Vital Times 2020 - 72

GLOBAL HEALTH

Physicians Can Play Meaningful Role
in Combating County's Homeless
Public Health Crisis, a Crisis
Made Worse by COVID-19
Paul Yost, MD, FAAP, FASA

M

ost Californians
associate beautiful
Orange County
with its wealthy enclaves,
stunning beaches, and ritzy
shopping outlets. But there
is another side of Orange
County - one that includes
sickness, suffering, and
death.
In 2018, 210 people experiencing homelessness
died in Orange County, a pattern that appears to
be worsening. Toward the end of 2019, prior to the
outbreak of COVID-19, approximately 25 homeless
individuals died per month. Since then, more than
30 individuals experiencing homelessness have died
per month. An estimated 43 percent of deaths of this
population are attributed to " natural causes, " meaning
that more than half may be preventable.
Many in our homeless population are vulnerable, and
include individuals with mental illness, women fleeing
domestic violence, LGBT youth, immigrants, and the
elderly. That vulnerability, coupled with exposure to
the elements and lack of stable housing, complicates
health needs, and exacerbates the challenges in
meeting those needs. Add an infectious disease
pandemic, and this population becomes even more at
risk for early death and disease.

72 |

CSA Vital Times

Orange County has enacted an aggressive testing,
quarantine, and contract tracing effort which has, so
far, blunted the expected COVID-19 health catastrophe
among this at-risk population many have predicted. At
the state level, Governor Newsom enacted emergency
actions to provide funding, purchase trailers, lease
hotel rooms, and halt evictions. But we must not think
this problem is being solved - as healthcare providers
on the front lines, we must redouble our efforts
as part of the care continuum for this population,
and help advocate for long-term funding, increased
housing options, and sustained increases in social
services. Even after the COVID crisis has waned, we
should continue these programs and maintain this
urgent focus on public health improvements for those
experiencing homelessness.
The official Point in Time count from January 2019
revealed there were 6,800 individuals experiencing
homelessness in Orange County. Our data at
CalOptima showed that around 10,000 individuals
at some time during the past year experienced
homelessness. State forecasts of the economic
impact from COVID-19 are showing the population
of people in Orange County who will fall below the
income limit, and who will qualify for Medi-Cal health
benefits, will increase dramatically over the next
year, and the population of people experiencing
homelessness is going to rise.



Vital Times 2020

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