Homeless In A Pandemic: Fractured Services, A Recent Outbreak

At 10:58 a.m. last Friday, a voice took over the loudspeaker at the St. John Center for Homeless Men, telling the clients that it was time to leave and let the next group in. Because of COVID-19, only 24 men are allowed in the shelter for an hour at a time. Before the pandemic, the center used to hold 70 men at once, many of them often staying for hours. 

After the 10 a.m. group of men left, Marty Keck, 58, walked in. At the St. John day shelter, he has the opportunity to take a shower and speak to case manager about his pending food stamps application — or simply sit, enjoying the warmth. After his time is up, he will go outside to wait in line again. He repeats the process until he can go back to The Healing Place, where he has been living since October. He said one of his roommates died from COVID-19 and he was unable to afford another place, having suffered a stroke two years ago that left him unable to work. 

“The line’s pretty long, but it goes quick,” he said, his soft voice barely escaping through his surgical-style mask.   

When Maria Price, the executive director of St. John, talks about the line, though, the first descriptor she uses is “dreadful.”

“We’ve been around 35 years in April,” she said. “For the first 34 years, we looked nothing like this.”

COVID-19 has constrained services for people who are homeless in Louisville, impacting shelters and outreach groups that provide basic necessities and help transition clients back into homes. The shelters like St. John are no longer able to keep the volunteers they have relied on for years. Some people living on the streets who LEO spoke to said that outreach groups bringing food and warm clothes are visiting less often. And the one consequence of the pandemic that Louisville’s houseless citizens have been able to avoid, an outbreak, has finally occurred. Thirty-seven people tested positive for COVID-19 at Wayside Christian Mission after the shelter says one client visited family out of town for Thanksgiving, spreading it to others. None of the cases have turned severe, and those who have tested positive were quarantined, said Nina Moseley, the chief operating officer of Wayside. 

The one thing that is needed to finally bring things back to “normal” for Louisville’s homeless residents and service providers — which, for them, means being able to focus on the affordable housing crisis, said Executive Director of the Louisville Coalition for the Homeless Natalie Harris – is vaccine access. 

Currently, there is no special prioritization for those who are homeless, only for those living in “congregate settings,” and advocates are worried about the difficulty of vaccinating a group of people that is traditionally hard to reach.

If Price had it her way, Louisville’s homeless residents would get the vaccine first. 

“Of course I want them in tier one because they don’t have the ability to be healthy at home,” she said. “So, to not have that option, it seems like we would take extra steps to at least help them be protected against the disease the best that we can given the science and the tools of the vaccine.”

Cortney Foster, day shelter manager for the St. John Center for Homeless Men, takes the temperature of a client as he enters.

OUTBREAK

Before Wayside Christian Mission’s COVID-19 outbreak, Louisville’s homeless advocates were amazed by how well the community managed to avoid cases. 

“It really surprised us,” said Price. “We thought that with people living in a congregate setting where their health is already so compromised, that it would be a devastating domino effect.”

The Louisville Department of Public Health and Wellness could not provide numbers for how many homeless people have had the virus, because the testing system is not designed to ask about an individual’s housing situation, said Connie Mendel,  the department’s director of environmental health, public health preparedness and laboratory. But, she said, from what she knows, the city’s homeless community has not seen a lot of cases.

A man living in an abandoned building in Louisville’s West End who LEO spoke to on a Louisville outreach mission said that he doesn’t think people who are homeless are as likely to get COVID-19, because of how much time they spend outside. 

“We’re not going in the stores and in the buildings,” said the man, who did not wish to be named. “We’re not around as many people as the same as you may be.”

Mendel believes this could be true. Many of Louisville’s homeless residents may also have dodged the virus because the health department has been working with shelters on setting up different COVID protocols, she said, such as sanitation and what to do if a resident tests positive. At the start of the pandemic, The Salvation Army was running a quarantine shelter on behalf of the city where people could go if they had been exposed to the virus or tested positive. This transitioned to a hotel model in October when The Salvation Army needed its warehouse back for its Christmas Angel Tree program. Shelters are also quarantining residents in their facilities within separate rooms. And, the Salvation Army opened up an overflow shelter for people to go to when other shelters in the area have grown too crowded. 

But, things changed when Wayside found a positive test in a member of one of its men’s programs. The shelter then started testing other people in the program. Soon, there were enough positive tests for Wayside to test the entire shelter, finding 37 positive cases out of a group of 385. Since Wayside’s outbreak, The Salvation Army had 11 people test positive, too, all of whom have also been quarantined. 

Moseley, Wayside’s chief operating officer, told LEO that some of those who tested positive had pre-existing conditions making them more vulnerable to COVID-19. But so far, none of those who have tested positive have had to go to the hospital, and some have started to be released from quarantine.

