Rough sleepers and drug users are highly at risk from coronavirus – but the government isn’t protecting them

Of course the elderly should be a priority – but there are marginalised groups we conspicuously aren’t prioritising

Ian Hamilton
Wednesday 11 March 2020 14:08 GMT
Related video: John Healey – government is failing on homelessness
Related video: John Healey – government is failing on homelessness

Coronavirus doesn’t care if you’re rich or poor – we are all equally at risk. But the care we receive is proving less equal. As with so many things, your health outcomes are highly contingent on where you are in the social hierarchy.

So, while the government concentrates on the specific risks that older people face when they contract this virus, other high-risk groups appear conspicuously absent from official messaging. Perhaps it’s who they are that explains this silence: rough sleepers and intravenous drug users, groups whose welfare the government routinely neglects.

The growing homeless population are particularly vulnerable to coronavirus. Many will have the same physical risk factors as the elderly, including respiratory problems – a risk amplified if you are a smoker, which many homeless people are, or use drugs like heroin, which many do. Even without a coronavirus outbreak, homeless people have among the highest healthcare needs but among the poorest healthcare access. Yet this outbreak will make this group particularly vulnerable.

Those who inject drugs are another high-risk part demographic that seems to be missing from our national conversation about coronavirus. Sharing needles increases the risk of contracting a range of blood-borne viruses like hepatitis and HIV, though also quite possibly coronavirus. Reducing this risk would be simple were clean needles more readily available; unfortunately many needle exchanges have been withdrawn in budget cuts. Then there are those who regularly snort drugs like cocaine. Many will do so using rolled-up bank notes, which are known to be effective carriers of this virus, via a nasal membrane via which infections can pass relatively easily. The solution is simple: clean any surfaces where you place the drug, then use clean paper or an unused straw to snort it. Although simple, it is unlikely that any government agency will be heard offering this advice.

National emergencies bring out the best and worst in human behaviour, and coronavirus is no different. Resources will be rightly be focused on high-risk older people, but they aren’t the only parts of the population we should protect. So far it seems we have rationed our compassion, exposing our collective prejudice about who deserves care, and who we deem to have brought their ill health upon themselves. Coronavirus grimly testifies to the health inequalities we lack the political will to change.

Ian Hamilton lectures in mental health at the Department of Health Sciences, University of York

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