Contents
Up to November 2020, the total cases of COVID-19 in the United States have exceeded 11 million, and more than 240 thousand people have died from this horrible pandemic. Approximately 3% of COVID infections ended in death in the United States. The increasing number still seems unstoppable right now.
COVID 19 is different from the seasonal flu or H1N1, which caused the last pandemic in 2010. It appears to be a well-balanced virus that causes a much higher infection rate than H1N1 or Ebola and a higher fatality rate than flu. On average, it infects 2.5 to 3.0 others, whereas common flu infects about 1.27 others. People can get infected without any symptoms within at most 14 days. That makes it much harder to prevent and control.
COVID 19 can infect anyone, but it’s more dangerous to the population with the compromised immune systems and underlying chronic health conditions, mostly for people over 65 years old or unsheltered homeless individuals. For people over 80 years old, the death rate is close to 15%, almost five times higher than average. As for people at the age of 20 to 50, less than 1 % die from COVID 19. Besides, though most infected people are mild, and many are asymptomatic, it’s implicated that there could be significant long-term damage to the heart, liver, and kidney. It is a much more critical condition for people over 65 who fortunately cured of the infection, which means long-term monitoring and healthcare would be needed. However, it will be much more difficult for people experiencing homelessness to get proper treatment and follow-up medical support, especially for homeless individuals over 55.
According to other countries’ successful experience, massive testing and active preventing approaches like wearing masks and keeping social distancing are necessary to control the virus’s spreading. But it can be challenging to provide testing and hygiene supplies to homeless people.
Therefore, helping homeless people overcome COVID-19 and provide healthcare in the future is critical at this point.
Homelessness is an increasingly severe problem in US society, and in a way, it tears the people apart. The lack of healthcare in the homeless group is becoming a major crisis, especially after the strike of COVID-19.
According to the US Department of Housing and Urban Development(HUD)'s annual point-in-time count in 2019, approximately 567,715 people worldwide are experiencing homelessness, which is about seventeen out of every 10,000 people. The total number increased by 3 percent from 2018, and there is no sign for the growing number to stop.
There are different groups of people within the overall homeless population. More than 2/3 are individuals. 171,670 people are in families. Ninety-six thousand one hundred forty-one people, around 1/6 of the community, are chronically homeless who have experienced homelessness for over a year while struggling with mental and physical disorders. The rest 1/6 are veterans and unaccompanied youth, which is about 72,123 people.
Males primarily represent the gender of the homeless group. Men and unaccompanied male youth take up more than 70 percent of the total population.
Figure 1 Overview of Homelessness in America (source:https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/)
Figure 2 Total Number of People Experiencing Homelessness per Year by Type (source:https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/)
Figure 3 Counts and Rates by Gender (source:https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/)
Figure 4 Counts and Rates by Race/Ethnicity (source: https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/)
The percentage of homelessness within each race and ethnicity varies substantially. For instance, even though white Americans take up the largest number, the ratio is lower than the national average. In contrast, Pacific Islanders and Native Americans are most likely to become homeless. Black Americans and Hispanics are also more likely to become homeless than the national average.
Many of the homeless are unsheltered who sleep in a harsh environment outdoor, which is not made for human habitation. This situation makes the unsheltered group more exposed to health problems, such as covid-19. According to HUD, in 2019, it’s estimated that there are 107,194 individuals over 45 years old were unsheltered in one single night. Half of the homeless individuals are unsheltered among all ages. What’s worse is that the number o f older adult homeless will keep increasing in the future. For instance, in Los Angeles County, it’s expected that, by 2025, the population of people over the age of 65 will increase by 54 percent.
Figure 5 Physical Health, Mental Health, Substance Abuse, Trimorbity by Shelter Status (source: Health Conditions Among Unsheltered Adults in the U.S.)
However, according to CDC guidelines, the population over 65 are at higher risk of getting seriously ill from COVID-19. Some research indicates that older adults experiencing homelessness tend to have similar physical conditions to people 15-20 years older than them. The circumstance put them in an even more difficult situation. A recent study by Janey Rountree, Nathan Hess, and Austin Lyke suggests that unsheltered people are far more vulnerable than those who have accommodations. The research shows that 84 percent of unsheltered people have physical health problems, while only 19 percent of sheltered people have the same condition. As for mental health, the percentage is 78% vs. 50%. This percentage means that, though unsheltered people are more vulnerable to physical and mental conditions, the mental health condition can not be simply solved by housing or shelter. It needs to be thoughtfully dealt with when starting a homeless housing program, such as developing a system to carefully categorize the housing tenants and group them into a separate caring program.
