“More Concerned About Mr. and Mrs. Denmark”: Coping with Pandemic Crisis at the Intersection of Homelessness and Drug Use

ABSTRACT

This article builds on fieldwork conducted during lockdown in Denmark among users of services at the intersection of homelessness and drug use. The paper bridges two distinct approaches to understanding the relation between marginalization and crisis, with one focused on the impact of “big events” on marginalized populations, and another on everyday strategies employed to survive situations of homelessness and drug use. The paper shows how past experiences of hardship became relevant for coping with pandemic crisis. It further exploreshow, through critical engagement with dominant accounts of vulnerability, research participants carved out a space for negotiating their marginality in the Danish welfare state.

KEYWORDS:

• COVID-19
• Denmark
• drug use
• homelessness
• risk
• social marginalization

Introduction

I was standing with Hus Forbi [a homeless street paper] in front of the supermarket, when apparently something came on the news, that they basically had to shut the doors. And the supermarket was empty, and then suddenly people come in like ants and begin stockpiling, and they run past me like it’s a war or something like that, right? And then I think “what’s going on?” and no one can spare a minute to look at me, and they nearly laugh at me because I’m standing there with Hus Forbi like some kind of idiot who doesn’t know a thing [Laughs]. And I didn’t, really! And then I walk back to the shelter and see that the streets are empty and people in here have gone home, and the staff were at a meeting and … it was just such a strange day (Jennie, 30, shelter resident).

In the quote above, Jennie, a homeless shelter resident with a history of drug use, recalls her first encounter with the effects of the lockdown announced in Denmark at a press meeting held in the evening of March 11 2020. The sudden context of uncertainty she describes bears resemblance to official accounts of COVID-19 of the pandemic as an “unprecedented” public health emergency (WHO 2021), and the task of identifying appropriate responses as a process of “navigating the uncharted” (Fauci et al. 2020). The quote also demonstrates how lockdown almost immediately positioned her and other unstably housed people differently to the housed majority population. While Jennie witnessed others prepare for lockdown by stockpiling for an as yet unknown period of isolation within restricted “social bubbles” in their households, she and unstably housed people had to find other ways of coping within empty urban landscapes and altered institutional landscapes of support in the Danish welfare state. Staying with the metaphor of navigation – ripe in Danish COVID-19 discourse and summed up in metaphors such as “paving the road as we drive” – as an analytical point of departure, this article examines the ways in which users of services at the intersection of homelessness and drug use coped with pandemic lockdown. As argued by Vigh, social navigation offers an “analytical optic which allows us to focus on how people move and manage within situations of social flux and change,” that is, in unsettled social terrains characterized by unpredictability and opacity (Vigh 2009:419). Jennie and other unstably housed research participants in this study were “fixed in mobility” (Jackson 2012:733). This entailed both structured mobility between the social services they relied on for assistance (Jackson 2012) and navigation through social terrains characterized by repeated crises (Vigh 2009).

The unequal distribution of harms for socially marginalized people, including virus transmission, lockdown measures, and public health guidance, have been well documented. For instance, it has been shown how people who inject drugs have experienced barriers to accessing harm reduction and treatment services (Croxford et al. 2021; Schofield et al. 2022) and are at increased risk of COVID-19 in terms of transmission, hospitalization, and recovery (Kesten et al. 2021). Among others, the risk of severe outcomes from COVID-19 infection is compounded by a higher prevalence of co-morbidities among marginalized people who use drugs (Grebely et al. 2020). In addition, the negative effects isolation may have on mental health and substance use have been documented (Kesten et al. 2021; Roe et al. 2021). Finally, research on homelessness during COVID-19 has pointed to the challenges associated with staying “at home while homeless’ (Fenley 2021:250) during lockdown. However, less work has been done on how unstably housed and people who use drugs coped with lockdown. This paper contributes to such a focus through an ethnographic examination of the everyday responses to lockdown measures in Denmark.

To support its analysis of how people at the intersection of homelessness and drug use coped with pandemic lockdown, the paper bridges two distinct approaches to understanding the relation between social marginalization and crisis. One focuses on the impact of large-scale crisis on marginalized populations, and another on the everyday strategies employed to survive situations of homelessness and drug use. On this basis, it is shown how research participants drew on past experiences of hardship to overcome the crisis of lockdown. Moreover, participants recast the collective experience of everyday survival in risk environments as a “measure of resilience” (Collins et al. 2022:3) against pandemic crisis. Their accounts, which play with official accounts of risk, at times outright resisting these, demonstrate the need for more nuanced understandings of social marginalization in relation to large-scale crises that incorporate a focus on social agency.

