Too early to declare it over – The ongoing implications of COVID-19 for homelessness responses
While COVID-19 is no longer considered a global emergency, it has enduring effects on homelessness policy and practice. Research Fellow Chris Hartley discusses the importance of avoiding the marginalisation of those who are still grappling with the virus's impact. This post was first published by the Centre for Social Impact.
On May 5th, 2023, the World Health Organisation (WHO) declared that COVID-19, though still prevalent, is no longer considered a global emergency. public health emergency of international concern. This declaration reflects that for many Australians COVID-19 is in fact over. Over time, media coverage of COVID has diminished, and state and territory governments have ceased providing daily updates on cases and deaths. Moreover, a significant portion of the population has already experienced and recovered from COVID-19.
When it comes to service delivery and policy responses to homelessness, COVID-19 seems to be mentioned sparingly, often relegated to the past tense. Numerous conference presentations and academic publications in the housing and homelessness sector speak on COVID-19 in the past tense- frequently employing the term post-COVID. While the term "post-crisis" accurately represents the era after COVID-19's onset, disability advocates and health professionals have raised concerns that its extensive use could inadvertently marginalise individuals who remain highly susceptible to the virus. Among this vulnerable group are people experiencing homelessness, who face elevated risks of contracting preventable acute and chronic medical conditions.
This article delves into the enduring effects of COVID-19 on homelessness policy and practice, emphasising the importance of avoiding the marginalisation of those who are still grappling with the virus's impact.
COVID-19 and Homelessness in 2020
In the early months of 2020, as COVID-19 began to arrive on Australian borders, people experiencing homelessness —especially those sleeping rough—were identified as being at an increased risk of infection due to inability to socially distance, limited access to infection prevention measures such as hand sanitisers and masks, and an inability to self-isolate (Pawson et al., 2020). People experiencing homelessness were identified as being vulnerable to serious complications from the virus given the high rates of preventable acute and chronic medical conditions (Flatau et al., 2020). Concerns were also raised about the need to provide accommodation to people experiencing homelessness to prevent them spreading the virus to the non-homeless population (Pawson et al., 2020).
In response, state and territory governments took extraordinary measures by providing unprecedented levels of funding, enabling many thousands of people to access decent accommodation that would have been out of reach in the absence of COVID-19. (Pawson et al., 2020). Amid the development of the COVID-19 vaccine, state and territory governments collaborated closely with health agencies and specialist homelessness services to ensure a swift and essential rollout of vaccination programs across Australia's homelessness services.
As the end of October 2021 brought about the easing of lockdowns and the gradual removal of COVID-19 transmission protections in Australia, there was a subsequent reduction in the public health measures aimed at safeguarding people experiencing homelessness. This included a decrease in efforts to promote the importance of COVID-19 boosters among this vulnerable group, as well as reduced funding for services to access personal protective equipment (PPE) and guidance on how to respond to COVID-19 outbreaks in specialist homelessness services.
COVID-19 had become the new normal, and for many this signified that we were now living in a ‘post-COVID’ society.
Is society post-COVID?
Although society has decided COVID-19 is over, the virus’ impact continues.
While the numbers are rarely reported, COVID-19 claims the lives of an average of 25 people each day in Australia (Cross, Miranda, 2023). While many people denote the end of the lockdown period as when we became post-COVID, almost 94% of the total 22,076 lives lost to COVID-19 have occurred after this period. In 2023, COVID-19 is the third most common cause of death in Australia (trailing only heart disease and dementia) (Cutter et al, 2023) and has pushed Australia’s death rate almost 10 percent higher than expected in the first three months of 2023 (The Australian, 2023). In terms of hospitalisations, the number has never fallen below 1,300 since the arrival of the Omicron variant in December 2021 (Hewat, 2023).
The brunt of COVID-19's devastating impact in Australia, characterised by elevated mortality rates and hospitalisations, falls heavily upon marginalised and disadvantaged communities. Statistics from the Australian Bureau of Statistics (ABS) reveal that individuals living in poverty or facing disadvantage are facing a threefold higher risk of succumbing to COVID-19 compared to their wealthier counterparts (ABS, 2023; Carey, 2022). Among the hardest-hit groups, two communities stand out prominently: people with disabilities and elderly Australians.
The continued impact of COVID-19 can also be seen in increasing numbers of people experiencing long COVID. Long COVID, or post-acute sequelae of SARS-CoV-2 infection (PASC), comprises a multitude of symptoms persisting for weeks or months after the acute phase of COVID-19 has passed (Hartley, Williams, 2023). The Australian Institute of Health and Welfare estimates the prevalence of long COVID in Australia to be about 5-10 percent of COVID-19 cases (AIHW 2023).
Is homelessness post-COVID?
Assessing the persistent effects of COVID-19 on homelessness populations presents a significant challenge due to the scarcity of data. In Australia, there is a notable absence of information concerning the housing status of individuals who have died or been hospitalised due to COVID-19.
Nonetheless, considering their disproportionate representation across various health inequality indicators (Vallesi, 2021), it is reasonable to infer that individuals experiencing homelessness or residing in marginal housing are likely overrepresented in COVID-19 statistics.
