Covid-19 : Challenges for Residential Facilities

With more than 1.7 billion people confined to their homes, how can residential care centres cope with the situation?

Dianova Italy campaign

A quarantine period permitted to ensure that Dianova Italy’s centers are free of contamination: “The coronavirus must not enter here, help us keep it out!” – photo Dianova Italia, CC

By the editorial teamAs of March 27, 536,617 people worldwide have been infected since the Covid-19 outbreak, 24,119 have died from it, and every passing day these numbers are growing. The pandemic due to this novel coronavirus is wreaking havoc on a global scale and on the long run its repercussions on the social, economic, and environmental levels will be profound, but yet difficult to determine.

The most vulnerable populations face great challenges in coping with the pandemic, including people who use alcohol and other drugs. According to the UNODC Global Report 2019 on the world drug problem, 35 million people suffer from illicit drug use disorders while only 1 in 7 people receive treatment. As for the prevalence of alcohol use disorders, it is estimated that they affect about 1.4 per cent of the world’s population.

Depending on the severity of their condition and their access to health and social resources, many people with substance use disorders cycle in and out of emergency departments or residential or outpatient treatment facilities. Others have no other choice but to live in the streets and at night often end up in homeless shelters, or police and prison cells.

Although they are not those on the front line of the epidemic, residential or outpatient reception centres (addiction treatment centres, therapeutic communities, reception centres for minors, accommodation for the homeless, etc.) often find themselves powerless in the face of Covid-19 because of the specific vulnerability of their residents.

Specific vulnerability of patients

People with substance use disorders, as well as the homeless and other highly marginalized people in general, have a number of risk factors for developing Covid-19 infection.

These risk factors include having liver, heart or kidney disease, or living with HIV/AIDS. In addition, because of deteriorated socio-economic situations, they are more likely to have poor access to quality health care, and sometimes are even unable to access it.

In its acute forms, Covid-19 primarily attacks the lungs, causing respiratory distress. This is why the virus can have a significant impact on these people, especially those who use inhalation drugs. Smoking tobacco, cannabis, opiates, crack cocaine or methamphetamine can decrease lung function, thus increasing the risk of respiratory infections.

Many challenges for shelters and residential centres

All centres must now adapt their functioning in order to preserve the health of their patients and professional teams through the recommended social distancing and other prevention measures. However, this is easier said than done: the teams in the residential or outpatient centres, whatever their activities, are currently going through a very difficult period.

SPYM volunteer

Teams are often exhausted… A volunteer from the SPYM association (an associate member of Dianova, India) in front of a van providing emergency assistance to the homeless – photo: SPYM, CC

What can or should be implemented

Reception of patients: Before receiving patients, it is essential to ask them about possible symptoms: people with fever, cough or shortness of breath should be advised to stay home. They should also be asked about recent travel to areas of particular risks.

Waiting rooms if available: post signs about hygiene (wash hands, cough etiquette, single use of tissues) and social distancing (at least 1.5 metres between each person); mask and isolate sick patients.

Reorganize activities: In many treatment models, social support and connection is an important part of recovery. Addiction treatment in therapeutic communities, for example, relies on self-help peer support and discussion groups. In the face of the epidemic, it is essential to avoid bringing too many people together in one room so that they can keep their distance. Everyone must adapt

Testing patients prior to admission: Some residential centres have been able to isolate their uncontaminated patients after maintaining a quarantine period without any symptoms and by requiring their staff to take strict preventive measures. This is the case of Dianova Italy’s five facilities.


These are difficult times, which is why we must also support the work of these other healthcare professionals who are also doing essential work. Addiction counselors, street workers, educators, social workers, therapists, psychologists, doctors and support staff are committed everywhere to continue helping the most vulnerable, whether or not they are Covid-19 carriers. They do this work in often difficult conditions, with too few resources. A huge thanks to all of you for your commitment and humanity!

And in the meantime, protect yourselves, protect others!