There are two useful ways to get information about the challenges homeless systems are facing. Counts are the approach to examine the locations with the highest homeless population. Rates reflect the percentage of homelessness to the general population. These two ways indicate the number of people who need homeless services. However, another challenge emerged during the current pandemic. It’s hard to determine the number of people infected by COVID 19 while demanding homeless services. In particular, for those who are unsheltered, self-quarantine, social isolation, and stay-at-home are almost impossible to follow when you don’t have a home.
how can the design of physical space and the affordable housing program help the homeless people to overcome the pandemic and trained to get back to society(during and after the pandemic)
In the short term, there are several ways to alleviate the difficulties homeless people face during the pandemic quickly. Firstly, provide temporary shelter for the homeless to benefit from physical protection, social distancing, concentrated testing, and accompanies from other groups. Secondly, follow the guidelines from the Centers for Disease Control and Prevention. Third, give homeless shelter workers training to ensure they can adequately take care of the vulnerable groups.
In the long term, we need to develop a more sophisticated system to meet homeless people’s needs. Firstly, affordable housing programs should be more open to the homeless population. Secondly, think about how we can use design to improve homeless people’s living quality and help them get back to society. Thirdly, develop different kinds of healthcare services for homeless people, like shelter-based clinics, student-run homeless clinics, etc.
Two approaches are very innovative and effective during such a difficult time and intrigue massive discussion.
Figure 6 Parking lot homeless shelter in Las Vegas was last resort (source:https://www.reviewjournal.com/news/politics-and-government/clark-county/officials-parking-lot-homeless-shelter-in-las-vegas-was-last-resort-1996083/)
Temporary shelter for homeless people in a parking lot in Las Vegas
The first is utilizing the parking lot to gain benefit from physical protection, social distancing, concentrated testing, and accompanies from other groups.
After being rejected by local landlords and hotels in Las Vegas, Clark County, and Las Vegas officials seek accommodation for homeless people from the Cashman parking lot. However, many people were criticizing such an act in that there are a large number of empty hotel rooms in the city during the pandemic that can be used as a temporary shelter for homeless people. And the lacking public-private cooperation to temporarily or permanently house the homeless was also disappointing.
I agree that the difficulty of finding support from the local community is an unfortunate situation. But in terms of using the parking lot as a shelter, I believe there is great potential in designing an excellent public shelter for unhoused people. The parking lot is a space with natural air and has clear signage for distancing. These are good qualities to prevent the spread of the virus. And to transform the harsh, human-made environment into an inhabitable place requires cooperation between the local government and the landowner. As the cities are metabolizing, the parking lot will gradually transform into other programs. The city government should encourage the owners of those parking lots to develop affordable public housing or public parks with shelters for unsheltered individuals.
Metro system helps unhoused people looking for shelters
The second is using public transportation to help unhoused people to find shelters.
Figure 7 The city of Los Angeles’ Unified Homeless Resource Center (source: https://thesource.metro.net/2020/05/01/metro-helping-more-unhoused-people-get-into-shelters-during-covid-19/)
In April 2020, to prevent the spread of COVID 19 and comply with the L.A. County Department of Public Health’s and the city of Los Angeles’ “Safer at Home” emergency order, the metro system set up several new measures to focus on ensuring the basic need of the commuters. One of them is to offer bus transportation to help unsheltered and other vulnerable individuals who may desperately need homeless services, shelters, or medical treatment.
This approach helped more than 290 unsheltered individuals to nearby shelter beds in only a month, which is substantially more than the agency’s average outreach rate for homeless housing services. In addition to that, the Metro system has assigned a few full-time employees to provide help to homeless people finding available housing. Metro has started an outreach team called People Assisting the Homeless(PATH) and transit security, fare inspectors, and specialized law enforcement at some of the busiest metro stations like 7th Street/Metro Center, Union Station, and North Hollywood. This program aims to offer the homeless people the resources of nearby shelters within 15-20 minutes from the transit point.
In such a case, the transit station was no longer a nasty cave for unhoused people but rather a small housing information center for people who do not have access to housing resources. “Ultimately, the goal is to keep our transit system running during the COVID-19 crisis so that we can provide rides to those who need it most,” said Bob Green, Metro’s Chief of System Security and Law Enforcement in Los Angeles.