Background

Denmark was among the first European countries to install a national lockdown in what has been characterized as an “act fast and act with force” response (Olagnier and Mogensen 2020:10; see also Schnaider et al. 2021) supported by political consensus (Nielsen and Lindvall 2021) and overall compliance with government-issued restrictions and a high level of public trust in government responses to the pandemic (i.e. Baekgaard et al. 2020; Nielsen and Lindvall 2021). The first pandemic lockdown included schools and education facilities and public workplaces, while private employees were also encouraged to work from home, and later, the partial closure of national borders. However, social services such as drop-in centers, shelters, and drug consumption rooms were labeled “critical functions” which were to remain open during lockdown (Ministry of Social Affairs and the Interior 2020; see also Danish Health Authority 2020a, 2020b). In addition, unstably housed people and marginalized people who use drugs were singled out at the policy level as constituting a particular risk group, with reference to both somatic as well as social risks such as lifestyle factors associated with homelessness and substance use. While the organizational response of social services was guided by recommendations from the Danish Health Authority, it was up to the individual shelter, drop-in center, drug consumption room, or drug treatment center to adjust their services in accordance with the guidance they received. This led to some variation in responses. For instance, homeless shelters made restrictions on outside visitors. Drop-in centers continued serving food but to a restricted number of users or only in the form of take-away servings to be consumed elsewhere, while some shelters restricted their opening hours. Many services reduced their capacity to the most urgent functions. This meant that many housed service users were cut off from the social environments that for many made up a significant aspect of their use of services (see also Johnsen et al. 2005; Roe et al. 2021). In addition to cutbacks on service provision, social distance regulations in public space restricted access to places such as the public toilets and libraries that homeless people use to find rest or warmth, and the closure of bank branches complicated peoples’ ability to collect social benefits. Access to informal means of getting cash was likewise restricted by empty urban spaces, with no bottles to collect for deposits and few options of begging on the street or in public transportation (Nygaard-Christensen and Søgaard 2023).

At the same time, the crisis brought renewed attention to the structural vulnerabilities experienced by people at the intersection of homelessness and drug use. In the weeks following lockdown, media and policy discussions highlighted the impacts of lockdown and virus transmission on socially marginalized people. Articles described socially marginalized citizens as “particularly vulnerable” to the virus, both in terms of the risk of contracting it and of experiencing serious complications from the virus. This assessment was made with reference to the difficulties marginalized individuals would have in following the Danish Health Authority’s guidance surrounding hygiene, quarantine, and isolation, as well as to concerns that health complications among homeless populations and marginalized people who use drugs would put them at further risk (Information 2020; Nordjyske Stiftstidende 2020b; Politiken 2020; TV2 Lorry 2020). Other articles pointed to mental health issues and potential escalation of substance use as additional risk factors for socially marginalized people (Arbejderen 2020; Danmarks Radio 2020a, 2020b; Nordjyske Stiftstidende 2020a). As elsewhere, the household level emerged as a responsibilized site of protection of risk management with restricted social bubbles as new social units from which to limit possibilities for transmission (Trnka and Davies 2020). No doubt, this focus on domestic households contributed to the heightened focus on the ability of homeless individuals to respond to new public health guidance. However, in a context where the vulnerability of homeless populations to infection became linked to broader public health concerns (Parsell et al. 2023), the need for urgent solutions accelerated cross-sectoral and cross-organizational collaboration, and led to the increased influence of low-threshold services such as homeless shelters and drop-in centers on policy making (Nygaard-Christensen and Houborg 2023). This temporary breakdown of silos, which normally present an obstacle to service provision and coordination to people with complex problems in the Danish welfare state (Bjerge et al. 2020; Herold et al. 2019) led to considerable service innovation (Nygaard-Christensen et al. 2021). Among others, temporary service infrastructures emerged such as restaurants serving food to socially marginalized people, the possibility of homeless sellers of a street paper receiving medication prescribed by their doctor free-of-charge at pharmacies and staying in empty hostel rooms, and the establishment of services such as soup kitchens for those unable to visit their regular services due to restrictions. In some settings, local-level innovations contributed to alleviating more permanent structural barriers to public and private services in the short term. For instance, the setup of a local “corona bank” in one city supported service users’ ability to access social benefits as bank branches closed down. More lasting service innovation also occurred in some settings, including the initiation of outreach opioid substitution treatment which allowed people to initiate substitution treatment at homeless shelters or drop-in centers (Nygaard-Christensen and Houborg 2023; Nygaard-Christensen et al. 2021).

