As I was reading the excellent "Six Months of Coronavirus: here's some a what we learned" NYTimes article ( https://www.nytimes.com/article/coronavirus-facts-history.html ),
I was thinking that a bit of a recap about best practices around coronavirus and homeless providers would be useful. Would it be possible for the Health Department to do a fairly substantial presentation to the Coalition to End Homelessness at a coming Friday
meeting? I think our Coalition would benefit from a summary of about the guidance the Health Department is providing and/or planning to provide to the homeless providers and funders in Pierce County. I'm looking for something that where health department details
their recommendations to design a system to be very safe for people experiencing homelessness, both sheltered and unsheltered. I've cc'd folks from the City of Tacoma and Pierce County Human Services departments. While I realize they are involved in this work,
I'm really most interested in what the Health Department is recommending; the Health Department is the area expert on how to prevent the spread of covid-19. In addition, the Health Department has invested time developing expertise in how the homeless system
operates, providing liaison's we've relied upon to make health and safety recommendations over the years. So this seems to me like the Health Department's wheelhouse - please let me know if I'm off base. I'm not sure sure who at the Health Department is the
best person to send this to, so I'm hoping you'll route it to the appropriate individuals.
In particular, I would like the following items discussed. These are topics I've heard confusion on, as well as items I've heard questions from Coalition members about. Additional topics the Health Department thinks should be covered would be much appreciated.
I realize that the Health Department has provided some guidance on these topics, but I think revisiting them would have some real benefit. A few of these items relate to policy or procedure, and providing written versions of those policies and procedures would
be of great value. Now that I've written all this out (sorry this is so long), it seems like a big list, but I suspect you have developed guidance on all these topics. Anyway, the list:
- Recommendations on the future of congregate shelter. We hear from some communities across the country that they are considering eliminating congregate shelters
from their homeless response, in favor of solutions that provide separate living quarters. Does the Health Department have recommendations around this? Clear guidance from the local experts on public health will be of great value in designing any shelter
changes.
- Is the health department making recommendations around design of congregate living in homeless shelters? Is the health department reviewing airflow patterns in congregate living situations? Many communities are spending CARES Act funding on upgrading HVAC
systems to reduce spread of disease through contaminated airflow. Will the Health department review airflow patterns in shelters and make recommendations on airflow changes, or the need for pipe and drape systems or other barriers? If they have done this
already, how safe are they rating community shelters? Are they recommending any changes?
- What are the Health Department's recommendations around using hotels to house vulnerable individuals experiencing homelessness? Should we be expanding our community's hotel programs or reducing them?
- Guidance from the CDC considers comprehensive site testing of all homeless shelters guests and staff to be optimal. The health department is choosing not to follow this path. Could this decision be explained? If lack of resources is the cause, could a
full description of how testing is currently being prioritized, including weekly unmet testing need or excess capacity, be provided? And an identification of specific bottlenecks would be appreciated - media, lab capacity, and staffing all play a part, of
course. Both the lack of growth in testing and the recent mention of available capacity seems to indicate we have adequate resources for more elective testing of asymptomatic, such as all individuals in congregate living situations.
- if someone living in a congregate living facility is found positive for covid-19, would the health department recommend the all guests and staff be tested? That seems ideal. If not, will the testing recommendations follow the same protocol as if they had
been living alone - the close contact requirements. Or should those tested be expanded because of the significantly increased exposure of others in congregate living? I suspect a contact tracing protocol is in place, so perhaps reviewing that with a focus
on the specifics of how the unique requirements of congregate living necessitate a different approach to testing?
- People experiencing homelessness have significantly fewer hygiene options than prior to the COVID-19 pandemic, and far more need for them now. What would the health department consider minimal hygiene services for people experiencing homelessness across
Pierce County? For instance, what would the minimum and perhaps ideal locations, hours and services (shower, laundry, bathroom, hand washing, etc) be? This would be useful information as providers look to supply these resources.
- The success of contact tracing relies a great deal on trust. What recommendations does the health department have for creating the teams that do contact tracing for people experiencing homelessness? Staffing the contact teams with people with a history
of homelessness or serving the homelessness, and representation from the underrepresented populations that make us the bulk of people experiencing homelessness seems ideal. Is there an active plan to recruit staff with these characteristics?
- If the presence of antibodies provides some immunity to the disease, will there be a plan use antibody testing to identify congregate facility staff who may be a lower risk to vulnerable clients, so we can attempt to design staffing plans to minimize opportunities
for transmission?
- Does the Health department recommend testing guests prior to staying at a congregate homeless shelter? It seems there are dangers to introducing new clients who may have COVID-19 to the shelter population, and that testing of asymptomatic clients prior
to entry (with a brief hotel stay while awaiting results) would be a good way to improve safety at a shelter. Is this something the Health department would recommend?
- In congregate settings, keeping guests and staff safe can run counter to the desire to respect client confidentiality. Could the Health Department describe their recommendations for how a shelter or homeless program should approach handling a guest or client
who tests as COVID-19 positive? Specifically, what are best practices regarding how to limit identification but still ensure any possible contacts are identified. In addition, how should one provider respond to inquiries from other providers about the status
of a past or current client? Will the Health department act as a central repository of known positive cases, and could that be a resource to check before admitting a client to a program? Other communities provide a list of positive cases to EMS, so 911 operators
can alert response teams of known positive cases when they are dispatched to a location, so there is some precedence for this type of information to be made available in limited ways to protect others from potential infection.
- The Health Department chooses to identify facilities of 30 or more residents when over 10 COVID-19 cases are found at a site. Is there a reason sites with over 30 individuals and fewer than 10 cases are not identified? It seems that understanding case
counts at different facilities would be beneficial to the community so it is possible to better understand where additional resources may be needed, or to simply understand the spread of the disease. It seems this transparency would have some value and has
no more chance of a client being identified vs the facilities with larger case counts.
- The Health Department has over 100 rooms of unused hotel space - the temporary isolation and quarantine facility - that could be used to house people experiencing homelessness. Is there any effort underway to use this available space to provide people
experiencing homelessness a safe place for sleeping and hygiene? Even if people were evicted from those spaces when the rooms needed to be allocated for the primary mission - isolation and quarantine - it would still have provided substantial benefit to many
people now unsheltered. And by unsheltered, I mean having bowel movements in the woods with no ability to wash their hands afterwards - a concern as we see hepatitis A cases among the homeless population, not to mention COVID-19.
- Limiting movement of congregate shelter guests could provide substantial protection for shelter guests. Some shelters have limits on if and where guests to travel during the day. Does the Health Department have recommendations on policies around whether
guests should be able to leave congregate facilities?
Again, the overarching goal is to get a sense of how the Health Department would want to see the homeless system modified to best provide for the safety of those experiencing both sheltered and unsheltered homelessness. A secondary purpose is to remind the
Coalition members of best practices we can steer our programs towards, both in the short term and in the long term.
Thanks,
-Gerrit
Gerrit F. Nyland
Tacoma Pierce County Coalition to End Homelessness
http://www.pchomeless.org/
gnyland@pchomeless.org
253-304-5105