From the outside it still looks like any other budget hotel, with a bland corporate frontage and rows of small square windows. But its 80 rooms have been transformed by a NHS homeless outreach team and Médecins Sans Frontières into the UK’s only treatment centre for rough sleepers with coronavirus.
In room 116, former rough sleeper Paresh Shah is completing the final hours of his self-isolation. He was admitted to the east London facility 15 days ago, after testing positive for the virus. “I was glad I was brought in,” says the 55-year-old. “I must have picked it up when we were moved out of our night shelter. There was a drunk bloke splitting all over the pavement and it could easily have been him.”
Public health consultant, Al Story, who runs an London-wide NHS outreach service for rough sleepers with TB, set up the facility three weeks ago because he was worried about a potentially explosive coronavirus outbreak. “The reality is the average age of death on the streets is 45 for men and 43 for women,” he says. “If they get a whiff of Covid, they’re on a fast track to a very poor clinical outcome.”
Story, who is based at University College London Hospital, chose the hotel because its basic facilities made it easy to clean. “It is perfect for infection control,” he says. “It’s well ventilated. There’s no carpets. There are no soft furnishings other than the mattress.”
So far nearly 40 homeless people have been treated, with more expected in the coming weeks as the facility starts to take homeless patients with Covid-19 directly from A&E departments in London. “Many of the people we support would be in hospital if we didn’t exist, because they have got nowhere else to go. We are also regularly observing them throughout the day and night as well as tending to all their health needs,” he says. Those in need of ventilation are sent on to hospital, with two going in the past three weeks.
The facility, known as Covid Care, is jointly run by MSF, in its first-ever deployment in the UK. The international humanitarian organisation primarily works in war zones and natural disasters in the developing world, but realised it had the capacity to help protect one of the UK most marginalised groups. “It is in our DNA to provide emergency lifesaving medical support,” says Rosamund Southgate, MSF’s UK medical coordinator. “Our overseas field projects remain our priority, but we saw vulnerable people being affected by the coronavirus outbreak in the UK.”
The rent is being covered by the Greater London authority, with the NHS and MSF meeting their own staffing costs. MSF has provided 10 nurses, as well as logistical support to turn the hotel into a treatment facility in just 24 hours. “What we bring from our experience in outbreaks and emergencies is that we can respond rapidly,” she says. The charity, which also hopes to help care homes in the north of England, has also deployed medics for the first time in coronavirus hotspots in other developed countries, including France and Spain. “We are deploying in these countries for the first time because of the unprecedented crisis we are facing,” she adds.
Exclusive figures from the UCL Collaborative Centre for Inclusion Health, seen by the Guardian, show that those living in London’s homeless hostels are 15 times more likely to die from Covid-19 than the rest of the working-age population. The centre, which researches health inequalities, has identified at least three suspected coronavirus deaths in hostels since March, with a third of hostels reporting suspected coronavirus cases.
There are an estimated 11,000 rough sleepers in England. More than 5,400 rough sleepers known to councils have been offered accommodation since March but there are still more than 35,000 homeless people living in hostels across the UK. Forthcoming UCL modelling indicates that more than one-third of the hostel and street homeless population could get Covid-19 without intensive infection controls. This could lead to 4,000 hospital admissions and 364 deaths by August.
“Hostels are as risky as care homes and prisons,” says epidemiologist Andrew Hayward, director of UCL Collaborative Centre for Inclusion Health. “There are lots of people with chronic diseases sharing toilets, showers and communal spaces. They provide the perfect conditions for coronavirus outbreaks.”
Another patient at the hotel fell ill while living in a crowded hostel in Shepherd’s Bush, west London. “I tried to self-isolate in my room because I’ve had pneumonia,” says Luke Donnelly, 39. “But I had to run the gauntlet to get my dinner every day by queuing up at a hotplate with 30 or 40 people. There were also probably about six or seven residents on my landing using the same toilet. It was a recipe for disaster.”
Still, London has managed to avoid the far larger and deadly outbreaks seen in US cities, such as New York and San Francisco. Testing by UCL’s outreach team suggests only 3-5% of rough sleepers in London are now carrying the virus. “There’s a very low rate of asymptomatic carriage in our homeless population, particularly when you compare it to the American numbers,” says Story. So far, the three UCLH outreach teams have tested nearly 500 rough sleepers, of whom 29 had the virus. From this week, they will be ramping up their testing capacity to over 100 people a day. One of the teams is led by John Gibbons, a former heroin user and hostel resident. Gibbons has referrals coming in constantly. “We go and immediately test any suspected cases. If they are positive, we take them to the care hotel,” he says. “We also contact trace and test people they have been in contact with. ”
Both Shah and Donnelly were tested and then removed from situations where they could have put others at risk. Donnelly is grateful for the care he received as he feared he would lose his life. “I was very scared,” he says. “I thought I was going to die. I was gasping for air all the time. But when I got to the hotel, the nurses were like friends, family and carers. They were brilliant.”
Yet provision outside the capital appears to be patchy. Other UK cities with high number of rough sleepers such as Liverpool, Manchester and Newcastle do not have equivalent medically run isolation facilities for homeless people and few appear to be carrying out targeted testing. Instead, rough sleepers with Covid-19 symptoms are having to self-isolate as best they can in homeless hostels or in hotels.
The lack of a nationwide Covid care network makes Hayward nervous about future waves of the virus. UCL’s modelling estimates that a second wave could lead to 22,000 homeless people getting the virus. “I’m really concerned we could see further outbreaks in hostels throughout the UK when the lockdown is eased and the transmission starts to pick up again in the wider community.”
A Ministry of Housing spokesman says: “Over 90% of rough sleepers known to councils at the beginning of this crisis have now been made offers of safe accommodation – ensuring some of the most vulnerable in society are protected from the pandemic.”
Back in the hotel, Story is watching six convalescing Covid-19 patients reading donated books on the other side of the hotel car park. He wants every part of the country to fully prepare for a potential re-emergence of the virus in the homeless population – as well as thinking about how to permanently house the people currently accommodated in empty hotels. “We’ve managed to prevent massive outbreaks among rough sleepers by quickly isolating and treating those with Covid-19. But if we kick everybody back into an environment that is completely unsafe, then we are asking for trouble,” he says. “They are the dry tinder waiting for a spark.”
