New data shows that people experiencing homelessness in Denver who get COVID-19 are much more likely to be hospitalized than those who test positive in the general population.
"I think anybody in health care recognizes that people experiencing homelessness are very medically fragile," says Sarah Rowan, an infectious-disease doctor at Denver Public Health. "If you are someone with a lot of comorbidities and you are in a shelter or encampment, you are at a high risk for getting COVID and at a high risk for getting a severe case."
As of December 7, 29 percent of people experiencing homelessness who had gotten COVID ended up hospitalized; in the general population, 10 percent of those with the coronavirus wind up hospitalized. In 2 percent of the homeless cases, the patients died — the same percentage as with cases in Denver's non-homeless population.
The data comes from a report submitted by the City and County of Denver in response to a federal lawsuit it's facing over homeless encampment sweeps during the pandemic.
"People experiencing homelessness are two to four times more likely to have diabetes, cardiovascular disease and respiratory conditions. All of those can make it much more likely that COVID is going to impact them negatively," says Gregory Whitman, a public health physician who will be testifying in court on behalf of the plaintiffs suing Denver over homeless encampment sweeps.
But while those living outdoors may be in a vulnerable position, shelters aren't necessarily safer during a pandemic. "We’re continuing to see pretty consistently lower rates in the encampments," says Rowan. "When we tested in the summer at the city’s request, we found that one encampment near Stout Street Health Center had no cases of COVID out of fifty. When we tested in encampments in front of the Capitol and around Morey Middle School, they had significantly lower rates than the shelters did in June and July." The city dispersed those two large encampments in the Capitol Hill neighborhood over the summer.
Aside from highlighting the medical vulnerabilities of those experiencing homelessness, the report also shows health-care access issues for homeless individuals, according to Marisa Westbrook, a Ph.D. candidate in the Department of Health and Behavioral Sciences at the University of Colorado Denver, who has done academic research in homeless encampments in Denver.
"It’s normal among the community experiencing homelessness to delay seeking care, because seeking care can be complicated and expensive," says Westbrook, who will also be testifying on behalf of the plaintiffs. "People with lower access to care are more likely to only engage in care at the time that they need to be hospitalized."
And even if they avoid the hospital, those experiencing homelessness may not have a safe place to recuperate, notes Jacob Wessley, director of outreach and engagement of the Colorado Coalition for the Homeless. "When a person who is housed gets sick, what do they do? They’re in a housed, safe environment, where the temperature is controlled, they have access to running water, they can get sleep," says Wessley. "When somebody is homeless, especially living outdoors, their camp is getting swept a lot, they're not in a temperature-controlled environment, they have no access to running water."
The city's report, as well as other information, will be the focus of an evidentiary hearing in the U.S. District Court of Colorado on December 15 and December 16. Civil rights lawyers, expert witnesses and people experiencing homelessness will be testifying about the damaging effects of Denver's sweeps of homeless encampments during the pandemic, while the city and its own witnesses will be attempting to justify the sweeps.
The crux of the lawsuit, filed in October on behalf of Denver Homeless Out Loud and multiple homeless individuals who were displaced by sweeps, is that the City of Denver is violating federal government guidance during the pandemic.
Centers for Disease Control and Prevention guidelines state that municipalities should not sweep encampments unless adequate housing is available. Without offering such housing, the CDC contends, sweeping these encampments during the pandemic only furthers the spread of COVID.
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