Illness and Economics: COVID-19 continues to devastate the marginalized homeless population
The novel SARS-CoV-2 has roared through the American landscape leaving physical, emotional, and economic devastation in its wake. By early July, known infections in this country exceeded three million, while deaths topped 135,000. Home to just over 4% of the global population, the United States accounts for more than a quarter of all fatalities from Covid-19, the disease produced by the coronavirus.
Amid a recent surge of infections, especially across the Sun Belt, which Vice President Mike Pence typically denied was even occurring, the Centers for Disease Control and Prevention (CDC) reported that the daily total of infections had reached a record 60,000. Arizona’s seven-day average alone approached that of the European Union, which has 60 times as many people.
Making matters much worse, the pandemic erupted during the presidency of Donald J. Trump, whose stratospheric self-absorption, ineptitude, denial of science, and callousness have reached heights even his most ferocious critics could not have imagined. His nostrums, including disinfectant, sunlight, and hydroxychloroquine, could be dismissed as comical if they were not downright dangerous, encouraging possibly fatal experimentation, while breeding false hopes.
Public health safeguards that should have been initiated early on were neglected, above all testing and contact tracing. At the end of April, when President Trump first crowed that “we are the best in the world in testing,” the U.S. ranked 22nd in tests per 1,000 people in the 36-member Organization for Economic Cooperation and Development, the club of the globe’s wealthy states. Although testing nationwide had increased from 250,000 a day in early May to a current 571,574, that is still less than half the number needed to begin to lock down the virus.
By portraying mask-wearing as effete and elitist, even as those who come near him are tested, disparaging social distancing (recall his reckless rally in Tulsa, Oklahoma, and unmasked Fourth of July celebration at South Dakota’s Mount Rushmore), and downplaying the danger of a second wave of infections, President Trump has been the problem, not the solution. It would be hard to imagine a less suitable helmsman to steer this country out of a public health catastrophe. His eternal spin, tweets, and fulminations about “fake news” cannot obscure the obvious: his administration’s management of the pandemic has been shambolic.
The Variability of Vulnerability
It is common to hear that we are all caught in the COVID-19 crisis, that we are all its victims. Having spread across the country, afflicting people of all backgrounds, it certainly qualifies as a national security crisis, a concept that, militarized for so long now, seems odd when applied to the pandemic. The coronavirus, of course, has neither tanks, nor missiles, nor roadside bombs, and that may help explain the government’s abject failure to plan for and contain it.
Still, take a deeper look at COVID-19’s destructive path and you will see that it is been highly selective in the suffering it is caused and the lives it has taken. Adjusted for age, fatalities per 100,000 have been significantly higher for African Americans, Hispanic-Latinx, and Native Americans than for whites across all age groups, as detailed studies demonstrate: for Blacks, 3.6 times higher and for Hispanic-Latinx, 2.5 times. The disparity becomes even greater when the comparison is made by age groups. Ditto hospitalization rates: 40.1/100,000 for whites, 160.7 for Hispanic-Latinx, 178.1 for African Americans, and a whopping 221.2 for Native Americans.
In addition, places with the highest income inequality have had the highest death rates. New York State, which surpasses its counterparts in income disparity, has had a COVID-19 death rate 125 times that of Utah, which has the least inequality. In big metropolitan areas like Los Angeles, New York, and Chicago, where the number of infections has been particularly high, the death rate has unsurprisingly been steepest in low-income communities. People living in such neighborhoods, most of them minorities, are significantly less likely to have health insurance or access to good healthcare services and far more likely to have underlying respiratory ailments including asthma, in part because the air in their communities tends to be more polluted. Poor people also have less chance of surviving COVID-19 because the quality of care in hospitals closely matches the wealth of the neighborhoods they are in.
National economic statistics help highlight COVID-19’s uneven effects. Thirty-nine percent of those who have lost their jobs since March made less than $40,000 a year compared to 19% of those earning $100,000 or more. In addition, social distancing works for those whose jobs can be done from home, but bus drivers, cabbies, janitors, meatpackers, caregivers, hairdressers, farm workers, home health aides, and the like cannot use Zoom to sever themselves from their workplaces. If you do not have to work on-site (and can afford grocery deliveries to your doorstep), you are undoubtedly on the upper rungs of the income ladder. Nearly 62% of those in the 75th income percentile managed to work from home compared to 9.2% of those in the 25th percentile. There are race-based differences as well: 37% of Asian Americans and 30% of whites can work from home versus 19.7% of African Americans and 16.2% of Hispanic-Latinx.
Then there is age. The CDC reports that 80% of those who died from COVID-19 in the United States were 65 or older. The disease has particularly ravaged the elderly in nursing homes (as well as the personnel staffing them), accounting for about 43% of countrywide deaths attributable to the virus.
The upshot: If you are old, poor, and African American or Hispanic-Latinx, your chances of infection are especially high and your odds of survival significantly lower. So, no, we are not really all in this together, especially since not everybody can easily take elementary safety precautions, certainly not the two million Americans who do not even have running water at home and so cannot regularly wash their hands, let alone the Navajo, 30% of whom must drive an hour or more to fetch water. COVID-19, anything but blind to color and class, has visibly hit the most vulnerable segments of American society most fiercely.