Methodology and ethics

Ethnographic fieldwork took place in two large Danish cities. Fieldwork was conducted by the author and a research assistant while an additional small number of interviews was conducted by a student assistant. All were familiar with the institutional settings where fieldwork occurred. Fieldwork began in early May 2020. Primary field sites were drop-in centers, homeless shelters, and a temporary soup kitchen as well as public spaces where users of services gathered, typically in the vicinity of services. In addition, field visits and interviews were made at drug consumption rooms and drug treatment centers. The primary target group of the study consisted of users and staff at these services. In total, 30 interviews with service users were conducted and 21 with staff. Users of the services described above are normally categorized as “socially marginalized people,” but it should be emphasized that their use of these services are complex, uniquely composed, and shifting (Desjarlais 2011) and were, though identified as a shared risk group for COVID-19, positioned differently to each other in relation to coping with the pandemic and its effects. Interview participants consisted of people with substance use problems and homeless or unstably housed people, with overlaps between these categories. Unstably housed people typically described themselves as “technically” or “functionally” homeless, meaning that they had their own housing but sought out social services to alleviate loneliness, anxiety, mental health issues, or substance use problems. Interviews with staff included leaders, frontline workers, a municipal official in charge of service coordination, and street-level workers.

The primary bulk of data was collected between May and August 2020 during the first pandemic wave in Denmark. However, data collection continued through February 2021. In addition to interviews, participant observation conducted at different services during the first pandemic wave made it possible to trace how guidelines and restrictions were implemented in practice and how COVID-19 was discussed by service users and staff outside of the more formal context of interview settings. Moreover, the collection of qualitative data while lockdown measures were still in place was crucial in order to avoid “post-rationalization” (Fersch et al. 2022:42) of lockdown experiences. The article thereby offers a step toward the call of Grebely et al. for more “ethnography and qualitative research which will help to better attune epidemiological indicators of COVID-19 to their social contexts” (Grebely et al. 2020:4). In many settings of course, the possibility for such data collection has been hampered by restrictions on social contact. In the context of this study, it was possible to conduct fieldwork as long as researchers adhered to the guidelines in place at different services. For instance, if the number of people in services such as drop-in centers exceeded 10 – the maximum number allowed at the onset of fieldwork – we would be the first to step out to ensure our presence did not result in others being refused entry. Ethical dilemmas relating to social distance guidelines were not always as easily resolvable, as when a woman asked to participate in an in-person interview after having self-isolated for weeks due to illness that put her at high risk of infection. When possible, we conducted interviews outside, although this meant having to further balance participants’ right to privacy in interview settings – enabled by borrowing an office to conduct interviews – and protection from potential transmission – better supported if conducted in open, but less private settings. We made sure to involve participants in such considerations and, with respect to their preferences, together agreed on the most suitable sites for each interview. In the article, pseudonyms have been used to protect the anonymity of research participants and other identifying information has been removed.

Data was coded in NVivo following the themes outlined in the interview guide and emerging themes that occurred in the process of data collection. The critical engagement with official risk categories examined in this article emerged as an unexpected but recurring theme in interviews and conversations early during data collection that we pursued with analytical attention to participants’ framing and navigation of risk, engagement with official accounts of risk categories, and social distance practices. The study has been registered with the Danish data protection agency and follows the ethical standards required by the Danish social sciences.

Coping with pandemic crisis

Socially marginalized people are often overlooked in studies of “big events” (Friedman et al. 2009:283) such as political crises and disasters (Vickery 2017; Walters and Gaillard 2014:212; Wisner 1998). As noted by Vickery, there is a dearth of scholarship on how homeless individuals are impacted by disaster (Vickery 2018). Still, it is suggested that those most affected by crises such as natural disasters or pandemics are typically those who are already “chronically marginalized” prior to the onset of crisis (Walters and Gaillard 2014:212; see also Zolopa et al. 2021). For instance, factors such as unemployment, stigmatization, health problems or lack of access to medical treatment, financial resources, or places of escape contribute to significantly unequal opportunities for, for instance, unstably housed people in crisis situations. Yet the strategies employed by marginalized citizens in order to get by during crisis situations remain understudied (Settembrino 2017). As noted by Friedman et al., there is thus a lacking focus on social agency in studies of how “big events” such as political transitions, wars, and economic crises impact on risk environments of socially marginalized citizens (Friedman et al. 2009:286).

