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Roxie Danielson is a street nurse based out of Toronto.

As the reality of the COVID-19 pandemic becomes clearer across North America, the value of practising social distancing has become a truism. Governments across Canada have declared states of emergency to limit the numbers of gatherings and interactions, while the federal government has closed its borders to foreign nationals. Public-health experts across the country continue to urge that the best approach to limiting the spread is to remain at home.

But what if you do not have a home to remain in?

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Long before the first Canadian was diagnosed with COVID-19, Canada was already experiencing a homelessness and housing crisis. But the pandemic, and the ensuing response to flatten the curve by decreasing the number of COVID-19 cases per day, is about to exacerbate the issues faced by vulnerable communities.

In shelters, social distancing is an impossibility. People are forced to sleep in overcrowded spaces where they lie inches away from one another. There is no room to isolate anyone who might be sick. There are also not enough supports with which to properly screen and assess people with symptoms, and without those supports, their health – as well as public health – is at risk.

These shelter conditions will undoubtedly increase the risk of COVID-19 spreading, as we have already seen with other diseases. In 2017, an outbreak of group A streptococcus that killed 10 people in Toronto lasted 18 months in one downtown shelter.

The coronavirus is also particularly dangerous for people living in shelters as the population has a higher likelihood of having chronic health conditions, such as diabetes and lung diseases, as well as weakened immune systems, all of which put people at a higher risk of mortality.

Many already avoid shelters because of particular needs, and as such, they rely on public spaces, drop-in or meal programs, and some faith groups for food, sanitation and other resources. But in recent weeks, those programs have been suspended as volunteer numbers and food donations dwindle, while states of emergency have shuttered libraries, community centres and fast-food restaurants with seating. The closings of these de facto gathering places for the homeless have exposed the already urgent need for more emergency drop-in programs and an easing of society’s reliance on the existing safety nets. Poor conditions in shelters during the pandemic might prompt even more people to avoid them.

For many, the only options left will be living on the streets or in homeless encampments, where they face potential harassment and eviction. This instability will only worsen Canada’s overdose epidemic, especially as many addiction-support groups have suspended their services during the outbreak. And those who were receiving addiction medicine – as part of an opioid or managed alcohol program, for example – must now worry about finding safe access to their substances and endure uncertainty around their treatment.

With the overcrowding of shelters and closings of many important services during this time, it is obvious that many of the public-health measures made to protect people during the pandemic have neglected the needs of the homeless. But there are short-term ways forward in this moment of crisis.

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We need a moratorium on evictions of homeless encampments, along with more outreach support, including nurses and harm-reduction workers, to ensure people’s needs are being met even if the number of people sleeping outdoors increases.

To properly manage the COVID-19 pandemic, we need to rapidly house people – or maintain their housing. Extraordinary measures such as the use of rent supplements, prefabricated housing and the use of emergency powers to expropriate empty units can help. Addiction medicines must be made available to people for the full length of their quarantine, or they will be at increased risk of a fatal overdose.

In simpler times, we were not doing enough as a society for some of the most vulnerable people in our society. Now, amid COVID-19, it is an absolute necessity that we do better.

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