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OPINION

Small mercies in the midst of the coronavirus

'We know of no one in Boston living on the street, outside a shelter, who has tested positive for coronavirus.'

The sheltered homeless have a high infection rate but aren’t sick, and people who live on the streets report almost no positive coronavirus test results at all. How can this be?
The sheltered homeless have a high infection rate but aren’t sick, and people who live on the streets report almost no positive coronavirus test results at all. How can this be?David L. Ryan/Globe Staff

In April, Boston Health Care for the Homeless Program tested every homeless person arriving at the Pine Street Inn shelter for the coronavirus. A startling 36 percent of the 397 transient people tested positive for the disease. But no one was sick.

“Every one of these folks were asymptomatic,” BHCHP president Dr. Jim O’Connell said at the time, “None of them had a fever, and none of them reported symptoms. … This was stunning to us. We were not expecting that.”

Last week O’Connell’s organization released a more comprehensive report on the homeless and the coronavirus. On the one hand, it is testimony to BHCHP’s formidable organizational chops. Working with the city, the 35-year-old nonprofit quickly erected isolation and quarantine tents for homeless people who were infected. The organization also helped implement infection control measures, such as bed distancing, and staggered shower and meal schedules in the shelters.

The report further reinforced the puzzling nature of the outbreak in a population, numbering over 6,000, with “an already high likelihood of chronic heart and lung disease and accelerated aging.” Additional testing revealed a slightly lower, 33 percent infection rate, but still very little actual sickness.

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“We know of about 12 deaths,” O’Connell said. “These were people with end-stage cancer or severe liver disease. Otherwise, this has not yet been the devastating illness that we anticipated. We’re baffled by it.”

Another astonishing finding: “We know of no one in Boston living on the street, outside a shelter, who has tested positive for coronavirus,” according to O’Connell. “This is a very hard thing for me to say. We’ve done studies that show the mortality rate on the street is three times higher than in a shelter. For the homeless, the streets can be deadly, but right now, you are probably safer outside.”

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These facts parallel similar findings in Los Angeles, which has the largest homeless population in the country. “We started testing on the street,” said Brett Feldman, director of street medicine for the University of Southern California’s Keck School of Medicine, “and we haven’t had any positives. Logically you can see that the unsheltered would have a lower infection rate. They are already socially distanced from society, and the vast majority live in very small communities with very little connection to the outside world.”

So the sheltered homeless have a high infection rate but aren’t sick, and people who live on the streets report almost no positive coronavirus test results at all. How can this be? “Let’s start with, ‘We don’t know,’” O’Connell says. “If everybody is asymptomatic, maybe it’s the same virus, but they are only getting a little bit of it.”

Other explanations are floating around, but they seem tenuous at best. In March, former Centers for Disease Control and Prevention director Tom Frieden opined that Vitamin D might bolster a population’s resistance to the coronavirus. Homeless people might absorb more Vitamin D outdoors than ordinary Americans sheltering at home, although an Oxford University “rapid review” of Frieden’s hypothesis “found no clinical evidence” that it played a role in “preventing or treating COVID-19.”

A French study published in April reported that “daily smokers have a very much lower probability of developing symptomatic or severe SARS-CoV-2 infection as compared to the general population.” (The words “very much” were deleted from a May version of the study.) The homeless smoke a lot more than the general population, so …?

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“This tantalized everybody,” O’Connell said, before adding: “It makes no sense.”

The resilience of the homeless population to the coronavirus pandemic is a conundrum, but a happy one, compared with the shared misery rampaging around us. “We haven’t seen the coronavirus ravage the homeless population in the way that we originally feared,” Feldman said.

It’s a small mercy, but we’ll take it.


Alex Beam’s column appears regularly in the Globe. Follow him on Twitter @imalexbeamyrnot.