Alcohol and drug use behaviors are also likely to independently increase the probability of contracting coronavirus through a number of mechanisms including sharing substances, inhalation of substances, direct and indirect immu- nosuppressing effects (particularly when used heavily and chronically) and increased engagement in risky behav- iors. The lack of access to adequate hygiene supplies and consistent sanitation facilities, along with limited access to healthcare are factors that may increase the risk of transmission and spread of COVID-19 among unsheltered populations3.
For these reasons COVID-19 infection is likely to spread rapidly among people experiencing homelessness, particularly among those who have addiction. In addition, homelessness and addiction are both likely to be independently associated with a more severe course of COVID-19. People with addiction, and those experiencing homelessness have high rates of chronic health conditions (e.g. respiratory disorders, cardiac disorders, chronic infections [HIV, HCV, infective endocarditis]) that confer risk, and many individuals experiencing homelessness are over age 502. A recent analysis suggested that individuals experiencing homelessness who are infected by COVID-19 would be twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times as likely to die than the general population.3
In addition, homelessness and addiction are both likely to be independently associated with a more severe course of COVID-19. People with addiction and those experiencing homelessness have high rates of chronic health conditions (e.g. respiratory disorders, cardiac disorders, chronic infections [HIV, HCV, infective endocarditis]) that confer risk, and many individuals experiencing homelessness are over age 50.4 A recent analysis suggested that individuals experiencing homelessness who are infected by COVID-19 would be twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times more likely to die than the general population.5
The CDC has released guidance for Homeless Service Clinicians and Programs to Plan and Respond to COVID-19 and for people experiencing Unsheltered Homelessness. These guidance documents both highlight the need for and continued linkages to “medical, mental health, syringe services, and substance use treatment, including provision of medication-assisted therapies (e.g., buprenorphine, methadone maintenance, etc.).”.
Continuity of care is critical for patients during this time. The relationship with a supportive treatment clinician/ program may be one of the most stable relationships in the life of a person experiencing homelessness, so disruption of this relationship can be especially difficult.
Increased regulatory flexibility during this public health emergency is supporting increased access to treatment for addiction, including medications, through telehealth and increased access to take-home doses of methadone. However, individuals experiencing homelessness may not have access to a reliable phone, minutes, data plan, internet, or other technologies that would be needed to access telehealth services. In addition, they may not be able to safely store and manage a substantially increased number of take-home doses of methadone.