Homeless infections not as bad as feared
Health official: ‘We’ve been remarkably lucky so far’
Alameda County has seen reported coronavirus infections in its homeless communities nearly triple over the past three weeks. But with 74 unhoused people testing positive so far — and no deaths — health officials say the county’s experience is part of a broader Bay Area trend: For the most part, the virus has yet to rip through encampments and shelters.
“We definitely had fears that it could be worse,” said Kerry Abbott, director of the county’s Office of Homeless Care & Coordination, who said her team was “terrified” when the pandemic began.
But the virus has done plenty of damage in local homeless communities. And with limited testing and inconsistent data reporting, some worry the fallout is worse than we realize.
San Francisco, where a massive outbreak in the city’s largest shelter infected 96 homeless residents, is an exception. By the end of last month, the city had reported 167 infections among homeless residents — comprising 6% of the city’s total cases at that point. Alameda County, meanwhile, has seen smaller outbreaks at shelters and encampments in at least three cities.
Health officials in the five-county Bay Area have reported two COVID-19
“The number (of cases) is surprisingly low considering what we understand about the virus. And I don’t think we have a good handle on why that is.” — Dr. Mudit Gilotra, medical director for Santa Clara County’s Valley Homeless Healthcare Program
deaths in the homeless community: one in San Francisco and one in Santa Clara County.
“We’ve been remarkably lucky so far,” said Dr. Mudit Gilotra, medical director for Santa Clara County’s Valley Homeless Healthcare Program, which has reported scattered infections in shelters and encampments, but none that have turned into outbreaks. Even nationwide, “The number is surprisingly low considering what we understand about the virus,” he said. “And I don’t think we have a good handle on why that is.”
Some regions around the country have fared worse than others. In Los Angeles County, which has been particularly hard hit by the virus, 455 homeless residents had tested positive for COVID-19 as of June 5, and 13 had died.
As in other populations, the virus’s behavior in unhoused communities has been unpredictable.
“While there have been many examples of this very severe spread, there have also been cases where a few people were infected but it didn’t spread like wildfire,” said Dr. Margot Kushel, director of the UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital. “So there’s some hope there that perhaps in shelters, if they can do social distancing, if they can have people wear masks, if they can do frequent testing … they can potentially control the spread.”
Public health workers say preventive measures — setting up toilets and handwashing stations in encampments, depopulating crowded shelters, and moving sick or at-risk homeless residents into hotels — may have helped. But experts agree it’s hard to give those efforts full credit for preventing the virus from spreading.
The hotel program, for example, has housed a small fraction of the region’s thousands of homeless residents. And despite recent efforts, hygiene and social distancing protocols are incredibly challenging to enforce in shelters and encampments.
“That it’s all because of great prevention activities — that strikes me as not the most likely explanation,” said Dr. Arthur Reingold, division head of epidemiology and biostatistics at UC Berkeley.
Health experts initially estimated that homeless residents — who tend to be older and have more health issues than the general population — would be between two and three times more likely to die of COVID-19 once infected, and that they would be more likely than other populations to catch the virus.
Despite that, it appears there has been no statewide effort to track the virus’s spread among unhoused people. In the fivecounty Bay Area, Alameda and Contra Costa counties are the only two jurisdictions that post data online about COVID-19 infections in homeless communities. San Mateo County doesn’t track that information at all. And, citing privacy concerns, many Bay Area health officials won’t disclose which shelters and encampments have had outbreaks.
Like other COVID-19 data, the numbers reported by health officials almost certainly have large gaps because of limited testing. The problem is particularly acute in the Bay Area’s encampments.
“The truth is, in unsheltered populations, we actually don’t know,” Kushel said. “We don’t know what the rate of spread is.”
In an effort to fix that, Kushel and her team planned to conduct a twoday mass-testing event for unhoused residents in and around San Francisco’s
Bayview-Hunters Point neighborhood.
Santa Clara County also is increasing testing. For months, the county had focused on testing unhoused residents who had symptoms or were exposed to someone with the virus. But late last month, the county shifted its strategy. Now the goal is to test everyone in every shelter — as well as every encampment of 10 residents or more — by the end of June.
“We wanted to get a sense of, especially people in congregate settings, are there any asymptomatic outbreaks? Or are there cases we need to identify to stop an outbreak from happening?” Gilotra said.
As of June 3, the county had tested 528 homeless residents — up from 151 three weeks earlier — and moved 30 homeless households into isolation after members tested positive.
In Alameda County, homeless outreach workers started with a leg up on the pandemic. After the shelter-in-place orders began, the county went several weeks without seeing any confirmed COVID-19 cases among homeless residents.
That gave officials extra time to move people into hotel rooms and take other preventive steps, Abbott said.
The county has secured about 640 hotel rooms for the homeless, out of its 1,100-room goal. But all the existing rooms for homeless residents who do not have COVID-19 are full or have been reserved. There was already a waiting list for a new hotel that was set to open recently in Newark. And the pandemic isn’t over.
“Alameda County is certainly not out of the woods in terms of potential for exposure,” Abbott said. “It’s really important to not assume that we avoided more widespread infections.”