Searching for the Uncounted

Researchers are attempting to figure out exactly how many Americans were affected by COVID-19 as decreasing infection rates and increasing vaccine administration sweep across the country. But nationwide, COVID-related deaths among the homeless population remain uncounted.

And this problem existed long before COVID-19.

Homeless deaths are only counted at a local level and so far never on a national level. According to Tom Murphy from the National Alliance to End Homelessness, local organizations gather together to hold homeless vigils each year to mourn the loss of individuals apart of the unhoused community.

"We don't know the number. But that would be a powerful statistic to have," said Murphy.

Why isn't the number of deaths among the unhoused community recorded? University of Washington doctoral student Matt Fowle said most death certificates, hospital records, and other important documents do not list housing status.

According to the National Healthcare for the Homeless Council, areas with large homeless populations like Los Angeles, San Francisco, Denver, New York City, Philadelphia, etc. conduct annual or biannual reviews of homeless deaths by medical examiner offices.

But the number of communities actually keeping track is small and far between.

So how do we find homeless individuals that died each year? Researchers and organizations like the National Alliance to End Homelessness are still trying to figure that out.

"We are unsure of a methodology that is sound. That is something we are trying to research," Murphy said.

According to a report performed by the National Healthcare for the Homeless Council, achieving a universal methodology for a national count of homeless deaths would require a brand new system for data entry.

"Medical examiners’ documentation is relatively consistent, but data systems with the information are often owned by local jurisdictions, resulting in data inconsistencies," the report said.

Fowle is one of the first to start keeping a database on homeless mortality in the United States. His current methodology is to collect numbers through local news reports and public records requests from 18 cities/counties public health departments.

In Fowle's quest to make a database showcasing the homeless mortality, he came across several roadblocks. Turning to public health departments could lead to a dead-end since most official documents do not list housing status.

"I think a lot of places just don't record. They just aren't recording housing status," Fowle said.

But Murphy and Fowle believe finding the number is possible. Unfortunately, finding the correct methodology is proving to be complicated.

One methodology to collect the data is to comb through all the local coroner's offices to get an official county from each state's county. Without a team, that process could take months, if not a year, to fully get the data. This also relies on the public health departments in the county listing the housing status on the official records.

Fowle suggested that in order for researchers to get sound data, they should attempt to reach out to different shelters to track people's resident records to determine whether they were homeless that year.

"When you think about homelessness, it's often episodic," said Fowle. "Most people do not remain homeless for an extended period of time."

As of right now, there is no one-track method for finding how many homeless individuals died each year. But Fowle believes the first step is connecting with the community and figuring out who suffered from homelessness. Then, it should be easier to track to see how many were affected by COVID-19.

While this lack of data means that we might not ever know the true toll that COVID-19 took on the homeless community, it does raise awareness on the lack data reporting.