Among the homeless population, severe vulnerability is a bigger concern than the virus’ spread, a health official says, but safety measures are called into question
As of Tuesday morning, two people experiencing homelessness in Multnomah County had tested positive for COVID-19, making up less than 1% of local coronavirus cases.
The county would not provide any additional information about these two individuals, including their whereabouts or condition, and it declined to answer questions about whether they had stayed at any homeless shelters, where others could have been exposed.
The spread of the virus among Portland’s houseless communities is not the main concern, Kim Toevs, Multnomah County director of communicable disease programs, told Street Roots. Rather, she said, it’s the high level of vulnerability, on average, among the county’s homeless population.
Advanced age and underlying chronic health conditions put many people living outside and in emergency shelters at a higher risk for hospitalization and death should they contract the illness. Twenty-four percent of people who are unsheltered or living in emergency shelters are 55 or older, and 25% have a chronic health condition, according to Multnomah County’s 2019 Point in Time Count.
As more information about the novel coronavirus emerges, the effectiveness of measures the county and the city of Portland have taken to prevent its spread among some of its most vulnerable constituents is in question.
Multnomah County took its lead from the Centers for Disease Control and Prevention on issuing guidelines for homeless shelters. In addition to placing beds at least 6 feet apart, the county recommends shelters place barriers between beds, such as foot lockers or curtains. The CDC made this recommendation for people showing any respiratory symptoms and also recommended arranging beds so people sleep head-to-toe or toe-to-toe.
But, the county isn’t following its own advice. At the temporary shelter constructed within the Convention Center, there are no barriers between beds, only open air.
Daniel Whitehouse is a 54-year-old resident at the Convention Center shelter. He suffers from mild COPD and uses an inhaler to manage it. During orientation at the shelter, he said, residents were not instructed to sleep toe-to-toe or head-to-toe, but many are doing it on their own because they learned to sleep in that manner at other shelters.
Whitehouse said everyone is instructed to use hand sanitizer when they enter the building and before eating meals, where they are spaced 6 feet apart from one another while they dine. Handwashing is available in the bathroom.
Toevs said that because the Convention Center shelter is in such a large room, it’s similar to being outside. The additional airflow, she said, lessens the risk.
Portland and Multnomah County’s Joint Office of Homeless Services confirmed that none of the shelters in its system has erected barriers between beds.
As the pandemic emerged, public health guidance based on science at the time recommended separating sick people from well people within shelters, with 6 feet between the two groups, she said.
“I feel like we’ve done a tremendous job,” Toevs said. “We were doing the best that we could, with the best public health science we knew at the time, but with the limited resources that everybody had available.”
Following Street Roots’ inquiry, Toevs recommended to the county that the recommendation that barriers be erected between beds be removed from the county’s guidelines, saying they were written when it was expected that sick and well people would be housed together. The county’s guidelines were last updated March 30.
“I understand (Street Roots) expressed concern about asymptomatic transmission,” she wrote in an email to the Joint Office of Homeless Services and to Street Roots. “I suggested that as long as we have people in shelters instead of homes, and with undertreated chronic conditions, we are already not in a situation where we have best possible public health outcomes. Everything we do with a multilayered harm reduction strategy.”
Following new recommendations from the CDC, the county worked with the Joint Office of Homeless Services over the weekend to purchase 5,000 bandanas, 25,000 coffee filters and 10,000 rubber bands to be distributed yesterday and today so face covers could be fashioned for employees and guests at all the homeless shelters in the county. Outreach workers are distributing these supplies to people living close to others outdoors.
The CDC changed its recommendations regarding masks, which were originally recommended only for sick people, because it’s been learned that some people carrying COVID-19 show no symptoms. Either they are asymptomatic or pre-symptomatic.
“The early part of the sickness is pretty infectious usually for viral infection,” Toevs said.
Most shelters, including the county’s new temporary shelters, are relying heavily on the 6-foot rule for social distancing to keep people safe. However, this CDC-issued guideline has been criticized for being somewhat arbitrary, with experts recently telling The Oregonian that 10 feet or more is a much safer distance to keep between non-symptomatic people. One study showed the virus can linger in the air for hours and travel from 23 to 27 feet indoors from a single cough. And on the Diamond Princess cruise ship, the virus persisted for more than two weeks on some hard surfaces.
The more that’s learned about the virus, the less safe Portland’s houseless population seems to be, even with the extraordinary measures the city and county have taken to decrease the risk of contraction among its members.
Portland has stopped the majority of its homeless camp sweeps, and the county has been moving people living in camps and shelters who are showing symptoms into hotel rooms.
The county is funding rooms at the Jupiter and one other undisclosed hotel that’s also serving as a refuge for domestic violence survivors.
As of Tuesday, 38 of the 121 motel rooms available for county placements were occupied with 64 guests, with couples occupying some rooms.
“The idea is to be ready proactively with rooms in case there’s ever any kind of a surge,” Joint Office of Homeless Services spokesperson Denis Theriault told Street Roots in an email. “There is planning still for a third site, in partnership with Public Health and others, that wouldn’t be in a motel but would have a similar setup with private rooms that would offer more formal recuperative care to people who test positive and are too ill to be in the motel settings but not ill enough to remain in the hospital.”
Handwashing continues to be one of the best defenses against COVID-19, and the city has opened more than 50 park bathrooms and installed 21 handwashing stations, some of which also offer additional bathrooms.
COVID-19: Hygiene needs increase as homeless resources shrink with closures
The city’s temporary bathroom and handwashing stations were getting more use than originally expected, so the city began cleaning and restocking them three times per week instead of two times per week beginning the week of March 23, city spokesperson Dylan Rivera said.
The last six port-a-potties placed around the city were lacking some parts, including soap dispensers, said Katie Lindsay, a coordinator for the Portland’s Homelessness and Urban Camping Impact Reduction Program. For those, the city has been placing soap in the bathrooms, “but the soap does get picked up and taken out,” Lindsay said. “A sink was removed from one.”
She said the city hasn’t received complaints or requests regarding a lack of soap or toilet paper since the city increased the maintenance frequency.
Bathrooms among Portland's parks are cleaned and restocked daily, according to Portland Parks & Recreation spokesperson, Mark Ross.
“What would be the very best public health science that could inform? It would be to not have people be unhoused and to not have, therefore, all the other untreated chromic conditions that make someone more at risk for severe disease,” Toevs said. “We are all acknowledging that we are already starting at a place that’s vastly far from what gives us the best opportunity to keep everyone as healthy as possible.”
Email Senior Staff Reporter Emily Green at emily@streetroots.org. Follow her on Twitter @greenwrites.
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