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The homeless have been identified as a population vulnerable to the spread of COVID-19 1 , along with groups such as the elderly and those in nursing homes. Homelessness presents a particular set of challenges to the containment of COVID-19. Homeless people move from place to place and often work in the informal economy. They also may not have regular access to showering facilities or hygiene supplies which could facilitate transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many have poor nutritional and medical statuses and face barriers accessing healthcare. Homeless populations already have higher risks of infectious diseases such as tuberculosis, hepatitis C and HIV and higher mortality rates overall 2 .
Singapore has a population density of 7,866 per square kilometer 3 , one of the highest in the world. Such high density favours the spread of the SARS-CoV-2 virus. A study by Ng KH 4 on the homeless in Singapore estimated there to be 1000 homeless people in the city-state of 5.7million people 3 . Homelessness was found in most parts of Singapore with the highest concentrations around the city-centre. Most of the homeless people were older Chinese men. This is concerning as evidence suggests that men are more likely than women to suffer serious consequences from COVID-19 5 .
In Singapore, social challenges are largely managed by the Ministry of Social and Family Homeless populations have always been a part of urban city life. The COVID-19 pandemic has in fact exposed societal fault lines and raised greater awareness about the vulnerabilities and issues faced by this population. Societies, along with their governments, have to rally more resources to support the homeless. Failure to adequately shelter and accommodate homeless persons could lead to COVID-19 outbreaks that would be difficult to contain and track due to the nomadic nature of these persons. Homeless persons who contract COVID-19 may also present late in the disease course, rendering containment and treatment efforts more challenging 7 . Protecting homeless populations has to be part of a comprehensive strategy to contain COVID-19 in any city and requires a multi-pronged and multi-agency approach.