It is crucial to acknowledge that the groups most severely affected by COVID-19 also represent substantial segments of Australia's homelessness population. Studies have emphasised the notable proportion of individuals with disabilities experiencing homelessness, with 3% of all specialist homelessness service users in 2021-22 identifying as having a disability (AIHW, 2022). Additionally, data from the 2021 homelessness census reveals that 7% of the entire homelessness population in Australia comprises individuals aged 65 and above.(ABS, 2023)
The use of terms such as ‘post-COVID’ also fails to recognise the potential role of Long COVID as a cause of housing insecurity and homelessness. Long COVID is not yet recognised as a permanent disability in Australia, meaning that those suffering from it cannot access disability support like the NDIS or the Disability Support Pension (DSP). The link between Long COVID and homelessness has been identified as an increasing problem in the United States (Yuko 2022). While there is currently no available Australian data on the rates of homelessness among people suffering from long COVID, public hearings of the recent House of Representatives Standing Committee on Health, Aged Care and Sport have confirmed that homelessness as a result of contracting Long COVID is occurring in Australia (The Guardian, 2023) Importantly, immunologists have declared the future burden of long COVID to be "so large as to be unfathomable".(Altman et al, 2023).
Conclusion
While the emergency period of COVID-19 may be over, COVID-19 still has a devastating impact which falls heavily upon marginalised and disadvantaged communities.
It is important to be mindful of the language we use, with terms such as ‘post-COVID’ having implications for how we respond to ongoing vulnerability. Given the continued impacts of COVID-19, many disability advocates have expressed concerns over the usage of terms like 'post-COVID,' deeming them 'ableist' and asserting that such language marginalises their experiences. (Pulrang, 2022). It is argued that such language also marginalises the experience of people experiencing homelessness who face ongoing risk from COVID.
Such language also inadvertently shifts the focus away from the ongoing importance of public health protections, especially for marginalised and disadvantaged communities such as those experiencing homelessness. To reduce mortality rates and hospitalisations in these communities, it is essential for health services to collaborate with specialist homelessness services. This partnership can ensure that people experiencing homelessness have improved access to vital measures such as COVID-19 boosters, free rapid antigen tests (RATs), and P2/N95 masks for use indoors. Additionally, it is important to ensure that those eligible for antiviral treatments can promptly access them.
The use of terms like post-COVID can also make us overlook the potential emergence of long COVID as a cause of homelessness. As we advocate for other important reforms to prevent homelessness, we should advocate for government to introduce reforms which recognise the economic vulnerability of those with long COVID. Specifically, we should advocate for the Australian government to broaden the eligibility criteria of the NDIS and DSP to encompass individuals dealing with long COVID and other autoimmune disorders that lead to similar disabling symptoms.
References
ABS (2021), Estimating Homelessness: Census, ABS Website, accessed 25 July 2023.
ABS, COVID-19 Mortality in Australia: Deaths registered until 31 May 2023 COVID-19 Mortality in Australia: Deaths registered until 31 May 2023 | Australian Bureau of Statistics (abs.gov.au)
AIHW, Long COVID in Australia – a review of the literature, December 2022, Long COVID in Australia – a review of the literature, Summary - Australian Institute of Health and Welfare (aihw.gov.au)
AIHW, Specialist Homelessness Service Annual Report 2021-22, December 2022 Specialist homelessness services annual report 2021–22, About - Australian Institute of Health and Welfare (aihw.gov.au)
Altmann, D.M., Whettlock, E.M., Liu, S.et al. The immunology of long COVID. Nat Rev Immunol (2023). https://doi.org/10.1038/s41577-023-00904-7
The Australian, Covid still pushing death rate higher than expected, The Australian July 19th, 2023 www.theaustralian.com.au%2Fnation%2Fcovid19-drives-nations-mortality-rate-10-per-c…&form=IPRV10
Carey, G, O’Mara B, Australia is failing marginalised people, and it shows in COVID death rates, The Conversation, February 2022, Australia is failing marginalised people, and it shows in COVID death rates (theconversation.com)
Cutter K, Lyon R, Lang J. Counting the toll of covid, Croakey, 22 March 2023. www.croakey.org/counting-the-toll-of-covid.
Flatau, P., Seivwright, A., Hartley, C., Bock, C., & Callis, Z. (2020). Homelessness and COVID-19: CSI response. The Centre for Social Impact.
Hartley C, Williams, B. Putting homelessness on the agenda for long COVID policy, Croakey, February 2023 Putting homelessness on the agenda for long COVID policy – Croakey Health Media
Hewat, A. Changing Australia’s approach to managing COVID-19 pandemic may help reduce burden on health system, Croakey, July 12th https://www.croakey.org/changing-australias-approach-to-managing-covid-19-pandemic-may-help-reduce-burden-on-health-system/
Lu, D, Long Covid causing job losses and homelessness in Australia, inquiry hears, Guardian Australia Feb 2023 Long Covid causing job losses and homelessness in Australia, inquiry hears | Health | The Guardian
Miranda C, Cross, J. COVID killing 25 a day on average in Australia as people stop getting booster shots, The Daily Telegraph 29th July 2023
Pawson, H., Parsell, C., Liu, E., Hartley, C., & Thompson, S. (2020). Australian Homelessness Monitor 2020.
Vallesi S, Tuson M, Davies A, Wood L. Multimorbidity among People Experiencing Homelessness-Insights from Primary Care Data. Int J Environ Res Public Health. 2021 Jun 16;18(12):6498. doi: 10.3390/ijerph18126498. PMID: 34208580; PMCID: PMC8296483.
Yuko, E, First They Got Long Covid. Then, It Made Them Homeless, February 2022 Long Covid’s Cruelest Symptom: Homelessness – Rolling Stone
Chris Hartley is a Research Fellow at the Centre for Social Impact UNSW (CSI UNSW) with a research focus on housing and homelessness and expertise in social housing policy, outcomes measurement in specialist homelessness services, homelessness and trauma, and research co-design with people who have a lived experience of homelessness. You can follow him on Twitter here: @1chrishartley
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