COVID-19 and health care disparities: Innovative ways to meet the dermatologic needs of patients experiencing homelessness
Authors: Samantha M. Guhan, Neera R. Nathan, Haya Raef, Margaret Cavanaugh-Hussey, Jennifer K. Tan
Journal: Journal of the American Academy of Dermatology (2020)

To the Editor: The coronavirus disease 2019 (COVID-19) pandemic has affected every aspect of global society. The homeless population in the United States, which included 568,000 Americans on any given day in 2019,1Henry M. Watt R. Mahathey A. Ouellette J. Sitler A. Abt AssociatesThe 2019 Annual Homeless Assessment Report (AHAR) to Congress.https://www.huduser.gov/portal/sites/default/files/pdf/2019-AHAR-Part-1.pdfGoogle Scholar is disproportionately affected by this crisis and faces unique obstacles to combating the spread of disease.2Mosites E. Parker E.M. Clarke K.E.N. et al.Assessment of SARS-CoV-2 infection prevalence in homeless shelters - four U.S. cities, March 27-April 15, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 521-522Crossref PubMed Google Scholar People experiencing homelessness have limited access to resources necessary to prevent severe acute respiratory syndrome coronavirus 2. Guidelines to slow transmission, including social distancing and frequent handwashing, inherently present barriers to individuals who shelter in congregate settings and are often unable to procure face masks, soap, or hand sanitizer. Many people experiencing homelessness are also older adults from socially disadvantaged minority populations, who data suggest are at increased risk of COVID-19 mortality.1Henry M. Watt R. Mahathey A. Ouellette J. Sitler A. Abt AssociatesThe 2019 Annual Homeless Assessment Report (AHAR) to Congress.https://www.huduser.gov/portal/sites/default/files/pdf/2019-AHAR-Part-1.pdfGoogle Scholar,3Shah M. Sachdeva M. Dodiuk-Gad R.P. COVID-19 and racial disparities.J Am Acad Dermatol. 2020; 83: e35Abstract Full Text Full Text PDF PubMed Scopus (110) Google Scholar The medical community has taken multiple steps to increase access to care for this vulnerable population, such as creating facilities that offer isolation and treatment for people experiencing homelessness who have COVID-19. We hypothesized that dermatologists can further aid this population by mobilizing critical supplies commonly found in their offices and using the generosity of local companies to create COVID-19 care kits, which contain items necessary to protect people experiencing homelessness from disease. Goals of distribution included not only increased access to basic hygienic products but also acknowledgment of our common humanity during a time of crisis. Before supply collection, local shelters were contacted to identify the most useful items to patients. As dermatologists, we were especially well positioned to obtain products such as soap and hand sanitizer because of preexisting relationships with skin care companies. Local volunteers contributed face masks and donors provided additional funds for entertainment items, COVID-19 safety brochures, and packaging. The final kits contained soap, hand sanitizer, moisturizer, dental care products, puzzles, headphones, a COVID-19 informational pamphlet, and other personal hygiene items (Fig 1). To minimize the number of people in contact with patients, kits were delivered to a contact person at each shelter, who later distributed the kits. The success of this endeavor was measured by the number of kits distributed to local shelters. Greater than 1000 kits were assembled between March and June. This program is sustainable through the generosity of skin care companies, fund-raising efforts, and the incorporation of staff and trainees into the collection and assembly process. Limitations include distribution to a single geographic area and variation in supply of donated items. Building on relationships we already have as dermatologists, we were able to create a COVID-19 kit donation program that provided people experiencing homelessness with necessary supplies to minimize the spread of disease. In the post–COVID-19 era, this effort will be expanded to involve the assembly of kits containing over-the-counter products to treat common skin conditions, including acne, atopic dermatitis, and xerosis. We propose a call to action for the dermatology community to create similar programs to aid this critically marginalized population. To identify a clinic or shelter with which to partner, the following resources may be useful: National Health Care for the Homeless Council Respite and Grantee directories (http://www.nhchc.org), http://www.findahealthcenter.hrsa.gov, and http://www.homelessshelterdirectory.org.