However, there are some critical comments on this act. One of them states that the unhoused people are more susceptible to getting the infection from COVID 19 because of the horrible hygiene condition in shelters. They are likely to get even sicker due to the lack of reliable healthcare support. I think this is a very valid point. Nevertheless, we already know that unsheltered individuals are substantially more vulnerable than housed individuals, even if some shelters have severe sanitation conditions. And after that, we need to apply the CDC guidelines and use the tool of design to help those shelters be more inhabitable for those homeless people.
Until November 3rd, 2020, the Centers for Disease Control and Prevention(CDC) is still updating their Interim Guidance for Homeless Service Providers to Plan and Respond to Coronavirus Disease 2019 (COVID-19), which is a guidance based on their current knowledge about COVID 19. It’s intended to give support and instructions to public health authorities, homeless service providers, and emergency management officials.
Whole community approach
To prevent the spread of COVID 19 among the homeless group, a “whole community” approach is required. A “whole community” is a concept that involves everyone in the community, not just the government, in a shared responsibility of preparedness and keeps resilient when facing the challenge of natural disasters or pandemics. This group contains individuals and families, businesses, faith-based community organizations, nonprofit groups, schools and academia, media outlets, and all government levels, from state to federal partners. With the group’s efforts, it will be easier to implement community-wide approaches to help the people experiencing homelessness from COVID 19. For instance, the connection and communication with local and state health departments, homeless service providers, and Continuum of Care leadership, housing authorities, and other key partners would be easy and responsive. In addition to the statement that homeless shelters shall not be closed or excluding people who test positive for COVID 19 or have the symptoms, community coalitions are supposed to provide four types of additional sites for the vulnerable homeless groups. The four sites include an overflow site to reduce crowding, isolation sites for the infected people tested positive, a quarantine site for people waiting to get tested, and some protective housing for those at the risk of COVID 19.
Facility procedure
The guidance also states that clear communications with staff and clients are essential, including posting signs that encourage hand washing and use of masks, providing educational materials about COVID 19 in multiple languages, and updating information and changes in the procedure for clients and staff. The community coalitions are also required to offer hygiene supplies like soap, tissues, masks, PPE, hand sanitizer, etc.
In terms of facility layout considerations, firstly, there should be physical barriers to protect staff’s wellness when interacting with clients. All the daily activities should be kept 6 feet apart, including the meal service area and general sleeping area. In the meal services area, two seats should be at least 6 feet apart, and clients can choose to either get delivered to the table or take away. If there is not enough space for all the beds separated 6 feet apart in the general sleeping area, at least the distance between two faces should be 6 feet. Moreover, clients with mild respiratory symptoms or confirmed COVID 19 should be prioritized for individual rooms. Those who test positive should be controlled in the same area, and there should be a separate bathroom for these people.
Ventilation
The ventilation of the facilities is another vital consideration for homeless service providers. Increasing the percentage of outdoor natural air as high as possible and increasing the total airflow are the most critical consideration since COVID 19 is mostly airborne transmission. Natural ventilation, like opening windows, should be encouraged. Central air filtration should be improved, and the generating of clean-to-less-clean air movements would also help prevent the virus’s spread.
Basic training
Staff training will help them better understand the nature of COVID 19 and provide proper care to the clients. The training should include the necessary information on COVID 19 and the mechanism of the spreading. The service providers should be aware that staff and clients are possible to get infected and be asymptomatic. Thus, cloth face covering is a must for all the staff, same with all the clients in a public room. Setting up a physical distancing rule would also be helpful. For instance, service providers can set up maximum occupancy limits for specific places, like common rooms or bathrooms. When staff is screening the client, there should be physical barriers between the team and the client, like plexiglass. And if it is not installed yet, PPE should be supplied to the staff, and they need to stand 6 feet apart from the client when conducting the screening.
Screening protocols
Helping screening clients’ symptoms is an integral part of staff training. Usually, there are two steps for staff to ask about the symptom from a client. The first step is trying to determine if the client has a fever. The team has to use the temporal thermometer and also ask the client if they felt like having a fever in the past few days. Cleaning the thermometer is necessary for each client. The second step is to ask about symptoms. The phrasing would be, “Do you have a new or worsening cough today?” And “Do you have any of these other symptoms?” These symptoms include not limited to shortness of breath or difficulty breathing, headaches, congestion or runny nose, fatigue, the new loss of taste or smell, nausea or vomiting, muscle or body aches, sore throat, diarrhea. And suppose they have a fever or some symptom in the list. In that case, staff should immediately provide them a cloth facing covering and give them suggestions that they need to remain in their rooms, keep hand hygiene and front coverage, and keep staff notified of the symptoms’ changes.
