TORONTO -- Sanctuary Ministries Toronto is normally bustling with as many as 200 people, but nowadays it鈥檚 filled with about half a dozen staff members floating around in protective gear, and about just as many members of the city鈥檚 homeless community.

Whenever there鈥檚 a drop-in, Kathleen Smith, an outreach worker and media spokesperson for Sanctuary, usually stands just outside its doors, screening homeless individuals before they step in. This involves taking their temperature and asking if they鈥檙e showing any symptoms of the novel coronavirus.

鈥淚t鈥檚 night and day,鈥 she told CTVNews.ca over the phone on Thursday. 鈥淲e would know at least 70 per cent of the people coming in the doors before COVID 鈥 people that we had existing relationships with and who mostly hung out in our neighbourhood.

鈥淣ow, [we鈥檙e seeing] lots of new faces, lots of unfamiliar faces of people who are coming from farther away because there are just no resources in the part of the city where they normally hang out.鈥

As a result of the pandemic, the community outreach centre has had to adjust many of the services it offers. Before the outbreak, Smith recalls the organization would serve between 300 and 400 meals per week to clients who sat inside to eat. Now, the shelter packages meals in takeout containers and hands them out to those in need 鈥 as many as 600 meals a week are distributed, Smith said.

Clients are still allowed to eat their meals inside the facility as well as take showers or use the restroom, but they can only stay for 30 minutes. Only 10 clients are allowed inside at a time 鈥 five on the main floor and another five in the basement.

In a building with a dinner capacity of nearly 200 people, you won鈥檛 find more than 20 people at a time now, Smith said, including staff.

鈥淣ormally, drop-ins are a really great chance to just connect with people as human beings,鈥 Smith explained. 鈥淎t Sanctuary, we try to eat together, so the staff will eat with everybody else and just try to create a comfortable, homey atmosphere.

鈥淭hat鈥檚 just impossible right now; we have to be so careful with [physical] distancing.鈥

Not only have these measures made it difficult for people who are homeless to connect with the community around them, but measures have also made it hard to secure a space in existing shelters.

According to Smith, one of the main issues Sanctuary Ministries Toronto is facing right now is locating spots for homeless people in local shelters. She said it has been impossible to find shelter spaces nowadays, mainly due to physical distancing measures.

Sanctuary Ministries Toronto is one of several advocacy groups that have with the City of Toronto involving physical distancing standards.

Previous guidelines allowing beds to be placed less than a metre apart were revised to maintain two metres of distance, in accordance with government and public health recommendations for physical distancing.

While these new guidelines were recently put in place, Smith said there continues to be a lack of proper physical distancing in most shelters she鈥檚 aware of.

鈥楥ROWDED SETTINGS鈥 PUT HOMELESS AT RISK

The communal setting that characterizes many homeless shelters places clients at a greater risk of transmitting and contracting COVID-19, explained Dr. Sarah-Taïssir Bencharif, an emergency department doctor based in Ottawa.

鈥淲e always have a high index of suspicion for COVID-19 because our homeless patients are living in more congregate, crowded settings in homeless shelters,鈥 she told CTVNews.ca on Thursday via telephone. 鈥淔or any communicable disease, that increases the chance of both getting the disease and spreading the virus.鈥

Aklilu Wendaferew, assistant executive director of Good Shepherd Ministries, a charity for homeless people in downtown Toronto, explained that the organization has been at capacity for some time and isn鈥檛 taking any new clients.

鈥淚n terms of people that are staying in the shelter itself, [interaction] has reduced because movement is very low,鈥 he told CTVNews.ca over the phone on Thursday. 鈥淧eople don鈥檛 move out of the shelter [unless] into housing and we can鈥檛 really bring in new clients.鈥

The charity group鈥檚 Queen Street location had a 95-bed capacity prior to the COVID-19 outbreak, said Wendaferew. This has been reduced by about 50 per cent to create more physical distance between clients, with 50 beds remaining at the shelter and 45 clients moved to rooms in a hotel paid for by the City of Toronto. Wendaferew said this has greatly helped the organization better adhere to the city鈥檚 physical distancing measures.

SHELTER OUTREACH

The impact of the COVID-19 pandemic is most felt in the shelter鈥檚 outreach efforts, particularly its housing resettlement program, which provides support to former homeless people that have secured housing.

Previously, case managers would assist former homeless people in looking for a place to live, following up with them during their transition and offering support. Not only has much of this been impossible to do, but virtually any contact between case managers and clients will have to take place over a phone or computer. With many former homeless people facing a lack of resources, this makes it hard to stay in touch, explained Wendaferew.

鈥淭here鈥檚 a significantly reduced service in terms of support for people who have been housed,鈥 he said. 鈥淎 lot of former homeless people may not have a telephone or access to Wi-Fi, therefore it is a big challenge.鈥

He also points to the sense of loneliness and isolation perpetuated by the pandemic, which also presents a challenge for those who are homeless.

鈥淚nteraction, particularly in terms of [individual and group] counselling, has really decreased,鈥 he said. 鈥淔or a lot of homeless, counsellors are the only support that they have on their journey to get out of homelessness and be independent.鈥

Dr. Asha Seth is an obstetrician and gynecologist based in Toronto and a former senator. She has been working with Toronto鈥檚 homeless community since 2009 and has volunteered with Good Shepherd Ministries for the past four years. 

During the pandemic, she has spent time at the shelter handing out pre-packaged meals to vulnerable members of the community. 

Resources like food are something many of those experiencing homelessness greatly rely upon shelters for, she explained.

鈥淚 was surprised when I was serving the food鈥 and the same people would come not one, but twice, three times,鈥 she told CTVNews.ca over the phone on Thursday. 鈥淲hat they were doing was storing the food for a day or two, so they don鈥檛 have to come to the shelter. 

