ENDING A COVID-19 OUTBREAK
How homeless shelters turned the tide
The urgent drive to vaccinate Ottawa's shelter population began in early March under the most trying of circumstances.
The city's downtown homeless shelters were then in the midst of a massive COVID -19 outbreak: More than 300 clients and staff had been diagnosed with the respiratory disease in the two months since cases started popping up in early January.
Every day, shelter managers met with officials from Ottawa Inner City Health, Ottawa Public Health and the city's Human Needs Task Force to manage the crisis.
It was a Hydra-headed challenge. First, there was the scale of it. Three of the four largest institutional outbreaks recorded in Ottawa this year have occurred in homeless shelters. In one four-hour period, 60 shelter clients tested positive for COVID -19. Controlling the spread was difficult since it was the depth of winter and the shelters were crowded: Almost everyone in the system was either a positive case or a close contact of one.
“The shelters are not conducive to isolation,” said Dominique Bremner, the city's manager of public health inspections.
In late January, the downtown shelters closed their doors to new referrals in an effort to stem the tide of the disease. By then, about one-third of the city's shelter population had COVID-19.
A temporary shelter was established at Tom Brown Arena for people new to the system. Those clients were later moved to a former youth hostel on Nicholas Street. Another physical distancing centre was also opened by the city at the Dempsey Community Centre so people could sleep two metres apart.
Shelter clients who tested positive were moved to isolation centres established at Routhier Community Centre and, later, Le Patro. More than 100 people were in isolation at the height of the outbreak.
Ottawa Public Health and shelter staff tracked each case, and those who had close contact with confirmed cases had to be monitored for the disease and moved into isolation as soon as they tested positive. For two months, the four adult shelters suffered a rotating series of outbreaks.
“We have such a transient population that it always seemed like we were in constant outbreak in one shelter or another,” Shepherds of Good Hope CEO Deirdre Freiheit said.
Then there was the unusual nature of the outbreak. Oddly, the vast majority of affected shelter clients had asymptomatic cases of COVID-19; infected staff members tended to become much sicker with the disease.
It's not clear why shelter clients were mostly asymptomatic. One theory holds that they were regularly exposed to other kinds of coronaviruses, which afforded them some protection against COVID-19. Some call it “shelter immunity.”
With asymptomatic cases so difficult to spot, daily COVID-19 tests were introduced to identify new infections before they could spread.
“As you can imagine, people are not necessarily that cooperative with being tested every day, so it was very challenging to convince people to let us stick a swab up their nose day in and day out,” said Wendy Muckle, executive director at Ottawa Inner City Health. “It was not a happy time for anybody.”
The asymptomatic nature of the infections had allowed the outbreaks to grow unchecked in early January. When health officials began to suspect that something was wrong — following a few symptomatic cases — widespread screening revealed the true extent of the problem. “The vast majority were asymptomatic — that's why it was so startling for us,” said Aileen Leo, director of the communications at The Ottawa Mission.
It meant that, by the time health officials became aware of the outbreak, there was no stopping it. “It basically just spread like wildfire,” Muckle said.
All of which made the arrival of the COVID-19 vaccine such a welcome development for all those trying to withstand and manage the outbreaks.
Ottawa Inner City Health and city officials lobbied the province to gain access to the vaccine for homeless people during Phase 1 of Ontario's vaccine rollout, alongside long-term care home residents and health-care workers. (Homeless people were initially designated as Phase 2 recipients.)
The government ultimately moved homeless people into Phase 1 in recognition of shelter outbreaks happening in major cities across the province, including Toronto, Hamilton and Ottawa.
This city's first mass vaccination clinic for homeless people was held March 5 at The Ottawa Mission. “For many of the clients, it was the first nice thing we had done for them in a year, basically,” Muckle said. “The COVID measures that the rest of us find inconvenient for them are devastating: The attack on their physical and mental health and their very humanness has been unrelenting.”
Peer support workers known as “vaccine ambassadors” sat with some of those who were vaccine hesitant to explain the benefits of inoculation and to address the specific concerns of each client. Most didn't take much convincing to roll up their sleeves, but some needed reassurance or information to counter the conspiracy theories that have plagued the vaccine rollout everywhere.
At Shepherds of Good Hope, a boardroom was converted into a makeshift vaccine clinic. Staff also canvassed the neighbourhood to engage people on the street about vaccination, and nurses sometimes delivered shots curbside. “There was a nursing team on the ground every single day able to vaccinate people on the spot,” Freiheit said.
At The Ottawa Mission, some clients said they didn't think they deserved the vaccine: “Some people quite poignantly said if vaccines supplies are limited, you should give it to someone else,” Leo said.
Others were in no position to consent to vaccination because their mental health had deteriorated so much.
In response, during the past few months, Ottawa Inner City Health has concentrated on improving mental health services for the homeless population. It now offers an outdoor drop-in clinic at Shepherds and has doubled the amount of psychiatry available.
For those with mental health issues, vaccine consent is won slowly, on a case-by-case basis. “Our clients need individual attention, to talk it through, and they need to be given the vaccine by someone they know and trust,” Muckle said.
Vaccines are still being administered. The Ottawa Mission continues to offer vaccines at weekly pop-up clinics, and last week, Ottawa Inner City Health took a food truck to Shepherds and offered an
ice-cream sundae bar alongside a vaccination clinic. Mental health nurses flooded the downtown area to spread the word. The agency was able to deliver 21 more vaccines, many of them first shots to people who don't normally visit the shelter system.
Muckle estimates that about 80 per cent of the city's homeless population is now vaccinated, but that number fluctuates since new people are always coming into the shelter system. (According to the latest statistics, 79 per cent of Ottawa residents over the age of 12 are fully vaccinated.) OICH has delivered more than 4,300 vaccination shots this year.
“We vaccinated our way out of the outbreaks,” Muckle said. “We wouldn't have gotten out of it with just the isolation measures we had.”
Said Leo: “The provision of vaccines has been a tremendous vehicle for offering hope and relief.”
Freiheit said the vaccine program was a remarkable accomplishment and a testament to the cooperation between Ottawa Inner City Health, Ottawa Public Health and the shelters.
Two people from the homeless community died from COVID-19 during this year's shelter outbreaks, but their names have not been made public.
The shelter outbreaks are now officially ended: Earlier this week, the last shelter client was released from the city's isolation centre. But health officials are warily eyeing the fall and the looming threat posed by the Delta variant. “We will have more cases and sooner rather than later: that's just how it is,” Muckle said. “We always plan for the worst and hope for the best.”
Said Freiheit: “People are tired. It has been a long 18 months … and it's going to be tougher if this drags out.”