Figure 8 CDC's Guidance on Screening Protocol for Homeless Shelter Workers Training
Reactions to symptoms
When a client has some severe symptoms, staff need to utilize their protocols to determine if the client demands direct medical support or not and help provide access to nearby medical care services. And when someone is having emergency warning signs of COVID 19, such as trouble breathing, persistent pain, or pressure in the chest, etc., the staff should have a quick response and seek emergency medical attention.
In the long term, we need to develop a more sophisticated system to meet homeless people’s needs and have the resilience to face all kinds of challenges, such as natural disasters or another pandemic.
Firstly, affordable housing programs should be more available to the homeless population.
As stated above, people living sheltered are much less likely to be exposed to physical Health conditions and substance abuse conditions, and they tend to have better mental health conditions. This condition demonstrates the phrase “housing is healthcare” and stresses the importance of developing affordable housing for people who are experiencing homelessness.
Brief history of affordable housing program
In United States history, the Federal Housing Administration was created in 1934 t o alleviate some of the housing hardships after the Great Depression. This administration made homeownership more affordable for a broader portion of the general public. Later in 1965, Housing and Urban Development(HUD) was established and started to provide subsidies to Public Housing Agencies, which helped make up the difference between Rent’s revenues and the cost of maintaining the housing. In 1986, the Department of the Treasury’s Internal Revenue Service was given the “Tax Reform Act of 1986”, which created the concept of the low-income housing tax credit. This act gave tax credits to the developers who investigated affordable rental housing and encouraged this housing type. Around the 2000s, the National Housing Trust Fund was established, targeting extremely low-income people and helping build, preserve, rehabilitate, and operate housing for them. The impact of the low-income housing tax credit is still up until today. This starts with the Federal government allocating housing credit to each state, which is $2.35 per person. Then the developers are awarded tax credits through each state’s Qualified Allocation Plan. Later, on behalf of the developer, the syndicator sells tax credits to investors in return for equity. In the end, equity covers about 79% of the development cost for a project funded with 9%-type credits. According to the works and researches of Lawrence Scarpa, a typical development project uses over eight total funding sources. The stakeholder map of a project is very complicated. The developer will communicate with the design team and construction team and the owner, the traditional lenders and financial institutions, syndicator, state housing agency, advocates, and representatives who have a connection with municipal government and local communities residents and target demographic. Among these groups, the architect team would have conversations with the advocates and representatives to understand the project’s needs and expectations. According to Lawrence
Figure 9 Complex Stakeholder Map (source: Brooks + Scarpa)
Scarpa, 70% of design decisions happen in the first 10 % of a project, and 80 percent of the budget is used in 20 percent of the places with the complexity of affordable housing development. The way he conducts the design is to spend more on the public area and modularize the housing unit.
Case studies
Figure 10 Star Apartment by Michael Maltzan Architecture (source:https://www.architecturalrecord.com/articles/7997-star-apartments-los-angeles)
Figure 11 The Six by Brooks + Scarpa Architects (source: https://www.archdaily.com/877376/the-six-affordable-housing-brooks-plus-scarpa-architects)
In the affordable rental housing area, several architects in Los Angele s have done quite a few fantastic projects, such as Michael Maltzan Architecture’s Star Apartment in skid row in downtown Los Angeles, Lorcan O’ Herlihy Archtiects’s MLK1101 in Los Angeles, and Brook + Scarpa’s The Six Disabled Veteran Housing in MacArthur Park, Los Angeles. These projects all have some key innovations, like sustainability, construction method, view control, and so on, with a low cost and have won a lot of awards. And more importantly, they all prioritized user experience based on substantial research about the life pattern of people with low-income or experiencing homelessness, which resulted in better designs than many other public housing projects built by bigger developers.
