Response to Covid-19 in Wales may have helped limit infection among people experiencing homelessness

Researchers associated with WISERD working at the Administrative Data Research Centre Wales have been looking at coronavirus infection rates among people experiencing homelessness in Wales. Their research was in response to concerns from the outset of the Covid-19 pandemic of possible high rates of infection, hospitalisation, and death amongst homeless populations.

Experiencing homelessness potentially means having to share space in temporary or unsuitable accommodation. In some cases, people may also lack sanitary conditions. People experiencing homelessness may therefore have faced difficulties in social distancing, isolating when sick, and maintaining hand hygiene. People experiencing homelessness have also been found to have higher prevalence of health conditions, increasing the chances of Covid-19 related complications and death amongst this group.

Evidence on coronavirus infection rates among people experiencing homelessness mainly comes from the USA and has focused almost exclusively on people accessing homeless shelters. As has been found with other infectious diseases, the conditions people face in shelters, such as overcrowding and shared air spaces, represent a particularly high risk of transmission. Estimates of coronavirus infection rates for people using shelters have therefore been highly variable, largely dependent on whether there was a local Covid-19 outbreak—evidence synthesis has found highs of 32% during outbreaks, to lows of 2% without an outbreak.

However, at the start of the pandemic, specific policies were put in place in Wales to reduce the use of shelters and other forms of accommodation with shared communal airspace.

The Welsh government made a £50m investment and mandated a move away from communal accommodation solutions for people experiencing homelessness, instead favouring self-contained

This compares to the United States and other nations where communal shelters continued to operate, with attempts made to reduce contact between people using them. The divergence in
policies meant that existing evidence of coronavirus infection rates among people experiencing homelessness was not directly transferable to a Welsh context.

In conducting the study, data from healthcare providers and substance use services were used to identify people experiencing homelessness in the population in Wales. Coronavirus infection data from PCR and blood tests were then used to calculate rates for people experiencing homelessness, not-homeless people, and people not experiencing homelessness but with similar characteristics to people who had experienced homelessness.

The study’s surprising finding was that despite fears of high infection rates among people experiencing homelessness in Wales, a year intothe pandemic, rates were lower than ‘not-homeless’ people in the general population of similar demographics—5.0% compared to 6.9. These findings suggest that changes to homelessness policy during the pandemic, and the subsequent actions
by local authorities, social landlords, and third sector organisations, may have had a positive impact in relation to infection rates on people who were experiencing homelessness at the time.

The Covid-19 pandemic has provided a stark demonstration of the public health issues arising when people are housed in inappropriate forms of temporary accommodation. This joins a
large body of evidence suggesting that use of communal shelters can cause more harm than good. Phasing out the use of problematic communal forms of accommodation for people experiencing homelessness is something that all nations should move towards. It is therefore appropriate that in their ‘post-pandemic’ recovery programme, the Welsh Government’s homelessness policy implies an end to the provision of night shelters.


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