Devastating the Homeless
Among those especially hard-pressed to avoid infection and death are people who sleep in shelters, on the street, in deserted buildings, in subway cars, or — and they are perhaps the “lucky” ones — in their own cars. The homeless do not get all that much COVID-19-related media coverage, in part because they are a sliver of the population (0.2%) and so lack a significant political voice: you will not find pricey lobbyists working for them in Washington. They cannot even take that most basic precaution advised by medical experts, sheltering in place. To do that, you need dependable shelter, which the homeless, by definition, lack.
If you live in a big city, you can hardly miss the homeless, and you are undoubtedly familiar with the rituals of passersby. Some simply walk on, perhaps at a slightly quickened pace; others glance at the homeless but ignore, or pretend not to hear, their pleas for help. Some do give them money or food from time to time, knowing that the gesture amounts to slapping a band aid on a serious wound. Even those who see the homeless daily generally know very little about them — who they are, how they ended up on the street, how they manage to survive — and even less about the homeless who, having found a place in a shelter, are out of sight.
While statistics cannot substitute for this lack of knowledge, they can help us grasp the magnitude and nature of homelessness. According to the Department for Housing and Urban Development (HUD), on any given night in January 2019, 560,715 people were homeless. Nearly two-thirds of them lived in shelters. The rest slept wherever they could, often on sidewalks, relying, if in places with cold winters, on steam grates to stay warm. About a quarter of them were deemed “chronically homeless,” which, by the definition HUD adopted in 2015, meant that they had been “living in a place not meant for human habitation, a safe haven, or in an emergency shelter” for 12 months running or for that total over a three-year stretch. Since 2007, when the compilation of data began, homelessness decreased by 12% until 2018-2019 when it rose by 3%, chiefly because of a 16% jump in California. The economic damage done by COVID-19 will, however, ensure yet more future increases.
Four states alone – California, Florida, New York, and Texas – contain nearly half of the homeless. Add Massachusetts, Oregon, Pennsylvania, and Washington, and you will hit two-thirds. The vast majority of them live in large urban areas, with five — New York County, Los Angeles County, Seattle/King County, San Jose/Santa Clara County, and San Diego County — accounting for 29% of the homeless nationwide. A clutch of cities (in descending order, Washington, D.C., Boston, and New York) have a homelessness rate six times the national figure of 17 per 10,000, with San Francisco barely escaping this list of ill-fame.
So, though homelessness exists in every state, as well as in suburbs and rural areas, spatially it is highly concentrated – and that concentration is racial, not just spatial. Whites comprise 76% of the American population but only 49% of its homeless. For African Americans, the corresponding figures are 13% and 40%, for Hispanic-Latinx Americans 18% and 21%. Native Americans and Native Alaskans, a mere 1.2% of the population, make up nearly 9% of all homeless people. The homelessness rate is similarly skewed: 66.7 per 10,000 for Native Americans and Native Alaskans, 55 for African Americans, 21.7 for Hispanic/Latinx, 11.5 for whites, and 4 for Asian Americans.
COVID-19 and the Homeless
From the start, the homeless were among the groups most threatened by the coronavirus. Compared to other adults, a far higher proportion of them have respiratory or cardiovascular illnesses, which increase the risk of being infected and reduce chances of survival. Because of the physical wear and tear produced by exposure to the elements, poor nutrition and hygiene, and the stress of living on the streets or in shelters (while fearing being robbed or assaulted), the state of their health resembles that of people who are two decades older. Moreover, an estimated 38% of the homeless are addicted to alcohol and 26% of them to drugs. Substance abuse can, of course, weaken the body’s immune system, putting the homeless at an added disadvantage in warding off the virus.
Some experts claim that infections and deaths among the homeless have belied the direst predictions. Still, by mid-May, the COVID-19 death rate for New York City had reached 187/100,00. In the city’s homeless shelters, however, it was 291/100,000, or 56% higher. A CDC study covering March and April found that in Boston, San Francisco, and Seattle, 25% of the residents and 11% of the staff in homeless shelters tested positive for the virus.
None of this should be surprising. After all, regular handwashing, hard enough for the homeless who do not live in shelters, became especially so once bathrooms in places like libraries, restaurants, and bus stations were ever less available as the pandemic revved up. Hand sanitizer can, of course, substitute for water, but not if you do not have enough money to eat regularly, much less buy such products. Psychological disorders create an added barrier to self-protection as about 25% of the homeless — some studies report even higher numbers — suffer from severe mental illness and fewer than half receive any treatment.
Testing and contact tracing have reduced the virus’s spread substantially in a number of countries, but considering how far behind the U.S. has been in both realms, you can bet that the homeless were not anywhere near the head of the line for either. In addition, many of the organizations that care for them lack the money, kits, disinfectants, protective gear, and trained personnel (relying as they often do on volunteers) needed for an effective test-and-trace regimen. Fever and coughing were used as markers for testing early in the pandemic, so those in shelters who exhibited neither symptom but were infected transmitted the virus to others unnoticed. A single individual in a San Francisco shelter, for instance, infected 90 fellow residents and 10 employees before he tested positive.