MLK1101 Supportive Housing
Figure 12 Original Site of MLK1101 by LOHA (source:https://www.archdaily.com/805070/lohas-latest-supportive-housing-complex-curbs-las-increasing-homelessness)
A great example is Lorcan O’ Herlihy’s MLK1101 Supportive Housing in South Los Angeles. It is a LEED Gold level building and has won many awards, including AIA Merit Award in 2020. This project is a 26-unit affordable housing project with street-level community space, supportive space, and a community garden. In this project, Lorcan collaborated with Clifford Beers Housing, an organization that aims to alleviate homelessness and provide a friendly and healthy community for all people. The site was transformed from a vacant parking lot and turned into a 100 percent affordable housing community.
In my opinion, there are several aspects that this building had adequately dealt with.
Figure 13 Diagrams of Site Design by LOHA (source: http://loharchitects.com/work/mlk1101-supportive-housing)
The first is the way it treats the relationship between the street and the community. The building was pushed into the private corner of the site, and the large space that linked with the street was turned into the public community garden. Instead of having parking on the site, it places the parking underneath the community garden and creates a height difference between the semi-public garden and the public street. The private realm boundary was smoothly transformed from the street level with a sloped platform that connects the community garden and the street. This gives a visual connection with the street level and also creates a sense of security to the shared community garden.
Figure 14 Floor Plan of MLK1101 by LOHA (source:http://loharchitects.com/work/mlk1101-supportive-housing)
The second is the design of corridors and public realms. The building utilized a mix of single-loaded and double-loaded hallways. The hallway surrounds the community garden and goes through the whole site from the south to the north. The two ends of the corridor are open, which allows natural ventilation to occur. That is the key to prevent the spread of airborne transmissive diseases. Besides, the corridors vary in width among each floor, which not only gives dynamic to the elevation and creates a series of informal meeting/gathering spaces. These spaces can intrigue unplanned social interaction that helps to establish a sense of community. And when it comes to COVID 19 situation or any possible future pandemic, these widened corridor spaces can be utilized to keep social distancing and allow natural ventilation. In this case, the entry and community garden’s openness would be the right place for screening and temporary sheltering tenants who test positive for COVID 19.
Last but not least, the street-level community space is another crucial feature of the project. In the design aspect, the irregular shape in contrast to regular housing units gives some variation and playfulness to the site, which gives character to the project and creates a sense of place for the users. On the other hand, the street-level retail units can generate income to subsidize the housing cost and create job opportunities and pieces of training for the tenants to help them transition back into society.
The Nest Toolkit
Figure 15 Unit Plan by Brooks + Scarpa (source:https://brooksscarpa.com/the-nest-toolkit)
Figure 16 Shared Space Plan by Brooks + Scarpa (source:https://brooksscarpa.com/the-nest-toolkit)
Another excellent architect company in the affordable housing area is Brooks+Scarpa. They recently designed a resource called “The Nest Toolkit” to address the shortage of supportive housing for people experiencing homelessness in Los Angeles. The home concept in this toolkit is flexible to meet the varying needs of different sites and neighborhoods. Rather than a fixed model, it is a combination of scalable and adaptable parts that can fit into different conditions. For the housing unit, the base module is 12 feet by 28 feet rectangular plan, one of which can be a single bed studio, two can constitute a two-bedroom unit, and three can become a three beds family unit. Since there are multiple types of base units, the possible combination varies vastly. This housing module can provide a single bed up to eight-bed units. Other than living units, the shared space is also modularized with the same unit size. These shared units include two types of community kitchens, a laundry room with an office, a public shower room, a public restroom, a water pod/ electric room, and an open community space. With the standardized unit size, designers can arrange them based on the site condition into a single-loaded building, double-loaded, or a mix of both.
Figure 17 Possible Configurations by Brooks + Scarpa (source: https://brooksscarpa.com/the-nest-toolkit)
This methodology enlarged the capacity of a site to accommodate the homeless. For example, on a 50-by-150-foot lot, such supportive housing can permanently shelter as many as 224 people. This module can also be used in off-the-grid situations. Since all the units can be pre-fabricated in a factory, they can be installed in vacant spaces like parking lots. This gives this toolkit even greater flexibility to adapt to various urban conditions and profoundly influence the cityscape in the future.
These cases show that architects are capable of designing large public housing projects with the consideration of user experience, sustainability, and budget control. And thanks to these architects’ insistence on creating beauty in architecture, the cityscape is becoming a better place.
