Protecting the Homeless During the COVID-19 Pandemic

The homeless have been identified as a population vulnerable to the spread of coronavirus disease 2019 (COVID-19),¹ along with groups such as the elderly and those in nursing homes. Homelessness presents a particular set of challenges to the containment of COVID-19. Homeless people move from place to place and often work in the informal economy. They also may not have regular access to showering facilities or hygiene supplies, which could facilitate transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many have poor nutritional and medical statuses and face barriers accessing health care. Homeless populations already have higher risks of infectious diseases such as TB, hepatitis C, and HIV, and higher mortality rates overall.²

Singapore has a population density of 7,866 people per square kilometer,³ one of the highest in the world. Such high density favors the spread of the SARS-CoV-2 virus. A study by Ng⁴ on the homeless in Singapore estimated 1,000 homeless people in the city-state of 5.7 million people.³ Homelessness was found in most parts of Singapore, with the highest concentrations around the city center. Most of the homeless people were older Chinese men. This is concerning, because evidence suggests that men are more likely than women to suffer serious consequences from COVID-19.⁵

In Singapore, social challenges are largely managed by the Ministry of Social and Family Development in conjunction with numerous community partners and non-governmental organizations. To coordinate efforts to help the homeless in Singapore and in recognition of the multifaceted help they need, the Partners Engaging and Empowering Rough Sleepers Network was formed in July 2019, comprising the Ministry of Social and Family Development and various community groups. Through the Partners Engaging and Empowering Rough Sleepers network, Safe Sound Sleeping Places (S3Ps) were set up, which are officially designated places that provide shelter to rough sleepers to sleep safely at night. As COVID-19 infections increased exponentially in Singapore in the end of March 2020, the Singapore Multi-Ministry Taskforce announced more stringent measures to act as a “circuit-breaker” to break the trend of rising infections, mirroring similar measures put in place by many other countries. Our neighboring country Malaysia had already enacted a movement control order weeks earlier on March 18, 2020. This led to an unprecedented situation of more than 300,000 Malaysians who cross the Singapore-Malaysia Causeway daily having to decide on which side of the border they would reside for the duration of the movement control order.⁶ In anticipation of more people not being able to find shelter because of the unprecedented movement restrictions, a government appeal was made for more organizations to open up as S3Ps. In a short time, the number of S3Ps increased from 8 to 35, with a capacity to accommodate up to 700 homeless people. Safe distancing measures were also implemented in the S3Ps, with beds placed at least 1 m apart and meals and shower times being staggered to minimize close interaction amongst residents. These measures have led to each shelter being able to accommodate fewer guests than before to prevent transmission of COVID-19. Thus far there have been no known outbreaks of COVID-19 among homeless shelters in Singapore.

Homeless populations have always been a part of urban city life. The COVID-19 pandemic has in fact exposed societal fault lines and raised greater awareness about the vulnerabilities and issues faced by this population. Societies, along with their governments, have to rally more resources to support the homeless. Failure to adequately shelter and accommodate homeless people could lead to COVID-19 outbreaks that would be difficult to contain and track because of the nomadic nature of these people. Homeless people who contract COVID-19 also may present late in the disease course, rendering containment and treatment efforts more challenging.⁷ Protecting homeless populations has to be part of a comprehensive strategy to contain COVID-19 in any city and requires a multi-pronged and multi-agency approach.