There are 4,555 homeless people currently living in Japan, according to the latest figures published by the Ministry of Health, Labor and Welfare in April last year. Of those, 1,126 live in Tokyo, the epicenter of Japan’s COVID-19 outbreak.

A September 2017 survey by the Ministry of Health, Labor and Welfare revealed that 42.8 percent of Japan’s homeless population was over 65 years old, the first time the figure topped 40 percent. The average age — 61.5 – was over 60 for the first time.

Many of Tokyo’s homeless also have underlying health problems like diabetes and heart disease, making them particularly vulnerable as cases of COVID-19 continue to climb in the capital.

“Each person looks at it differently,” said Kenji Seino, director of nonprofit organization Tenohasi, which provides food, clothing, advice and medical checks for homeless people in Ikebukuro. “It depends on the person. They don’t go to the hospital when they get influenza, and some of them think the coronavirus is just like that. And then some are very scared and don’t want to go anywhere.”

Homeless people in Japan do not have health insurance but can access health care if they apply to go on welfare. Given the powerful social stigma that surrounds homelessness in a country that traditionally places great importance on self-reliance, however, many choose not to take that step.

Welfare is only granted if a person cannot be supported by their family and has no other means of support. Many homeless people feel too ashamed to allow their family to be contacted and asked.