The following is a co-signed statement from the CAEH and health leaders who are calling for urgent government action to protect people experiencing homelessness from Omicron.
Dr. Andrew Bond, Canadian Network for the Health & Housing of People Experiencing Homelessness and Inner-City Health Associates
Dr. Andrew Boozary, Executive Director of Population Health and Gattuso Centre for Social Medicine
Tim Richter, Canadian Alliance to End Homelessness
Angela Robertson, Executive Director of Parkdale Queen West Community Health Centre
The sector serving people experiencing homelessness is in an even deeper crisis than March 2020. We are hearing more and more that organizations and agencies across Canada are completely overwhelmed. Staffing is a major concern along with the inability to keep people healthy and safe. Staff are traumatized, burnt out and falling sick, dealing not only with the pandemic, drug poisoning epidemic and the ‘normal’ challenges of the sector, but also dealing with home life and keeping their own families safe. Amidst growing frustration and anger with government’s years of inaction to address the homelessness crisis.
As we enter year two of this global pandemic, some provinces have pulled back COVID measures (like shelter hotels and quarantine facilities) leaving shelters and front-line organizations unprepared in the face of the omicron variant. According to the ongoing community survey from the Canadian Alliance to End Homelessness:
- Vaccination rates among people experiencing homelessness are relatively low.
- Funding is becoming a barrier as it dries up after four waves of COVID-19.
- Access to PPE is constrained once again, especially the acquisition of N95 masks (which are more effective for preventing the spread of the Omicron variant).
- Frontline staff mental health continues to deteriorate, while staff and capacity shortages continue to increase.
- Growing inability of emergency shelters to support clients who test positive.
Most importantly, people experiencing homelessness are facing life-threatening risk. We know from previous waves of COVID-19 that people experiencing homelessness are 20 times more likely to be hospitalized for COVID-19, over 10 times more likely to receive intensive care, and are over 5 times more likely to die within 21 days of a positive test. This elevated risk is also present with the Omicron variant, which will spread like wildfire through an under-vaccinated population living in congregate settings with already compromised health.
Faced with a homeless system in crisis, people experiencing homelessness will be pitched into even more danger facing winter conditions, violence, deprivation, and a brutal drug poisoning crisis alone.
The solutions fall across Federal, Provincial and Municipal responsibilities and requires urgent and simultaneous action at all levels. This is a matter of equitably protecting some of the most vulnerable people in the country to prevent predictable and avoidable disproportionate infection, illness and mortality, increased outdoor encampments at the most dangerous time of year and the overwhelming of emergency departments and hospitals. We must do something, now.
Call to Action
Urgent measures to effectively address the new pressures on an already overwhelmed system, include:
1. Funding for Housing and Safe Indoor Spaces: Immediate funding and deployment of as many housing and individual room shelter-hotel options as are possible instead of congregate shelters. Individual rooms are a minimum precondition for equitable safety and isolation along with any other residents in the country. These should be converted or transitioned to rapid permanent housing at the earliest possible opportunity thereafter as part of the National Housing Strategy. With higher representation of Indigenous and racialized populations among those who are unsheltered, housing access is a direct response to racism and discrimination.
2. Update Directives: The Public Health Agency of Canada / Health Canada must urgently update guidance/directives for shelters as high-risk congregated environments, including access to testing and shortening the interval between second and third vaccine doses.
3. N95 Masks: Shelter staff and clients require the appropriate masks given Omicron transmissibility, which would include either KN95 or N95. KN95 and made-in-Canada 1870 N95s are available in adequate numbers compared to others and should be distributed to all sheltering staff and residents by combined federal, provincial and territorial efforts as needed. Without them, it will not be possible to slow progression through existing congregate shelters.
4. Infection, Prevention and Control Guidance and Supplies: Public health units will need to provide guidance and operational oversight of the implementation of the best possible IPAC recommendations for the built form of individual shelters/shelter operators. Where this cannot be provided by public health units, consulting agencies, emergency management services, health relief organizations could be approached for support as has occurred in previous waves.
5. Rapid Antigen and PCR Testing: Rapid Antigen Tests are critical for clients and staff in shelters and homeless drop-ins to manage work-home isolation for staff to preserve staffing capacity and to test clients concerned about exposure or symptoms for supports and possible isolation. This is critical as without adequate staff, shelters across the country will predictably close and clients leave for encampments and emergency departments at a time when most of Canada is now in constant sub-zero temperatures. Testing centres and hospitals should be informed to continue PCR testing of all those in high-risk settings, including shelters. While Ontario’s formal provincial guidance provides this direction, provincial and territorial practices vary and the implementation of guidance where provided is inconsistent.
