Student Reflection: Impact of Covid-19 on the Homeless

As the pandemic continues to surge on one year after the first case of Covid-19 was diagnosed in America, certain individuals continue to be affected disproportionately. This virus does not discriminate between those who have means to protect themselves and those who live day-to-day not knowing where their next meal is coming from or if they will be safe and warm overnight. The unsheltered population is particularly vulnerable to Covid-19 as their barrier to healthcare is already higher than those with a roof over their head.

When I had a high-risk Covid exposure, I was able to immediately isolate in my room, with ready access to online grocery delivery and a warm bed to rest in. I could give my immune system the best shot it had to fight. When healthy, I work with the homeless population weekly at Tampa Bay Street Medicine (TBSM) Clinic. When I got sick, I reflected on how different my experience would have been without the comfort of the indoors and the ability to Google any symptoms I had to get a better understanding of the disease. It is sobering to think about vulnerable individuals, helpless and often overlooked, facing the challenges of a global pandemic that has already taken more American lives than World War 2.

Unsheltered Covid-19 patients have more adversity to good health outcomes than patients with similar symptoms at any other point in recent history. Although research on Covid-19 is being churned out as fast as possible, we simply don’t have long term data to guide treatment options for these individuals. The constellation of symptoms associated with Covid-19 is ever-evolving, broad enough to include everything from fever, myocarditis, and dermatologic manifestations to chronic fatigue and dysautonomia.

People suffering from Covid-19 have to weigh the benefits of isolating and taking time off work versus the risk of being unable to feed their family. Others must navigate telehealth visits without a computer. They may pay exorbitant fees to have the latest treatment regimen while receiving inpatient hospital care, only to see the research tout a new drug as the mainstay for preventing long-haul symptoms a few months later. Many jobs can transition to work from home, but many also require in person interactions and will never be able to fully operate from behind a screen. What happens to individuals who develop chronic fatigue but are the sole breadwinner for their family from their healthcare income? Will the entire family then become unsheltered and find themselves on the street?

These times are unprecedented, and it is vital for healthcare workers to take into consideration the physical and mental strain that the socioeconomic impact has on Covid-19 patients, particularly the unsheltered. Our vaccine distribution efforts should actively include the homeless population when we think about individuals over the age of 65 years and those with chronic medical conditions.

Through TBSM, we try to get masks, basic hygiene supplies, socks, over the counter medications, and medical attention to those on the street who will otherwise go without. We are currently in the process of registering patients for the vaccine to be administered in a couple weeks. While the vaccine is an exciting initiative, seeing how grateful our patients are for masks and socks always puts my problems into perspective. Because of this pandemic, being mindful of our patients who may not have a home to go to after leaving the hospital is of greater importance than ever before from both a public health and humanistic standpoint.

Kim Menezes is a third year medical student and current Vice President of TBSM. She previously served as a TBSM Clinic Director.