Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics

Guise, Andy; Burridge, Stan; Annand, P.J.; Burrows, Martin; Platt, Lucy; D. Rathod, Sujit; Hosseini, Paniz; Cornes, Michelle

Abstract

High rates of COVID-19 infections and deaths amongst people who are homeless in London, UK were feared. Rates
however stayed much lower than expected throughout 2020; an experience that compares to other settings
globally. This study sought a community level perspective to explore this rate of infections, and through this
explore relationships between COVID-19 and existing health inequalities. Analyses are reported from ongoing
qualitative studies on COVID-19 and homeless health service evaluation in London, UK. Repeated in-depth
telephone interviews were implemented with people experiencing homelessness in London (n¼17; 32 interviews in total) as well as street outreach workers, nurses and hostel staff (n¼10) from September 2020 to early
2021. Thematic analysis generated three themes to explore peoples’ experiences of, and perspectives on, low
infections: people experiencing homelessness following, creating and breaking social distancing and hygiene
measures; social distancing in the form of social exclusion as a long-running feature of life; and a narrative of
‘street immunity’ resulting from harsh living conditions. Further study is needed to understand how these factors
combine to prevent COVID-19 and how they relate to different experiences of homelessness. This community
perspective can ensure that emerging narratives of COVID-19 prevention success don’t ignore longer running
causes of homelessness and reinforce stigmatising notions of people who are homeless as lacking agency. Our
findings aid theorisation of how health inequalities shape pandemic progression: severe exclusion may substantially delay epidemics in some communities, although with considerable other non-COVID-19 impacts.

Citation

Guise, A., Burridge, S., Annand, P., Burrows, M., Platt, L., D. Rathod, S., …Cornes, M. (2022). Why were COVID-19 infections lower than expected amongst people who are homeless in London, UK in 2020? Exploring community perspectives and the multiple pathways of health inequalities in pandemics. #Journal not on list, 2, https://doi.org/10.1016/j.ssmqr.2021.100038

• Journal Article Type: Article
• Acceptance Date: Dec 31, 2021
• Online Publication Date: Dec 31, 2021
• Publication Date: Jan 3, 2022
• Deposit Date: Feb 21, 2024
• Publicly Available Date: Feb 23, 2024
• Journal: SSM - Qualitative Research in Health
• Peer Reviewed: Peer Reviewed
• Volume: 2
• DOI: https://doi.org/10.1016/j.ssmqr.2021.100038