6. Outbreak Management: Public Health Units are the responsible authorities for communicable disease control in shelters in most jurisdictions in Canada. As the most responsible agency, they must assume oversight, support, and direct management with public health personnel of all outbreaks in shelter systems. This is not occurring in any jurisdiction of which we are aware – public health units most often provide remote recommendations about contact tracing, confirming an outbreak, and provide written documents while noting the beginning and end of outbreaks, but not providing any direct support to control outbreaks.
7. COVID-19 Treatment: Some provincial guidance, such as that in Ontario, includes consideration of homeless and underhoused people as being high-risk communities eligible for COVID treatments when mildly ill if also having other identified risk factors. Most jurisdictions, however, have not provided for similar risk-based guidance and where such guidance exists pathways have not been created to accessibly provide available treatment options.
8. COVID-19 Vaccination: People experiencing homelessness have one of the lowest vaccination rates in the country, largely because of extremely limited access and barriers to those that are provided. Low-barrier vaccine delivery programs that include incentives are required in every jurisdiction to protect the most vulnerable and blunt outbreaks to bring 3 dose protections to the highest level possible.
9. Overdose Prevention: A poisoned drug supply and inadequate drug policy and program supports have led to overdose levels among homeless and underhoused people that have caused significant harm and death across the country during the pandemic. The risks of overdose are increased with COVID-19 isolation, which requires substantial additional supports for harm reduction, risk mitigation and safer-supply opiate programs, and opiate substation and treatment programs.
10. Encampment Eviction Prevention and Supports: We continue to advocate for a human rights approach to encampments, which precludes forced evictions and focuses on identification of individual health, social support and housing needs to support people’s fulfillment of the right to housing. It can be expected that encampment numbers will increase as a result of COVID-19 outbreaks in shelters and it will be important to ensure that individuals are not forcibly evicted for living in encampments. Given the sub-zero temperatures, additional survival supplies and supports will be required for those living and sleeping outdoors and sufficient warming centres and other indoor spaces will be required to prevent environmental cold injuries and freezing.
11. Housing Eviction Moratorium and a Residential Tenant Support Benefit: In light of the heightened risk of acquiring COVID-19 in the shelter system, homelessness prevention efforts are necessary to avoid predictable and preventable morbidity and the maintenance of system capacity for indoor spaces. Provincial moratoria on evictions for arrears should be put into effect immediately to reduce the risk of harm to those otherwise becoming homeless through evictions. The federal government should also put in place a targeted Residential Tenant Support Benefit to protect low- and moderate-income tenants who are at risk of eviction and homelessness due to a loss of income from the pandemic.
12. Homelessness Sector Funding Support: The homelessness services sectors are facing significant strain on staffing, operations, supplies, and infrastructure to adequately respond to the needs of clients and staff impacted by COVID-19. Federal and Provincial governments should urgently provide significant flexible relief funding to agencies impacted by COVID-19 to ensure their sustainability over the coming months, including pandemic pay supports and interventions focused on staff and management well-being.
13. Health Human Resources: Health human resource supports, including interdisciplinary primary care, mental health, substance use, population health, palliative care and specialized medical services to homelessness services sectors across the country remain underfunded and inconsistent – and in many cases entirely absent. There is an urgent need to mitigate this long-established inequitable access to adequate health care for people who are homeless and underhoused given their disproportionate experience of physical and mental illness, disability, trauma and very premature mortality.
COVID-19 isn’t going anywhere any time soon. The frontlines of the homelessness crisis and emergency services continue to bear the brunt. They are going to lose if we do not step in collectively with the support they need to get their jobs done. More and more people will fall into homelessness without more funding interventions. Much like the first wave, the Omicron variant is threatening a catastrophic toll on human life and support systems.
Governments must step up and get the funding, resources, and guidelines in place, so we avoid another worst-case scenario—immeasurable (but preventable) loss of life of people experiencing homelessness and the collapse of the homeless response system across Canada.
If we work together across all levels of government and public agencies, the more lives we will save. We have survived each wave so far, and once again we are being tested to pass this one. Let’s face this variant head on, masked up, vaccinated and in safe indoor spaces to prevent the worst of it.