Case Study

It is November 2022 and COVID-19 is on the rise in Toronto. As winter approaches, many homeless people find housing in congregate living settings such as shelters, drop-in centres, and group homes. You are a public health nurse responsible for working to reduce COVID-19 transmissions and outbreaks in congregate living settings. Your role is to provide information to the public, assist with outbreak investigations, follow up with confirmed cases, and provide infection prevention and control education and services to mitigate outbreaks.

You conduct an on-site visit to assess the infection prevention and control measures at a shelter for men. You find out that due to COVID-19, the shelter remains open to current residents but is not accepting new residents for long-term (up to four months) stays. The shelter supports homeless or impoverished individuals and accepts individuals with mental health illnesses and addictions as well. The shelter has suspended its regular daily drop-in medical clinic hours due to COVID-19. However, there is a Registered Nurse that visits once a week.

When you assess the physical space, you realize that 30 men share one room filled with bunk beds. There is only one washroom facility shared amongst all the residents and it includes two showers, four bathroom stalls, and four sinks. There is a shared cafeteria, and you can see many residents roaming around this open area, sitting wherever they please. As you tour around the facility, you realize that none of the residents are wearing masks. The staff states, “Because this is their home, it is not realistic to require them to wear masks 24/7”. You observe that there are no posters raising awareness on Covid-19 or signages regarding the proper infection prevention and control measures. One staff member informs you that many of the residents ripped down the posters as they believe the virus to be a hoax. Another shelter staff confirms that some of the residents have poor literacy skills or language barriers and are unable to understand the posters. The staff inform you that almost all the residents are unemployed or receive disability checks.