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Homeless advocates knew positive cases of COVID-19 would begin to reveal themselves in shelters as testing for the disease caused by the novel coronavirus increased. In congregate settings like shelters, where dozens of people can sleep in one room, slowing the spread of the virus has been a challenge.
As of Tuesday, five individuals in the D.C. shelter system have tested positive for COVID-19. These positive cases are spread across three shelters—the Harriet Tubman Women’s Shelter on Massachusetts Avenue SE, Patricia Handy Place for Women on 5th Street NW, and the Community for Creative Non-Violence on 2nd Street NW—Department of Human Services DirectorLaura Zeilinger tells City Paper. At this point, DHS is not disclosing the number of cases by site out of privacy concerns.
Individuals that were in close contact with infected patients at those locations have moved to a quarantine site where they can self-isolate. In addition to contact tracing, shelter staff and on-site medical providers performed additional screenings of residents staying at the three shelters out of caution. Just over 20 people left the shelters and entered self-quarantine with the expectation that they can return to their beds once it’s safe. Per DC Health protocol, individuals who came in contact with infected patients will only be tested for COVID-19 if they display symptoms (cough, fever, or shortness of breath). Shelters with positive cases notified those staying there and underwent deep cleaning. Every shelter in D.C. is expected to follow these protocols if a positive case turns up.
“We will hold their beds for them so that in the end, they will have a safe place to come back to,” says Zeilinger. “We don’t want to give anybody a reason to feel that they have to make a tradeoff between being able to come back to their space and seeking medical treatment or being able to self-quarantine.”
Homeless shelters across the District are doing the best they can to keep their residents and staff safe during the coronavirus pandemic. Central Union Mission staff, for example, are all required to wear N95 masks and clean every hand surface multiple times per day. The homeless shelter on Massachusetts Avenue NW near Union Station also suspended a rule that limits individuals to stays of 15 consecutive days. Under normal circumstances, individuals would have to find alternate accommodations for another 15 days before returning. Even though the emergency shelter is working with the same bed roster, staff members check the body temperature of all overnight guests every day.
The best way to slow the spread of coronavirus is to follow social distancing and hygiene guidelines. But people experiencing homelessness don’t have regular access to sinks where they can wash their hands and those staying at homeless shelters can’t always remain six feet from another person. There are simply too many people and not enough space.
“Shelters by nature are communal. They also tend to be dormitory-style bedding facilities and lots of human contact so trying to do six foot distancing in a shelter is difficult or impossible,” says Central Union Mission President and CEO Joe Mettimano. “The only way to do it would be if you significantly decrease the number of people that you are housing and so that’s not an option. D.C. already has a homelessness rate that’s twice the national average.”
Shelters are trying to implement social distancing practices by transitioning away from cafeteria-style food service to grab-and-go and having people sleep head to toe or moving beds further apart. In some shelters, staff cannot create a significant distance between beds because there are 30 sets of bunk beds for 60 individuals in one room. Some Catholic Charities shelters had to move beds into unconventional areas like common rooms to make space. “It doesn’t look necessarily normal right now,” says Amanda Chesney, Catholic Charities’ director of housing and homeless services. “We are trying to be as creative as possible with the situation we have. This is definitely not a typical operation for anybody in the city, let alone us.”
Everyone working with the homeless population is keenly aware of the logistical challenges of practicing social distancing at shelters, from advocates to health care providers to government officials. If any population needs to be practicing social distancing to reduce opportunities for disease transmission, it’s people experiencing homelessness, who tend to skew older and sicker. If they get infected, some might need to be hospitalized, possibly in intensive care units. Some will likely die.
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Homeless advocates have asked the D.C. government to take extra steps to protect individuals experiencing homelessness that are at high risk of severe illness. In a letter sent Friday to DC Health, DHS, and the Office of the City Administrator, several homeless services agencies, including Miriam’s Kitchen, submitted a list of recommendations, including secure locations where high-risk individuals experiencing homelessness can self-isolate. Ideally, they would be offered hotel rooms.
“We believe that preventing them from getting sick is the best way to go because that way that won’t only keep them safe and healthy but will also reduce the pressure and burden put on the health care system,” says Jesse Rabinowitz, an advocacy and campaign manager at Miriam’s Kitchen.