Alongside such work, another body of research has extensively documented the strategies and resources individuals employ and mobilize to overcome everyday crises at the margins. For instance, studies have examined how the cultivation of short-term “disposable ties” support newly homeless peoples’ ability to get by after eviction (Desmond 2012:1296), how fragile alliances are mobilized among homeless people who use heroin to survive on the street (Bourgois and Schonberg 2009), and highlighted the role of informal and mutual systems of support to overcome situations of acute crisis for people living in poverty or situations of homelessness (England 2022; Mazelis 2017). Moreover, it has been shown how the relational constitution of people who use drugs in open drug scenes became crucial for their adaptive responses to drug market changes during COVID-19 (Nygaard-Christensen and Søgaard 2023). In addition to this focus on the importance of social relations to get by (Lang and Hornburg 1998), other studies have pointed to the entrepreneurial, income-generating strategies of homeless individuals who use drugs as they struggle for autonomy and self-respect (Gowan 2010). Thus, research has explored how piecing together a living at the margins entails various forms of “shadow work” such as panhandling and scavenging (Snow and Anderson 1993:159) and other forms of hustling (Dordick 1997) outside of formal economies.

To support the analysis of the coping strategies of socially marginalized people during the pandemic crisis, I aim to bridge these somewhat distinct approaches to understanding the relation between social marginalization and crisis, with one focusing on the impact of large-scale crisis on marginalized populations, and another on the strategies employed to survive everyday situations of homelessness and drug use. As noted by Johansen, “marginalization describes a process of radical othering” (Johansen 2022:406). As documented elsewhere, this might be exacerbated in contexts such as COVID-19 through “pandemic othering” (Dionne and Turkmen 2020:215) of already marginalized or stigmatized populations. Moreover, marginality might be understood to denote a position from which relation between center and margin is subject to negotiation and resistance (Green 2006; Tsing 1993). Further building from this understanding, the paper shows how lockdown enabled participants to carve out a space for engaging their marginality (Tsing 1993) in the Danish welfare state. Thus, it further adds to a small body of research that has touched on the ways in which past experiences of hardship might be mobilized as survival strategies to overcome adversity as people endure life on the street (P. Higate 2000, P. R. Higate 2000), after release from prison (Kolind 1999), or in risk environments (Mokos 2017; Nygaard-Christensen and Pedersen 2020). This enables an understanding of people at the margins of the welfare state as more than passive targets of official risk management strategies. Instead, participants developed a variety of “health maintenance strategies” as they pieced together “landscapes of care” during pandemic lockdown (Stolte and Hodgetts 2015:147).

Co-producing public health measures

As fieldwork began in May 2020, practically all conversations in locations such as drop-in centers and homeless shelters, revolved around COVID-19. On one of the first days of fieldwork, a man at a drop-in center loudly insisted that we watch an old YouTube clip on his phone, in which former president Obama anticipated the future onset of a viral pandemic. As we watched it, the video appeared an uncanny prediction of the exact situation we found ourselves in at the drop-in center, where COVID-19 related public health guidance framed new practices and interaction between staff and service users. All visitors made use of disinfectant placed at the entrance, and many research participants carried hand disinfectant with them. If a drop-in center visitor forgot to cough in her elbow, it was promptly pointed out by other service users present. Handshakes had been replaced by a routine, mutual knock against elbows, and an elderly man made a fuss when he estimated that staff were positioned too closely around a table. “Two meters distance,” he objected, “that also goes for staff!” he continued, before requesting a folding ruler so that he could measure the distance between them. As such examples suggest, drop-in center visitors actively took part in regulating the space of shelters and drop-in centers according to new public health guidance.

It has been broadly described how public health guidance has unequally affected homeless people and marginalized people who use drugs (Fenley 2021; Roe et al. 2021). It has been argued that social distance regulations worked to cut homeless people unable to “isolate at home” off from the co-productive act of contributing to public health values implicated in “stay at home” regulations (Fenley 2021:246). However, as underlined by Robertson (2006:326), homeless people and people who use drugs are not cut off from engagement with large-scale crisis narratives. Instead, these might be viewed as a “shared field of public events” that draw our collective attention (Robertson 2006:302). Thus, research participants actively engaged with “globalized forms of risk” (Robertson 2006:326) and identified a range of “risk navigation strategies” (Fersch et al. 2022:36) to overcome adversity in the context of pandemic crisis. Indeed, as already noted, responsibilized social units at the household level were central in state-level risk management strategies to curb transmission. However, while many research participants in the present study were unable to isolate at home, they actively engaged in translating rules into new meaningful practices at social services. They were, in other words, far from passive recipients of new health guidance, but – as indicated in other research on health practices among homeless people living in “unhealthy spaces” – undertook considerable “health maintenance practices” (Stolte and Hodgetts 2015:147) as they responded to pandemic health risks. In a study of how people with mental illness coped with pandemic lockdown in Denmark, Jønsson et al. similarly found that Danish public health guidance that emphasized “group-belongingness and responsibility” contributed to carving out a shared national task that enabled marginalized people to perform “good bio-citizenship” in line with the majority population (Jønsson et al. 2022:304,312). As will be seen in the following, public health guidance further required individuals to establish new routines and practices that enabled them to cope with reduced support from the social environments of social services.

