Protecting rough sleepers during the pandemic
UCL research and guidance informed England’s largest ever health-led action on homelessness, preventing 20,000 COVID-19 infections during the pandemic’s first wave and housing 33,000 vulnerable people
28 April 2022
Homeless people sadly die younger than the general population. Research carried out by Professor Andrew Hayward and Dr Al Story at the UCL Collaborative Centre for Inclusion Health (CCIH) has shown that this group is eight to 12 times more likely than the general population to die prematurely, particularly from chronic cardiovascular and respiratory diseases.
This inequality took on new urgency during the global pandemic, when evidence emerged that death rates were much higher among COVID-19 patients with these same underlying chronic diseases. Drawing on their existing research data, CCIH modelling exposed how vulnerable homeless people were to COVID-19, not only because of underlying disease but also their high risk of catching respiratory infections from shared sleeping spaces within homeless night shelters and communal hostels.
Drawing up a national plan
CCIH researchers worked with NHS England, Public Health England, the Greater London Authority and government to draft a national plan for dealing with the impending crisis. This strongly recommended closing night shelters, providing safe single-room, ensuite accommodation and prioritising the clinically vulnerable for specialist health and care support. It also proposed active surveillance, outreach testing and triage programmes in homeless hostels and emergency hotels, and isolation of suspected or confirmed cases in dedicated facilities.
The plan was incorporated into the ‘Everyone In’ campaign, the UK’s national response to supporting the homeless during lockdown, and the largest single homelessness and rough sleeping initiative ever implemented in the UK. By mid-April 2020, 5,400 people – 90% of those sleeping rough at the time – had been offered emergency accommodation and by the end of November 2020 this figure had reached 33,139 people.
Infections prevented and lives saved
During the first wave of the pandemic the UK recorded only 16 COVID-19 deaths among homeless people, and a UCL model estimates that it prevented 20,000 infections and 266 deaths. Hayward and Story used this model to advocate for communal shelters remaining closed in the second wave. Everyone In not only saved lives but showed that with the right resourcing and coordination it was possible for rough sleeping to be ended within a very short time frame.
UCL staff also worked closely with the London Homeless Health Emergency Planning group as advisors during the pandemic. They designed and initiated real-time online reporting of suspected cases across London’s homeless accommodation facilities to enable clinical triage and target outreach teams of nurses and peers to find and test suspected cases and contacts. They also developed a comprehensive health needs assessment tool which helped thousands of homeless people access specialist accommodation for those with clinical vulnerabilities, register with a GP, and receive COVID-19 vaccination through targeted outreach teams.
Baroness Louise Casey, Chair of the Government’s Rough Sleeping Taskforce, said: "[Prof Hayward and Dr Story’s] use of emerging information on the transmission of COVID-19 in communal facilities helped me to make the case that everybody needed an opportunity to self-isolate from the virus. Their research therefore helped to make a convincing case for the need for an urgent housing and health response.”
The CCIH research team also included Professor Robert Aldridge, Dr Binta Sultan, Serena Luchenski and Dan Lewer.
Everyone In: Saving lives by shaping the health and housing response to COVID-19
UCL research and guidance has informed England’s largest ever health-led action on homelessness, preventing 20,000 COVID-19 infections during the pandemic’s first wave and housing 33,000 vulnerable people in safe accommodation – transforming the UK’s rough sleeping problem within a few weeks. The research has been critical to homeless COVID-19 surveillance, outreach testing, triage and care across London, saving many lives.
- Professor Andrew Hayward’s academic profile
- Dr Al Story’s academic profile
- Professor Robert Aldridge’s academic profile
- Dr Binta Sultan’s academic profile
- Serena Luchenski’s academic profile
- Dan Lewer’s academic profile
- UCL Collaborative Centre for Inclusion Health (CCIH)
- UCL Institute of Epidemiology and Health Care
- UCL Faculty of Population Health Sciences
- UCL Faculty of Population Health Sciences REF 2021
- Image credit: Getty / Christopher Furlong