As it so happens, DHS and their partners have been actively thinking about this. On Monday, DHS began moving high-risk individuals experiencing homelessness to vacant hotel rooms for self-quarantine. Locations for any DC Health quarantine sites aren’t being disclosed for privacy reasons. The agency is using criteria “that is consistent with what has been published around age and co-occurring medical condition” to decide who to move, says Zeilinger. As of Tuesday, 51 rooms are being used as isolation sites for those unable to self quarantine in a residential setting. This number is not limited to high-risk individuals.
“We continue to look at all options,” says Zeilinger, “as well as the potential that we may have an increase in demand for shelter and we don’t want to create more density.”
The department is proactively moving people in collaboration with Unity Health Care and other homeless services providers. The director of homeless outreach at Unity Health Care, Dr. Catherine Crosland, says her team and shelter staff have been working to identify individuals that should proactively self-quarantine. “Nobody is being forced to do anything against their will,” she notes. Unity Health Care, along with shelter staff, has been selecting individuals over 80 years old and anyone younger with “significant comorbidity.” A study out of Hubei, China, suggests that the fatality rate was significantly higher for individuals over 60 years old, at 9.4 percent. It’s unlikely that D.C. can offer every person experiencing homelessness over the age of 60 the opportunity to proactively self-isolate; that’s more than 1,000 individuals.
The letter homeless advocates sent Friday also asks the D.C. government to create a group quarantine site for those who tested positive or are awaiting results; reduce crowding in existing shelters by developing new ones; set up mobile hand washing stations and portable toilets across the city; and establish universal testing procedures for the homeless population. Already, District leaders created a quarantine location for the populations requested, along with those that have to self-quarantine due to COVID-19 exposure, and erected 17 hand washing stations.
Recent progress has been made on testing. Individuals experiencing homelessness who display symptoms are now a priority testing group, according to DC Health guidance released March 25. The news cheered homeless advocates. Previously, it was hard for patients experiencing homelessness to get tested, as it is for everyone, and presumptive positives were asked to self-quarantine but couldn’t really do so.
Prior to the testing guidance, Unity Health Care was sending patients to the hospitals for testing, where it would sometimes take seven to 10 days to get results back. It wasn’t always clear where individuals could self-quarantine while they waited for results. Now, providers will screen homeless patients for COVID-19, and if patients tick two of the three symptoms, a doctor will call the DC Health hotline to trigger testing. Turnaround time for results should be within 48 hours because swabs are going to the public lab.
“We’re really trying to … proactively screen the whole population as much as possible,” says Crosland. She hopes that as tests become more widely available, D.C. can move toward universal testing to “shrink” the curve, or prevent the spread altogether. “My hope is that people in congregate settings will be absolutely prioritized for universal testing,” Crosland says. “The sooner we identify and isolate asymptomatic COVID positive individuals, the better our chances of getting a handle on this virus.”
To some homeless advocates, COVID-19 is just exacerbating problems at shelters that predate the pandemic, among them efforts to make facilities more private. Amber Harding, a staff attorney with the Washington Legal Clinic for the Homeless, recalls a 2015 campaign for private bathrooms when it came time to replace the family homeless shelter at DC General. Only 10 to 20 percent of units in each of the six short-term family housing facilities have a private bathroom. Long-term building plans still don’t resolve this issue. Singles shelters slated for improvement, like 801 East Men’s Shelter, will still be large and congregate.
“All this affirms what people in encampments have been saying for a long time, which is that shelters are dangerous,” says Harding. “This is very much worse than anything that has happened before but it’s not the only time in congregate shelters we’ve had the fear of or actual contagious disease spread throughout because they are congregate. We’ve had [tuberculosis] outbreaks in the singles shelters before, which generally people don’t have anymore.”
The hope now is that lawmakers learn from this pandemic. “We commend the Bowser administration and the D.C. Council for the urgency with which they’ve addressed COVID-19 and we hope that when this crisis is over, the same urgency, passion and resources will be used to ensure that all of our neighbors have housing they need to thrive,” says Rabinowitz. “This COVID-19 crisis illustrates that everyone’s health and wellbeing are linked and connected and that if D.C. wants to thrive and be healthy, everyone has to have access to the housing and resources they need.”
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