Reorientating everyday routines

Local-level restrictions had varied effects. At shelters and drop-in centers, restrictions led to new differentiations between the homeless and those who had their own housing. While housed/unhoused distinctions were made in accordance with new social distance regulations, they did not necessarily correspond with peoples’ everyday use of services. Comparing levels of shelter use in the Danish welfare system with the US, Benjaminsen and Andrade describe the annual prevalence of homeless shelter use in Denmark as one-third of that seen in the US and point to differences in the composition of shelter users. In Denmark, a “lower level of income poverty, a large public housing sector, and an extensive welfare system, homelessness is widely concentrated amongst groups with complex support needs due to mental illness and substance abuse problems” (Benjaminsen and Andrade 2015:873). The authors identify considerable vulnerability among episodic shelter users in Denmark, with 96.2% having mental illness or substance use problems (Benjaminsen and Andrade 2015:871). Among those cut off from services during lockdown in the present study were episodic shelter users who had their own housing but regularly made use of shelters and drop-in centers for other reasons. As they became cut off from services with almost immediate effect, lockdown necessitated a reorientation of everyday routines. Rikke, an elderly woman, lived a short distance from the city center. Before lockdown, her days followed the same pattern: in the morning, she left her apartment and headed to the city in a structured routine of circulation between several drop-in centers. Late in the evening, she would return home, exhausted, to her apartment. Another regular user of a drop-in center, Anders, described his immediate reaction to lockdown: “I was upset. I mean a week went by where I was at home a lot, and I cried once about all the people that died, and I also cried about having to be by myself so much.” Anders’ primary social contacts consisted of service users and employees at the city’s drop-in centers where he spent most of his days. At night, he sought out the comfort and sense of security he found among other people at a homeless shelter instead of in his apartment, where he felt unsafe and unable to sleep.

As described by Emma Jackson, homeless people’s mobility is often structured by the social services they frequent (Jackson 2012:725), so that mobility in itself may constitute a resource in terms of orienting access to relevant help (Jackson 2012:731). For some, particularly long-term service users, the drop-in center or shelter constitutes an anchor in an otherwise unstable life (Jackson 2012:738). While having their own apartments, Rikke and Anders made use of services in a manner that mirrored the actually homeless and were described by employees as highly dependent on the social resources offered at drop-in centers. For them, lockdown led to an abrupt break with the anchor offered by social services and the access to care, safety, or comfort these provided. However, their responses to lockdown proved to be flexible and adaptive. Anders described his immediate reaction to lockdown in the following way:

Then I said to myself, after a few days: “Now you simply man up, you man up, there is nothing else to do, and (…) you are not going to commit yourself [to the psychiatric ward], and you don’t do shit other than figure out how to deal with this situation.” And already at that time, after a few days, I could see that it could be months, and it has been really, and it might take another month before things go back to normal.

In time, Anders and others learned to cope with the increased isolation they experienced, some even pointing to positive outcomes. My first encounter with Rikke occurred at a temporary soup kitchen which enabled people with their own housing to share a meal in the company of others. “I have found calm,” she said in May, with reference to the time prior to lockdown. “I was simply run down by all my walks around the city; I slept the first two weeks. I also have an apartment to take care of. So now I need to be careful not to get back on the merry-go-round. I simply couldn’t cope with it.” Another service user, Peter, said that he had realized that he “maybe didn’t need to spend that much time with other people. That I can actually thrive in my own company.” In this way, some service users were able to restructure an everyday life previously anchored in the social life of drop-in centers and similar services.