Though housing and sheltering can contribute largely to improving the health condition of the homeless, proper healthcare support is also needed. According to research by Travis P. Baggett in 2010, 73 percent of the homeless people reported at least one unmet health need, including an inability to obtain needed medical or surgical care (32%), prescription medications (36%), mental health care (21%), eyeglasses (41%), and dental care (41%). This shows great inequality in the distribution of healthcare resources. Thus, it’s vital to address the question of what makes providing healthcare services to homeless people, in contrast to the indigent in general, more complicated?
Basic considerations
To address the problem, according to William Breakey, we need to look into the following four characteristics of homeless people which will impact the provision and planning of healthcare services. First, their daily activities tend to be different from ordinary people. It can be challenging to get a continuous medication supply while living on the street. Second, the multiplicity of needs like drug or alcohol abuse in addition to physical and mental health conditions, are expected. Third, a lot of homeless people, especially individuals, lack connections with others. This isolation often leads to disaffiliation that they can hardly establish a supportive relationship with other people. When it comes to medical support, they tend to be difficult to cooperate. Last, other than disaffiliation, many homeless people also distrust authorities and mental healthcare providers due to their bad experience with hospitals or other services professionals.
These four aspects make the supply of healthcare much more complicated than typical scenarios. However, there are several ways to enhance healthcare providers’ ability to reach out to specific groups. Communication is the key. The interaction between service providers and homeless people should occur regularly and frequently. Coordination rather than forcing them to get the service without assistance is essential. Moreover, programs should aggressively seek out homeless people instead of waiting for them to appear.
Development of healthcare service model
Since the 1980s, several healthcare service program models were developed that proved to be effective. The shelter-based clinic is one of the oldest and most popular models, an on-site clinic at shelter locations, targeting a single cluster of sheltered groups. Healthcare services in day programs are similar to the shelter-based clinic; however, sitting in a place independent from where homeless people live. St. Francis House in Boston is an excellent example of this model. Described as a “shopping mall of services to the homeless,” various mental health and vocational guidance services and a health clinic are provided in a single building. Free-standing clinics, funded by individuals, churches, and small grantors, provide health care services to the homeless and poor with dignity and a short waiting time. Also, there are some specialized health care approaches like respite and convalescent care, residential placement.
Student-run homeless clinic and mobile clinic
Started in 1990, the Student-Run Homeless Clinic(SRHC) from David Geffen School of Medicine at UCLA provided free medical care to people who are experiencing homelessness. Since then, more than 600 patients have been served by SRHC at different clinic sites across Southern California every year. These clinics are community-based, and the service includes preventive health, physical screening exams, urgent care, chronic disease management, wound, foot care, immunizations, referrals, and mental health evaluation.
In addition, the Mobile Clinic Project(MCP) is a sister organization to SRHC. The critical component of the MCP is the UCLA undergraduate community. This project’s students can gain excellent firsthand experience in community-based primary care in a rich learning environment.
These clinic organizations and projects can provide the community with healthcare support and bring the vision of inequality in healthcare to the students, leading to a more significant change in the future. Also, suppose the community-based shelter or supportive housing program can work closely with these clinics. In that case, they can be better at categorizing groups of homeless people based on their mental health condition or behavioral conditions and screening people for the infection of COVID 19.
COVID 19 has caused a great number of infections and death worldwide, especially for unsheltered individuals and older homeless people. The pandemic exacerbated the inequality in healthcare facilities’ distribution and put the senior homeless group in severe danger. Therefore, to help people experiencing homelessness, short-term and long-term approaches need to be thoughtfully considered, and communication and collaboration among different social groups should be well conducted.
In the short term, local authorities and healthcare service providers need to give fast and effective control of the virus’s transmission. The measures include not limited to following CDC’s guidance for facilities layout, ventilation instructions, “whole community” approaches, distribution of hygiene supplies, etc., and providing timely training to staff concerning screening protocols and fast reaction to emergencies. Besides, innovations in utilizing vacant public resources to help people in need should be encouraged, such as using public transit as a resource center to assist homeless people in finding shelters nearby.
In the long term, the government, homeless service providers and other non-profit organizations need to cooperate closely to solve the systematic problems for homeless people, like lack of access to housing support or medical support. There are quite a few excellent affordable housing projects built in Los Angeles, which shows that the design of physical space can massively improve the safety and life quality of low-income and unhoused people. On the other hand, several healthcare service program models were developed and proven effective since the 1980s. in addition, many institutes like UCLA started student-run homeless clinics and mobile clinics which not only provide support to homeless people in community, but also give the medical students opportunities to gain the first-handed information and a vision of the living situation of homeless people.
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