Letters
COVID-19 precautions: easier • Regular hand washing and hygiene (and with COVID-19 are untreated in this accessing soap or sanitiser and bath- highly susceptible population, the said than done when patients rooms in order to do this) is extremely mortality risk is high.1 Moreover, many are homeless problematic if living on the street. people will not receive critical treat- • Self-isolation by staying at home if you ment for other medical conditions, feel unwell and suspect having symp- such as depot medications for psy- To the Editor: Implementation of advice toms is impossible if you do not have a chotic illness and, as articulated in a to the public and general practitioners home to live in. recently published article, “lockdowns on minimising the risk of COVID-19 • Reducing face-to-face health service and disease containment procedures exposure and transmission is immensely contact is being advocated to GPs and might also be deleterious to the mental difficult for people experiencing health services in Australia and the UK. health of people experiencing home- homelessness and for the health The Australian Government has just lessness, many of whom have fears services working with them. Yet this is announced Medicare rebates for bulk- around involuntary hospitalisation and a population group more vulnerable to billed telephone consultations,3 but incarceration”.1 infection than most.1 The elevated risk this is problematic for people who are factors for COVID-19 are substantial, as homeless without a phone. Similarly, The higher risks of COVID-19 for people people experiencing homelessness have technological solutions such as video experiencing homelessness and, conse- a much higher prevalence of comorbidity or virtual consultations are digitally quently, for those working closely with and chronic disease compared with prohibitive for people without a home them present an enormous challenge that people of the same age who are housed.2 let alone a computer. has no easy answers. As new precaution- To illustrate further, among the 4000 • Outreach health services are among ary measures are being announced daily, active patients seen by Homeless the most effective ways of enabling it is critical that further marginalisa- Healthcare (Australia’s largest specialist people who are rough sleeping to ac- tion for this group is not an unintended homelessness GP practice based in Perth), cess health care.4 Homeless Healthcare, consequence. nearly all patients have comorbidities, for example, runs clinics at drop-in Lisa J Wood1 13% have chronic respiratory conditions, centres and crisis accommodation 2 Andrew P Davies 79% smoke (associated with poorer lung settings and has nurses out on the Zana Khan3,4 health and risk) and 8% have diabetes streets each day and doing home vis- 1 University of Western Australia, Perth, WA. (associated with supressed immunity). its to those recently housed. However, 2 Homeless Healthcare, Perth, WA. There are parallel calls in Australia implementing the use of personal pro- 3 South London and Maudsley Mental Health NHS Trust, and the United Kingdom for clearer tective equipment is difficult in these London, UK. 4 Collaborative Centre for Inclusion Health, University government guidance as to how the settings, and in the absence of primary College London, London, UK. precautionary measures can be applied care outreach, emergency department [email protected] in homeless populations. There are a presentations are likely to escalate. Competing interests: No relevant disclosures. ■ myriad of challenges to this, both for • Cancelling outreach GP clinics and people who are homeless themselves other outreach services for this popu- doi: 10.5694/mja2.50571 and for those providing health care to lation to reduce exposure risks would this vulnerable population group. These have severe unintended consequences. © 2020 AMPCo Pty Ltd challenges include: If risk factors for COVID-19 or patients References are available online. ▪ 4 May 2020 8 ) ( MJA 212
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1 Tsai J, Wilson M. COVID-19: a potential public 3 Australian Government, Department of Health. 4 Davies A, Wood LJ. Homeless health care: health problem for homeless populations. Lancet Fact sheet coronavirus (COVID-19) — National meeting the challenges of providing primary Public Health 2020; https://doi.org/10.1016/ Health Plan. https://www.health.gov.au/sites/ care. Med J Aust 2018; 209: 230–234. https:// s2468-2667(20)30053-0. [Epub ahead of print] default/files/documents/2020/03/covid-19-natio www.mja.com.au/journal/2018/209/5/homel 2 Story A. Slopes and cliffs in health inequalities: nal-health-plan-primary-health-respi ratory-clini ess-health-care-meeting-chall enges-provi ding- comparative morbidity of housed and homeless cs.pdf (viewed Mar 2020). primary-care ■ people. Lancet 2013; 382: S93. MJA 212 ( 8 ) ▪ 4 May 2020
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