Not surprisingly, the homeless sleeping rough did not rush to such shelters in these months, deterred by news that the coronavirus had hit places particularly hard where people were packed together and slept in close quarters, often in bunk beds. The chances of dodging COVID-19 seemed better on the outside.
Moreover, once infections soared, many shelters went into emergency mode. To implement social-distancing mandates and create space to isolate the infected, they froze new admissions or substantially reduced the number of residents they held. Some even shut down. People seeking beds faced long waiting lists. Meanwhile, cities, already under financial strain from the economic effects of the virus, scrambled to house their homeless in hotels, convention centers, or even in RVs, as the shelters disgorged people, leaving them to fend for themselves. In places like San Francisco’s Tenderloin district (already teeming with the homeless), they sleep on the streets or in makeshift tents, which increased nearly threefold citywide. Before long, cities were overwhelmed by costs, logistics, and lack of space. It was one thing for mayors to insist that the unsheltered homeless would be protected, quite another to foot the bill for hotel rooms and basic amenities in places designated for their housing, not to speak of supervisory staff and security.
Could It Get Any Worse?
COVID-19’s staggering economic effects will make it ever harder to manage homelessness, especially if its numbers increase due to an upswing in unemployment. Job losses in this country have already been estimated at up to 40 million and, despite the fall in the June unemployment rate, the virus’s recent surge across significant parts of the country will make matters worse. Another 10 million workers have seen their work hours or wages cut. Put it all together — the unemployed, those whose earnings have been slashed, and those who have simply stopped looking for work — and the real unemployment rate for May reached something like 21%. Unsurprisingly under such circumstances, in June, 20% of renters and 18% of home owners could not make their rent or mortgage payments, while an additional 10% in each category could only pay part of what they owed. Those earning $24,000 or less had the hardest time with 20% of them unable to pay and 18% paying only in part.
Rent strikes have proliferated and many localities have banned the eviction of those who fall behind on their rent due to pandemic-related circumstances. Yet while such moratoriums can be extended, there is nothing permanent about them. In fact, they have already expired in all or parts of more than a dozen states. Nationally, as many as 23 million renters could face eviction as the fall gets underway and those with low incomes run the greatest risk. Congress included financial assistance – plus a 120-day stay on evictions – for tenants and owners in its March Coronavirus Aid, Relief, and Security bill, but that legislation will expire this summer and Senate Republicans are anything but keen to support a follow-up bill.
The Federal Housing Finance Agency (FHFA) and the Federal Housing Administration (FHA) have banned home foreclosures until August 31st on mortgages backed by them. More than 30 states have also prohibited the filing of home-foreclosure proceedings against, and the eviction of, owners who have not paid their mortgages for COVID-19-related reasons, though the provisions vary greatly with lots of fine print, and not all will last until the end of the pandemic emergency. Once such moratoriums lapse, renters and owners will be on the hook for missed payments.
Together, prolonged unemployment, reduced earnings for those who retain their jobs, and a decline in savings for workers in the bottom 40% — a trend anyway over the past three decades — are likely to increase homelessness, especially if an eviction spiral begins. Columbia University economist Brendan O’Flaherty, who shared his data with me, estimates that the economic downturn caused by the virus could drive the number of homeless to 800,000, an increase of 40% to 45% from 2019.
Homelessness could increase for non-economic reasons as well in the COVID-19 era. Take recent moves to reduce the number of people in American prisons, one of the five top hotspots for the spread of the virus. Three-quarters of the inmates at Ohio’s Marion Correctional Institution, for instance, tested positive for the disease. At the Cummins prison in Arkansas, 891 inmates and 65 employees tested positive. From mid-May to mid-June alone, infections at U.S. prisons doubled to reach a total of 68,000, while deaths rose by 73% to 616 and had reached 651 by July.
In a rush to diminish population density, prisons and jails started releasing certain categories of inmates, though of this country’s 2.1 million prisoners, only about 20,000 have been freed so far, the vast majority from local jails. Keep in mind that people leaving prison have difficulty finding jobs in the best of times, so some of those released to manage the pandemic will undoubtedly find themselves both poverty-stricken and homeless. Even in the pre-pandemic moment, former prisoners were 10 times more likely to become homeless than other Americans and, according to a 2019 study by the Texas Criminal Justice Coalition, striking numbers of them end up in homeless shelters soon after their incarceration ends.
In short, as the coronavirus continues to rage, this country is ill-prepared to handle a surge in homelessness, let alone help those already homeless. The pandemic massively increased the federal deficit. The Congressional Budget Office projects that it could reach $3.7 trillion in this fiscal year, while other estimates go as high as $4.3 trillion. Meanwhile, without exception, states face steep drops in revenue.
Sadly, even if the plight of the homeless worsens and their number rises dramatically, it will barely register in the corridors of power. The homeless are a minuscule fraction of the population and have zero political clout. Politicians can safely ignore them, particularly because they know that most voters do and that the media covers homelessness sporadically at best. The homeless, society’s all but invisible castaways, can hope for little at a time when they will need more help than ever.