Statement in response to new UK Government guidance, 17 March 2020

Pathway is deeply worried that the guidance issued by Public Health England yesterday (16 March 2020) fails to address many of the practical concerns being raised by specialist homeless clinicians and the homeless charity sector across the country.

We are already hearing reports that following the guidance is resulting in homeless patients being told by NHS 111 and local authorities to go to A&E.  At the same time A&E colleagues in at least one central London hospital report telling people with mild symptoms to go back to the street. Homeless patients very obviously have nowhere to go and self isolation on the street is not possible!

Professional colleagues in infectious disease epidemiology and in the clinical management of homeless patients have been working on a detailed plan to look after homeless patients with compassion and care, and to avoid a serious spike in Covid 19 infections in the homeless population in London. The plan proposes rapid, active testing for Covid 19 in all London’s homeless services, separating homeless patients who test positive from those who are virus free, and setting up new emergency temporary facilities (perhaps in hotels or other currently available vacant buildings) to care separately for each group.

“Test – Triage – Cohort – Care.”

To be effective we need the NHS, homeless charity sector, local authorities and public health services to mobilise resources rapidly. Delay will increase the level of background infection and reduce the effectiveness of measures to isolate vulnerable patients.

People experiencing homelessness are a very high-risk group. Compared to the general population people experiencing homelessness are 2.5 times more likely to have asthma, 6.5 times more likely to have heart disease, 10 times more likely to have COPD and 34 times more likely to have tuberculosis. Long-term homelessness is already associated with a mortality risk 10 times that of the housed population.

Pathway’s CEO Alex Bax said: “People on the street are by definition vulnerable to infection. The homeless population has very high rates of all the conditions known to increase the serious risks of Covid 19. We need rapid, co-ordinated action across all services, underpinned by clear clinical leadership and based on a coherent plan. The Government has said resources are available. We need to see them start to flow now, and crucially this means access to testing.”