop-in sessions.

MoH co-founder Jess Turtle said: “We always run hygienic spaces anyway but it is really about amping that up to the max.

“Our first and only concern really is to make sure that our volunteers and people using the space are protected, of course we know through our work that many rough sleepers have underlying health problems and perhaps will be run down or have a compromised immune system so it’s really important that we all take extra precautions to protect the people in our care.”

Turtle’s words came as King’s Fund research was released this week reporting that the number of rough sleepers being admitted to hospital in the UK has increased by 130 per cent in the last five years. The report underlined the scale of rough sleepers seeking treatment – nearly 28,000 people with a primary or secondary diagnosis of homelessness were admitted in 2018-19 – and the challenges that rough sleepers face even before you consider the impact of the coronavirus.

Homelessness health charity Pathway have called on the government to ensure there are “adequate contingency plans” for people who are rough sleeping or in hostels that can be “rapidly acted upon”. They have also asked for quarantine accommodation from local authorities as well as funding for cleaning and distribution of hand sanitisers.

Abraham said that underlying health issues are a concern if the outbreak starts affecting rough sleepers – but the reaction in Glass Door shelters has been measured so far.

“Life’s hard enough when it comes to living on the streets,” she said. “There are so many challenges already, and this is just yet another challenge. The case where we did have to question whether the guest was allowed to come in – he was very understanding – so I think there is some awareness of the incoming need to protect others from potential exposure to coronavirus.”

As INSP reported last week, street paper vendors in other countries even more greatly affected at this time by the effects of the coronavirus, many of whom are either homeless or otherwise vulnerable in ways the general public are not to the impact of the contagion, are having their ability to sell magazines put under pressure.

This week, INSP released information and advice to all its members about putting contingencies in place when dealing with the aftermath of the virus.

In the US, there are over 100 confirmed cases of the virus and 9 deaths. The Pacific Northwest region is particularly hard hit, with all of the deaths occurring in Washington state, where street paper Real Change is based. The US Department for Housing and Urban Development has developed a toolkit for service providers dealing with people experiencing homelessness, and living in shelters and homeless encampments, which gives specific examples of planning and responding to infectious diseases, including the coronavirus.

INSP members can download this story from the News Service here.