鈥淭hese are heartbreaking stories.鈥

PHYSICAL AND MENTAL HEALTH

With shelters like this one operating at a distance and with limited services, Seth pointed to the toll this is taking on members of the homeless population, many of which are already vulnerable.

鈥淭here鈥檚 a lot of misconception surrounding homeless people,鈥 she explained. 鈥淗omeless people have a higher prevalence of mental illness than the general population.鈥

Studies conducted in a number of Canadian cities have shown that report having a mental illness.

Not only is adequate access to mental health services a challenge for homeless populations across the country, so is access to physical health-care services, said Smith.

鈥淟iving on the street is hard on your body in a lot of different ways,鈥 she said. 鈥淧eople who are homeless are a lot less likely to be able to access consistent preventative care.鈥

Based on her work with Toronto鈥檚 homeless population, she said there is a reluctance among members towards seeking care in the first place.

鈥淧eople are afraid about how they will be treated once they enter a medical institution,鈥 she said. 鈥淲e've seen that fear makes people really resistant to wanting to get tested.

鈥淓ven if they might want to get tested for their own wellbeing [or] they want to seek treatment, they don鈥檛 really feel confident that they're going to be treated with dignity, that they're going to be given good options.鈥

Many of those enrolled in the homeless system have a number of pre-existing health conditions, including lung diseases, heart disease and diabetes, explained Bencharif. 

鈥淗aving those other diseases and illnesses makes you more susceptible to getting more sick from something like coronavirus, especially when they鈥檙e not adequately or optimally managed to begin with.鈥

Studies have also shown that are more at risk for developing more severe cases of COVID-19.

Bencharif said that the number of homeless patients she鈥檚 seen displaying symptoms consistent with COVID-19 has decreased over time, which she thinks is the result of increased testing.

鈥淓arlier on in the pandemic, we were seeing more of these patients coming into the emergency department, but it鈥檚 been my experience that in the last many weeks, testing has been done more at the level of the shelters,鈥 she explained, pointing to a mobile clinic run by Ottawa Inner City Health that is testing patients in various homeless shelters.

鈥淪o I have not seen as many now in the last few weeks in the emergency department.鈥

A shows that 93 per cent of organizations working with Canada鈥檚 homeless say reasonable access to COVID-19 testing is provided for clients who are symptomatic.

A NEED FOR HOUSING

However, even with physical distancing measures and increased testing in place, Tim Richter, president and CEO of CAEH, insists neither of these addresses the larger issue at hand 鈥 the fact that a portion of Canada鈥檚 population lacks a home.

鈥淧ublic health tells us that we should be at home, isolating鈥and] wash our hands often with access to hygiene, which are all difficult to do when you鈥檙e experiencing homelessness,鈥 he told CTVNews.ca on Thursday via telephone. 鈥淐ommunities around the country have been scrambling to set up isolation shelters [and] create [physical] distancing. 

鈥淯ltimately, the best protection from COVID-19 is a home.鈥

According to the CAEH, up to 235,000 Canadians circle through homeless shelters each year. On any given night, it can mean as many as 35,000 people are in a shelter. 

The ultimate solution lies in getting people off the streets and into affordable housing, something that can be done with changes to government policy, Richter said.

鈥淭he housing and homelessness crisis we see today is a product of policy decisions made by federal and provincial governments over 30 years,鈥 he said. 鈥淲e have to move quickly to reverse policy decisions and start making investments in housing, moving people into apartments and housing as fast as we can.鈥

He urges the launch of initiatives similar to the Canada Emergency Response Benefit (CERB) that provide temporary income support to Canadians. CERB, for example, offers $2,000 a month to eligible Canadians who have lost their source of income as a result of the COVID-19 pandemic. This includes those who have lost their jobs, become sick, or entered quarantine. Those who are eligible can apply for this benefit for up to four months.

Richter also suggests that the government seriously consider guaranteed minimum income across the country. These, he insists, should come in addition to greater investment in housing while protecting the rental housing market from financialization.

Richter predicts that if the current situation continues, the consequences for Canada鈥檚 homeless population could be more dire than they already are.

鈥淚f it continues and if there aren鈥檛 support measures put in place for lower income Canadians, then there is a very real risk that more people will return to homelessness.鈥

HELP FOR THE HOMELESS ACROSS CANADA

While advocates have criticized government and public health authorities for their slow response in supporting the nation鈥檚 homeless, the federal government has for assisting the general homeless population with physical distancing.

The City of Toronto has also focused on moving people out of congregate living situations, such as shelters, and into hotel rooms and apartments that have been bought or leased. According to Toronto鈥檚 general manager of shelter, support and housing administration, Mary-Anne Bedard, more than 2,500 people have been moved out of city shelters and into 27 different temporary sites. 

As of Tuesday, the city says have tested positive for COVID-19, with two deaths and 306 active cases.

In British Columbia, more than 500 people have been in Victoria and Vancouver into housing. The provincial government is also providing the population . In total, 3,500 phones will go to those across the province, distributed by community organizations and the Social Planning and Research Council of B.C. Providing access to Wi-Fi and equipped with a data cards, the phones are meant to increase access to supports and services no longer offered in-person due to the pandemic.

In Winnipeg, for those experiencing homelessness recently opened. Montreal Mayor Valerie Plante also announced on May 21 that the city will be .

Seth calls on all levels of the government to come forward with organizing more housing and job opportunities, as well as mental health support. She explains that the cost of housing is cheaper than leaving the homeless population vulnerable and cycling through the health-care system.

鈥淢any studies have shown that giving the homeless a stable home is cheaper than hospitalization when they get sick.鈥

The CAEH places the at about $7 billion per year.

鈥淧revention is better than the cure,鈥 she said.