The wish to hold on to new routines established during lockdown was a recurring theme in these accounts. As described in other examinations of homeless peoples’ use of drop-in centers and homeless shelters, these are ambivalent spaces (Johnsen et al. 2005). On the one hand, they might be associated with safety and a sense of belonging (Johnsen et al. 2005). In addition to their offer of a free meal and access to clothing, health checkups or other welfare services to cover immediate needs, drop-in centers arguably constitute crucial settings for cultivating both short- and long-term social ties to support peoples’ urgent needs. At the same time, such settings are often experienced as chaotic, insecure, and associated with the potential for conflict (Johnsen et al. 2005) as “disposable ties” (Desmond 2012:1296) wear out. Although Anders often talked about the conflicts that played out at the drop-in center which he often felt involuntarily mixed up in, he had been a daily user of the center and its night shelter over a period of several years. With the return to his own apartment during lockdown, some of the unease he experienced when spending time at the center disappeared. Mirroring the accounts of Rikke and Peter, Anders recalled finding a renewed sense of stability in the new routine he was slowly able to establish:

After a month and a half, I began to sleep longer, and I started to go to bed straight away, and it was purely and only discipline that made me go to bed, because I thought, “you need to try to sleep again,” and in the process, I also stopped being scared when I woke up, and I wasn’t feeling low either. So it’s added progress that now I go to bed and sleep between six and nine hours, and that’s a lot actually, for me. It means, it has also meant that my wellbeing improved, I feel better in my body, and I feel better psychologically, but okay, there were these 14 days where I had anxiety attacks every day. The most positive effect of this will be that I, I go home from the city at ten in the evening and sleep at home, I mean when the drop-in center closes, right?

That pandemic lockdown carried unexpected positive benefits is not unique to participants in this study, but has been reported in other social and geographical settings (e.g., Cornell et al. 2022). However, this focus should not overshadow the serious impacts isolation had for other research participants. Indeed, some described lockdown as negatively impacting on mental health issues or access to critical social services and urban infrastructures central to the everyday survival of unstably housed people. As has also been documented, the solitude of lockdown has negatively impacted on substance use behaviors among some marginalized people who use drugs (Roe et al. 2021). Thus, homelessness, substance use or mental health issues unquestionably positioned socially marginalized people unequally during pandemic lockdown (cf. Settembrino 2017). With a view to how socially marginalized people navigated pandemic health risks in spite of such challenges however, a more nuanced picture emerges.

Marginalization as resilience in times of crisis

Rasmus, a homeless shelter resident with a long history of heroin use behind him, described lockdown and restrictions on social contact at the shelter in the following way:

I don’t think that I would have felt a huge difference because … I mean yes, there are many restrictions (…) I can’t have visitors and such, but I’m luckily, I mean not luckily, but I’ve been in prison so much, and institutions, social institutions for troubled youth. Uh so, so I’m pretty good at being in my own company without others [without] panicking, so I can deal with that (…) I’ve faced myself, or my demons, or whatever you say, right?

In a similar manner, Louisa, an elderly woman cut off from her regular drop-in center, described how she coped with long-term isolation in her home: “You think, ‘oh my, if I hadn’t been in prison for a month, I probably wouldn’t have been able to handle it.’” In this way, Cheryl Mattingly argues, binaries of “crisis and normalcy” are inadequate to capture conditions for people whose lives are characterized by enduring (Mattingly 2022:61) or “chronic crisis” (Vigh 2008:5). Instead, for people whose social terrains are constantly unsettled (Vigh 2009), past crises became crucial reference points for making sense of and adapting to the new reality of lockdown. Jeppe, another long-time shelter resident described his experience of healing from drug-related illness as indicative of how he would cope if contracting coronavirus:

I mean, my body has fought off Hepatitis C by itself too. When I started coming in here, I accidentally pricked myself on a syringe because someone … they tended to like hide syringes underneath the table with duct tape, so that when you sat down, you accidentally pricked yourself on the syringe. And then, I got Hepatitis C. Two and a half year later, my body had fought it off by itself.

In contrast with policy and media accounts of risk and vulnerability among socially marginalized people, several research participants in the present study thereby described past experiences of recovery from illness or violence as a “measure of resilience” (Collins et al. 2022:3) against COVID-19.

The role of past experiences of hardship remains understudied in studies of coping strategies among social marginalized people. However, as demonstrated in studies of homelessness, such experiences might be mobilized as coping strategies. Thus, in an examination of homelessness among ex-soldiers, Paul Higate demonstrates how knowledge of survival techniques obtained during military training supported interview participants’ ability to cope with life on the street. Past experiences of hunger or the ability to sleep in physically challenging circumstances made up a bodily repertoire which supported their ability to survive homelessness (2000). Moreover, notions about their perceived fragility as homeless individuals were challenged in narratives that highlighted masculinity, independence, and resilience achieved on the basis of military service (2000). While research participants in the present study similarly described past experiences as supportive of their ability to navigate through pandemic crisis, individual experiences gained on the basis of a life lived at the margins, rather than experiences lived prior to life on the street, were pointed to as bodily repertoires (P. Higate 2000, P. R. Higate 2000) that supported them through the crisis. Thus, research participants highlighted experiences intimately associated with marginalized lives as key to overcoming emerging challenges during lockdown. In a similar manner, Alexandra Collins and colleagues have described how unstably housed people who use drugs in Rhode Island, “situated COVID-related risks by drawing on their previous experiences of the overdose crisis and structural vulnerabilities, e.g., housing instability” (Collins et al. 2022:3).

