Homelessness, COVID-19, and discourses of contagion☆

**Background:** When the COVID-19 pandemic began in Canada in March 2020, public health authorities quickly identified emergency shelters and people experiencing homelessness as particularly at risk of contracting and spreading the virus. This study explores how discourses of contagion and infection were negotiated by people who worked in and accessed organizations serving people experiencing homelessness in Ottawa, Ontario, Canada. The research is informed by Goffman's (1963) theory of social stigma and Crawford's (1994) concept of the Self and unhealthy Other, examining how people experiencing homelessness were discursively marked as dangerous vectors of infection rather than as vulnerable to the health consequences of COVID-19.

**Methods:** From March to September 2021, the researchers conducted virtual interviews with 20 service providers who worked directly with people experiencing homelessness and 8 key informants from management roles with broad cross-sector knowledge on homelessness and COVID-19 in Ottawa. They also conducted a media scan of 71 Ottawa and Canadian news articles about homelessness and COVID-19 published from March 2020 to October 2021. Interviews lasted from 15 minutes to 1.5 hours. Thematic analysis was conducted using a provisional approach to coding, followed by axial and theoretical coding. Media articles were analyzed using Fairclough's intertextual analysis method as described by Huckin (1997). Ethical approval was received from two institutional review boards in Ottawa.

**Key Results:** Three main themes emerged from the analysis. First, 'identity work in COVID-19' revealed that people experiencing homelessness were positioned as a public health risk to the population rather than as an at-risk population. One media article quoted a city councillor who referred to people experiencing homelessness as "overdosing," "committing petty crime," and having "erratic behavior in our community." Service providers reported being asked by community members if it was "safe" to work with their clients, and one key informant described being verbally harassed after news of shelter outbreaks broke. Neighborhood residents protested the opening of an isolation center, expressing concern about its impact on the neighborhood. Second, 'individualization of risk and inevitability of spread' showed how service users internalized blame, with one service provider noting clients stated they were "the cause of the pandemic." A CBC News article described spread in shelters as "inevitable," and in January 2021, four Ottawa emergency shelters closed due to outbreaks resulting in 286 cases and one death. Service providers described being caught "between a rock and a hard place," having to choose between putting someone outside to potentially freeze or letting them sleep 12 inches from someone else and potentially spread COVID-19. Third, 'dehumanizing responses' described how people experiencing homelessness were moved from shelters to other places without complete information, causing them to feel unsafe and insecure. One key informant noted service users in isolation centers were being treated like "sewer rats." Service providers described clients' fear of dying alone, with one provider discovering a client had died after losing contact, noting "a lot of our clients share their biggest fear is dying alone and no one knowing."

**Clinical Implications:** The findings demonstrate that public health responses focused on individual responsibility failed to address the most significant risk factor facing people experiencing homelessness—the absence of a safe and secure home. The authors advocate for integrating trauma- and violence-informed care (TVIC) principles into public health responses, including trustworthiness and transparency, safety, peer support, collaboration and mutuality, empowerment and choice, and consideration of cultural, historical, and gender issues. Public health decisions must balance physical distancing with maintaining social connection and community care to avoid further traumatizing people experiencing homelessness. The authors recommend that public health decisions be made in collaboration with members of at-risk communities, service providers, and advocates to foster compassion rather than stigmatization.