As COVID-19 outbreaks continue to threaten the Bay Area’s homeless communities, a new CDC report supports what activists have long feared — when it comes to coronavirus, crowded shelters are a tinderbox waiting to explode.
The report studied coronavirus outbreaks at a handful of homeless shelters around the U.S. — including MSC-South in San Francisco, where 106 people have tested positive for the virus. The results, released in the “Morbidity and Mortality Weekly Report” published by the Centers for Disease Control and Prevention, alarmed local experts — even those who have been following this issue for months.
Health workers attempted to test all residents and staff, regardless of whether they showed symptoms, at 19 homeless shelters in Seattle, Boston, San Francisco and Atlanta. At those shelters, 25% of residents tested positive, along with 11% of staff. The results were much worse in San Francisco — where 66% of MSC-South residents had tested positive at the time the study was completed April 15. By Wednesday, infections had increased to 67%.
“It is terrifying,” said Dr. Margot Kushel, director of the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital. “And I think it has huge implications when people start talking about reopening.”
The results show how quickly and extensively COVID-19 can spread through homeless shelters, where residents generally sleep close together and share bathrooms and dining facilities.
And they underscore another dangerous aspect of the virus — how it can move undetected through a community. The study looked at shelters that had previously reported COVID-19 cases, as well as those that had no known cases. Among shelters that had reported two or more COVID-19 cases in the two weeks before the study, 37% of residents tested positive.
But the study showed that even when a shelter hasn’t reported a coronavirus case, people can still be infected. Health workers in Atlanta tested 249 residents and 59 staff members at two homeless shelters that had not reported any COVID-19 cases. The results were surprising: 10 residents and one staff member tested positive.
“We clearly need to do more testing,” Kushel said. “We clearly need to remove every single person we possibly can who’s vulnerable and get them to safety in a private room.”
Everyone who tested positive during the CDC study was transferred to a hospital or isolation area.
The CDC report suggests testing all residents and staff, regardless of symptoms, at any shelter that has reported COVID-19 cases. If possible, the researchers recommend going a step further and testing everyone even before cases are reported.
San Francisco Supervisor Matt Haney is pushing for universal testing of residents and staff at homeless shelters, supportive housing facilities and single-room-occupancy hotels (SROs) in his city. But so far, the Bay Area’s testing of the homeless — and of everyone else — has been piecemeal, and, for the most part, tests only have been offered to people who have certain symptoms or have had known exposure to the virus.
The flaws with this testing strategy became apparent this week, when 22 residents and two staff members at Casa Quezada tested positive in San Francisco’s Mission district. The first resident of the 52-unit supportive housing site for the homeless tested positive April 13 after suffering from a fever and cough for two weeks. Staff members immediately began pushing the city to test all residents, but it wasn’t until April 16, when a second case was confirmed, that the city agreed, said Laura Valdéz, executive director of Dolores Street Community Services, which manages the facility.
“Had (the Department of Public Health) started testing vulnerable populations in shelters, SROs and those who are unsheltered,” she wrote in a statement, “we could have prevented the outbreak at MSC-South and at Casa Quezada, and more outbreaks that are happening now.”
Bay Area homeless shelters are trying to protect their residents by enforcing social distancing, but it’s a major challenge.
St. Vincent de Paul of Alameda County transferred 26 residents from its West Oakland shelter into hotel rooms supplied by the county — allowing the shelter to thin its population and provide a little more space between residents. Staff members arrange cots in a complicated game of Tetris each night, trying to make sure no one’s head is closer than 6 feet to another person’s head — a move that only works if residents sleep head-to-foot. Every other stool in the dining room is marked with an “X” in tape, discouraging residents from sitting too close to one another. And signs outside encourage physical distancing while people are waiting in line to get in.
But by nature, congregate living facilities make it hard to enforce those rules.
To address the problem, Bay Area counties have leased thousands of hotel rooms where homeless people who have COVID-19, may have COVID-19 or are particularly vulnerable to the virus can self-isolate. But only some of those rooms have been filled, and many more people remain in the region’s shelters and on the street.
“Basically if we kind of pull away and look at what we’re doing in these shelters — we’re saying as a society we’re OK with losing the lives of the most destitute people, and we’re going to force them into close quarters, and we’re just going to wait, and then we’re just going to pull out the dead bodies as people pass away,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness. “And I don’t think that’s acceptable.”