In addition to individual experiences of past hardship as a measure of protection, research has documented how the collective experience of living in “risk environments” (Rhodes 2002:85) is at times attributed value by unstably housed people and people who use drugs. In a study of a California homeless camp, Jennifer Mokos thus contrasts external representations of the camp as a harmful risk environment with residents’ attribution of value to exactly the most stigmatized dimensions of camp life (Mokos 2017). Opposing external critiques, residents highlighted the remote location and alternative social codes as holding value due to the potential for privacy and escape from stigmatizing gazes in more public space (Mokos 2017). As these and other studies have shown, public health understandings of risk and vulnerability are far from always taken at face value by the target groups they describe (Stephenson et al. 2014). Instead, risk categories may be “actively appropriated, countered, ignored or reworked by the publics whose health is supposed to be protected by the public health response” (Stephenson et al. 2014:13; see also Jønsson et al. 2022) with risk and danger projected onto distant or intimate others (Crawford 1994; Dionne and Turkmen 2020; Smith 2003; Storer et al. 2022), including by those perceived to be most vulnerable. As shown in this article, marginalized populations deemed most at risk to infection were no exception to this. Instead, participants engaged with official risk categories in accounts that mimicked, played on, and challenged official accounts of socially marginalized people as a distinct risk group.

Mr. and Mrs. Denmark: Reversing categories of vulnerability

The reflective engagement with official risk categories described above gained strength as it became apparent that the health crisis among socially marginalized people seemed not to materialize to the degree anticipated in media and policy discourse. Although in one of the cities where fieldwork was conducted, hundreds of tests were carried out at mobile testing units near or at the social services, no one tested positive during the first months of lockdown (see Storgaard et al. 2020). This puzzled both service users and employees and was a frequently discussed topic as they searched for possible explanations: “We won’t bloody get corona!” a man yelled jokingly, with reference to the crowd he would often hang out with at a public square just outside the drop-in center; “We drink vodka all day, corona doesn’t bloody like that!” Anders moved in the periphery of the same public square and visited the same drop-in center on a daily basis. In his understanding, service users’ particular lifestyles became possible explanations of why everyone seemingly avoided transmission during the first lockdown:

I:

Why do you think no one has caught it? In that group?

Anders:

It’s because they are poor [laughs]

I:

Because they are poor? Then you can’t get sick, or what?

Anders:

No, I think it’s because they have a good immune system. Maybe. I mean we’re, we’re out in all kinds of weather, and we deal with all kinds of challenges, I mean I think we have a solid ballast, and our physique is good, even though we are weak too. So I still think that we don’t get it, and we don’t go indoors, and most of us don’t use buses, uh, and we aren’t in touch with the stores, and we aren’t in contact with the social office.

At times, official risk categories were turned entirely on their head. Thus, some shelter users challenged official accounts of their social environments as particular risk environments for the spread of COVID-19, as teasingly explained by Faizal, an elderly shelter resident:

We’re the healthiest people. There is nothing wrong with me. Do you know where I’m born, sister? I was born in a stable. As you say, “would you rather be born at a clinic or in a stable?” Because if you’re born in a stable, then you can tolerate bacteria, but if you’re born at a clinic, you’re too clean, just like a little baby, you’ll pick up all kinds of illness. Me, I can take anything.

To a degree, Faizal’s comparison of a homeless shelter with a bacteria-filled stable mirrors media representations of homeless peoples’ challenges with adhering to public health guidance. However, in Faizal’s understanding, it is exactly the risk environment that helped protect him from the risks associated with COVID-19.

