Placeless and powerless: Experiences of patients who are homeless and healthcare workers caring for them during COVID-19

Context: COVID-19 has posed unique challenges for people experiencing homelessness, who often live in congregate settings and cannot easily follow public health directives like social distancing. Responding to COVID-19 has also taken a psychological toll on frontline healthcare workers. Objective: This study aimed to explore the experiences of people experiencing homelessness and the healthcare workers who cared for them during the early COVID-19 pandemic. Study Design: Qualitative inquiry using a constructivist, interview-based approach and reflexive thematic analysis. Setting: An inner-city hospital in Toronto, Ontario. Population studied: 1) Shelter residents tested for COVID-19 during mobile outreach and 2) Healthcare workers in the COVID-19 testing centre and emergency department who interacted with people experiencing homelessness. Results: Three cross-cutting themes were generated: 1) A collective feeling of ‘Navigating the Unknown’ wherein healthcare workers were challenged with providing a frontline response to a novel virus amidst continuously evolving public health guidelines and patients faced uncertainty about te sting and isolation protocols; 2) A sense of ‘Placelessness’ among patients who were often left with nowhere to go early in the pandemic, unable to return to their shelters because they were awaiting test results or had tested positive and thus needed to stay in impromptu encampment spaces in the ED; and 3) A feeling of ‘Powerlessness’ among patients who lacked agency in their placelessness and among healthcare workers who lacked control in the care they were able to provide. Overall, participants conveyed that COVID-19 exacerbated the vulnerability and displacement of patients experiencing homelessness due to reduced access to public spaces and lack of isolation options early in the pandemic. Witnessing this displacement, and attempting to care for this population amidst resource constraints, led to