NEW YORK (REUTERS) - Dexter Johnson often comes to the Bowery Mission to get a free meal, having struggled off and on with homelessness, but the 33-year-old New Yorker is thinking twice about sitting down in the crowded cafeteria and risking exposure to novel coronavirus.
Johnson, one of an estimated 550,000 people to go homeless on any given night in the United States, is worried crowds at the lunch service could expose him to a virus that has no vaccine.
"This is the type of thing where you need to stay away from other people," he said from the Bowery Mission dining room, where volunteers have hung posters detailing ways to avoid catching or spreading the virus. "That's hard to do."
As known cases of COVID-19 in the United States quickly multiply, homeless people and their advocates are preparing for an outbreak in a population more susceptible to illness and with no way to isolate or recover at home.
Shelters and healthcare providers from Los Angeles to Boston are attempting to erect quarantine zones and purchase protective gear to stop the virus from spreading to the roughly 1 per cent of Americans who are homeless at some point in a given year.
But finding the space and the budget for even basic safeguards recommended by the Centres for Disease Control and Prevention - washing hands regularly and waiting out a potential illness in private - will be a complex undertaking when it comes to the homeless, advocates and health experts say.
"In a shelter system that is already bursting at the seams, the ability to isolate and quarantine people and families is going to be very difficult and very expensive," said Aine Duggan, president of homeless advocacy group Partnership for the Homeless in New York.
New York City, Boston and Washington, D.C. have the highest rates of men, women and children in shelters, while West Coast cities have the largest overall number of homeless people, according to a White House report from last September.
About 65 per cent of homeless people, many of them children, sleep in shelters and roughly 35 per cent live on the streets.
"As we've seen with tuberculosis, norovirus, and so many others, infections spread really quickly through the shelter system," said Dr. Jessie Gaeta, chief medical officer of Boston Health Care for the Homeless Programme (BHCHP).
Homeless people also suffer disproportionately from chronic health disorders, including heart and lung disease as well as diabetes, that make them uniquely vulnerable to respiratory viral infections like COVID-19, Gaeta said.
The homeless are more likely to contract illnesses in part because of weakened immune systems due to additional stress, lacking nutrition and sleep. Unsanitary living on the streets, where restrooms are limited, pose additional risks.
Los Angeles' Union Rescue Mission, which has beds for about 1,200 men, women and children at its 24 shelters, has turned its gymnasium into a quarantine zone for unsheltered people to go if they have a fever or other symptoms linked to COVID-19.
"Somebody who gets this and is alone on the streets will really suffer," said Union Rescue Mission Chief Executive Officer Andy Bales.
The shelter has also stepped up cleaning efforts to nine times a day and added hot-water hand washing stations outside of its buildings.
San Francisco officials this week said the city would set up recreational vehicles and other temporary housing to isolate homeless people with potential exposure to the virus.
While there is no indication the virus has reached homeless shelters or encampments, it has already started to curtail the number of volunteers at food banks and shelters in Texas, New York and elsewhere.
Founded in 1879, the Bowery Mission on New York's Lower East Side provides food, medical services and employment assistance to the working poor and homeless men women and children.
Many volunteers for the Mission's meal services have cancelled since the shelter's corporate sponsors began telling employees to work from home and avoid crowded areas, said James Winans, who heads the 370-bed shelter network, one of the oldest in the nation.
Cecil Barrow, who dines at the Bowery, said the new virus is just another hardship homeless people like him regularly endure.
"The homeless are treated like we already have a virus, and most people probably wouldn't care if we do," said Barrow, 66.