Similar findings are unfolded by Collins et al. (2022) in the context of rapid ethnographic research among unstably housed people who use drugs during lockdown in Rhode Island. In this context of overlapping overdose, homeless and pandemic crises, participants offered similar descriptions of COVID-19 “as a risk to the broader public” but emphasized their own “‘invincibility’ in relation to the pandemic – that is, that they would not necessarily experience harm because of their experience of surviving the ongoing overdose crisis” (Collins et al. 2022:3). In the present study, some participants constructed their own categories of risk, with an imagined housed majority population at its center. Thus, Jeppe, introduced above, commented: “Also because we live in so much bacteria in this kind of life. There are significantly more bacteria here than compared to a clean home, I mean, a clean, normal home … So, my immune system is probably stronger than Mrs. Olsen, who lives off of cleaning products.” Like Jeppe, Lærke described the risk environment as a source of strengthened immunity, as seen in her continued description of the homeless shelter where she resided:

But I had to comfort myself that if you survive so much in here, and in this environment, I mean, like, if my immune system could cope up until now, it can probably handle a bit more, right? It’s not because I’m one to go and feel poorly like that. We’re, I mean if you lived like we do in here you’d … . pneumonia, all kinds of … I mean you wouldn’t be able to cope with all that bacteria (…) But I mean, I’m less concerned really about people in here, than I am about Mr. and Mrs. Denmark. Because they don’t get out in the same kind of way.

In such accounts, a privileged housed population, captured in the metaphors “Mr. and Mrs. Denmark” or “Mrs. Olsen,” emerge as a counter image to the socially marginalized, further described as less resilient to pandemic risk because of their protected lives. This description draws our attention to easily overlooked resources gained on the basis of a life lived at the margins of the welfare state. It further entails a rejection of the stigma entailed in processes of “pandemic othering” that contribute to exacerbate existing inequalities (Dionne and Turkmen 2020:214). To a point, participants’ accounts reproduce dominant binaries of domestic vs. street life (see also Gowan 2010:209) seen in risk management strategies centered on the household level as a key site from which to limit transmission. At the same time, participants’ engagement with new public health guidance and the restructuring of everyday routines described above, challenges dichotomized understandings of healthy populations versus risk groups. Working through, resisting and at times reversing official categories of vulnerability, thereby enabled participants to carve out a new space for engaging with official constructions of marginality in the Danish welfare state.

Conclusion

As emphasized by Fersch et al., COVID-19 risk navigation strategies should be viewed in the context of the “pandemic phases” in which they occurred and the risk mitigation strategies they are framed by (Fersch et al. 2022:42). Coping strategies examined in this article unfolded in a context of urgency, rapid government response, social service innovation, and increased media and policy attention to the vulnerabilities of socially marginalized people. Moreover, the unexpected low rate of infection among socially marginalized people during the first lockdown impacted on research participants’ experience of pandemic lockdown as offering unexpected positive outcomes. Such perspectives contribute with important insights into how people at the margins of the welfare system navigate risk, drawing on everyday survival strategies in risk environments to get by in situations of large-scale crisis. As suggested by Kolind in an examination of former prisoners’ adaptation to life after prison, such positive ascription of value to experiences acquired in stigmatized contexts is rarely perceived as legitimate outside of environments of risk (Kolind 1999). However, the coping strategies described in this study underscore the importance of an increased focus on user perspectives in understandings of how marginalized populations get by during crisis situations.

It has been outside the scope of this paper to examine participants’ evaluation of changes to service provision during lockdown. However, existing research on user evaluations of low-threshold services has extensively documented how these are not only assessed with a view to their ability to provide for basic needs such as food and shelter. Instead, services’ effects on user autonomy and possibilities for user involvement play a significant role in users’ evaluations of service provision at services such as shelters and drop-in centers (e.g. Frank et al. 2021; O’Shaughnessy and Greenwood 2021; Parsell and Clarke 2012, 2019; Parsell et al. 2023). On this basis, the paper points to overlooked possibilities for more inclusive approaches to implementing public health guidance in risk environments, building on an understanding of people at the intersection of homelessness and drug use as actively engaging with official risk management strategies in situations of crisis.

Acknowledgments

The paper is based on findings first presented in Danish in Psyke and Logos (Nygaard-Christensen and Pedersen 2020). The author thanks the reviewers for their constructive comments to support the development of this article and research participants for sharing their time and reflections. The author also thanks Siri Mørch Pedersen whose work as a research assistant on the project was invaluable, as well as student assistant Nikolaj Mørk Thorsen for additional data collection.

Disclosure statement

No potential conflict of interest was reported by the author.

Additional information

Funding

The project is supported by a research grant from the Independent Research Fund Denmark, case number: [0213-00062B].

Notes on contributors

Maj Nygaard-Christensen

Maj Nygaard-Christensen is an anthropologist and associate professor at the Centre for Alcohol and Drug Research at Aarhus University, Denmark. Her research interests are social marginalization, drug use, and homelessness. Her current research includes projects focused on opioid use among young people in Denmark, user perspectives on outreach substitution treatment, and research on digitalization as a barrier to health services for marginalized people who use drugs.