By Erin Durkin
From accessing treatments to finding space to isolate, people experiencing homelessness have additional challenges when it come sto preventing and addressing the spread of monkeypox.
With cases in the U.S. reaching almost 22,000, advocates are concerned about resources available to the homeless population during the monkeypox outbreak.
“Monkeypox is really a double whammy for people experiencing homelessness because of the way it’s spread through direct contact: Skin-to-skin contact, some respiratory droplets, and the virus can live on linens for up to 15 days,” said Courtney Pladsen, clinical and quality-improvement director at the National Health Care for the Homeless Council.
Monkeypox infection causes a rash that may look like blisters or pimples and can be painful. Other symptoms include fever, chills, and muscle aches. Transmission occurs often through skin-to-skin contact and respiratory secretion. Touching clothing or bedding that has been used by someone with monkeypox can also spread the virus.
Given what is known about how monkeypox spreads, Pladsen said there is “great concern” for people in homeless shelters or densely packed encampments. And for individuals who are diagnosed with monkeypox, there may not be a place to send them to isolate, she said. The Centers for Disease Control and Prevention advises people to isolate if they have monkeypox until the rash has healed and a new layer of skin has formed. Recovery from monkeypox can take two to four weeks.
“One of the things that we saw with COVID is the increased spending for isolation and quarantine, specifically hotels and motels for folks experiencing homelessness to be able to isolate,” Pladsen said. “For monkeypox we have not seen additional funding and many cities have closed their [isolation and quarantine] sites, so there’s not the same infrastructure that we’re able to utilize. Even if a case is diagnosed and identified, many cities have nowhere to send someone.”
“One of the most difficult aspects of this disease is the isolation piece. … For people experiencing homelessness, this is almost impossible because the CDC recommends that anyone with an infection have their own room and a private bathroom,” said Carolyn Summer, a nurse practitioner for Unity Health Care,which has clinics throughout the city, including homeless shelters.
Summer added she was happy that the district expanded its resources to assist with cases of monkeypox.
“People experiencing homelessness have less control over their own environments, and so they do have this added stress of being constantly exposed to other people in their intimate environment,” she said. “While the vast majority of cases are spread through intimate contact, the nature of needing to share a bathroom or being in a bunk next to someone who may not know that they’re infected does increase that risk of being exposed to the disease.”
With winter coming, more people may head indoors, which can put them at risk for increased transmission, said Rosa Moudene, director of population health at Pathways to Housing DC.
“As the cold weather comes, people might be migrating more towards congregate settings like shelters; that would be my No. 1 concern for increased transmission of monkeypox,” Moudene said.
“I think we’ll need to see expanded resources if the cases climb,” she added.“Right now we’re at a nice stable point with infections, but if we do see an increase as the winter months come on, we’ll definitely need expanded resources.”
In San Francisco, there are not many options to isolate individuals facing homelessness who have monkeypox, said Clarissa Ospina-Norvell, interim medical director at the San Francisco Community Health Center. “At this point there’s really nothing available, and much of that housing that was for COVID is now no longer available,” she said.
San Francisco is in the process of winding down its Shelter-in-Place Hotel Program set up for COVID-19 through this fall as federal and state funding ends. Guests are being transitioned to other housing options.
Ospina-Norvell also said getting vaccines to the population that the center serves can be labor-intensive. “We know from our experience with COVID that there are people who are not going to be able to walk even a block to come in to get a vaccine,” she said.
The center’s street medicine team is taking the monkeypox vaccine to unhoused people. “They go by foot. … They found that going by foot was a little less intrusive, and they were able to encounter people on the street, and actually they have real relationships with people who are living on the street in certain locations,” she said.