Most have been living in an isolation dorm within the walls of Wayside or in their own separate rooms, while some have been taken to a downtown hotel that the city is now contracting with to quarantine Louisville residents who are unable to isolate at home. At the hotel, positive individuals are given their own room with a kitchenette. The city is spending $270,000 to rent out rooms in the hotel. The contract ends Jan. 31, and Metro Health is exploring multiple quarantine options for February, said Karl Bullock-Phillips, a department spokesperson.

Before the outbreak, Moseley said that Wayside was working hard to keep its shelter safe. 

“We’ve done everything we can to limit exposure,” she said. 

Wayside requires masks at all times except when residents are eating or sleeping. The shelter also has been rotating residents in and out of its dining room, transitioned its addiction recovery meetings to virtual, sent home volunteers and purchased an atomizer to spray a bleach cleaning solution in its restrooms, dining room and hallways. 

To Harris, the outbreak says more about the prevalence of coronavirus in the community at large than it does about Louisville’s homeless population. 

“It’s so prevalent right now in the greater community that it can’t be kept out of hospitals, it can’t be kept out of nursing homes and it can’t be left out of shelters,” she said. 

A room in an abandoned building belonging to a man served by the homeless outreach group Feed Louisville. The man, who did not wish to be named, lost his job due to the pandemic and vacated his home after he could no longer pay rent.

SHELTER STRAIN

Keck is not on disability, but Price thinks he’s an ideal candidate for the government program. 

But like Wayside, the St. John Center can no longer allow volunteers to enter the building, and that means the Legal Aid Society lawyers who used to help clients apply for disability can’t do so in person anymore, leaving some people like Keck waiting. This led to a 50% drop in the number of disability claims that St. John clients were able to file this past year, said Price.

St. John has strived to continue to provide the same resources it always has during the coronavirus. And it’s mostly been able to do so, through daily, problem-solving “situation room” meetings, donations from the community and staff members taking on different roles.

St. John has continued to offer clients housing counseling, employment services and help gathering documents such as social security cards and state-issued IDs. The Center also still has people go out five days a week on outreach missions. 

This past calendar year, the Center helped move 226 people who were homeless into housing, more than its goal of 200. And, it has taken on a new task of distributing masks. Since COVID-19, St. John has given away thousands.

But, there are some areas where St. John has not been able to make up for the complications caused by COVID — like with disability claims, for example. The amount of people the Center sees each day has also dropped to 100 from 175 with its new rotation schedule. 

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This, along with other loss of services during COVID, has had a negative impact on people who are homeless in Louisville, Price said. 

“It added to the level of anxiety and in some cases despair,” she said. 

Some opportunities have started to slowly come back. At the beginning of the pandemic, landlords stopped showing apartments, so St. John’s efforts to find housing for clients stalled. Now, that is no longer a barrier. And, the Louisville library, a de facto day shelter for many of the city’s homeless citizens, has started allowing people to visit again to use computers. 

But, where there has been progress, there have also been setbacks. In July, St. John started allowing volunteers again. But in November, when cases spiked in Kentucky again, they were banished. 

Price said she’s not sure when volunteers will be able to come back.

“We’re trying to figure that out. Previously, when [the positivity rate] was below 8% we felt OK about bringing volunteers back,” she said. “So, this time we kind of hunkered down and said let’s get through the New Year’s bump — thinking there would be another uptick, which if yesterday’s cases was indication, we’re in it — and take it from there.”

Donny Greene and his daughter Brynne with Feed Louisville pack up a truck with food and supplies for the houseless community.

OUTREACH

Donny Greene, his 20-year-old daughter Brynne Greene and his crew of volunteers, many of them regulars at Jefferson Square Park, go out five to seven days a week — handing out 300 to 500 meals, clothing, Sterno fuel cans and other supplies to people living in abandoned homes and in encampments across Louisville. 

Greene was doing this work before the pandemic, but his output has increased drastically since the beginning of COVID when he helped start Feed Louisville. Now, the 55-year-old and his rotating crew of 30 distribute food from Louisville restaurants. Last Tuesday, his haul included meals from Burger Boy, baked goods from Farm to Fork and personal pizzas from Pizza Hut. The Greenes and other volunteers started loading supplies into a white van at 3 p.m. and didn’t stop delivering goods until around 1 a.m..

Outreach groups differ from other homeless services in that they reach people where they are and serve those who are the most detached from society. Many are grassroots groups.

“I mean I hate to paint this bleak picture but, let’s put it this way, I’d love to be sitting at home, petting my dog and not have to worry about any of this, but the fact is that no one is coming to save us,” said Greene. “The city government isn’t coming to save us, the federal government isn’t coming to save us, the state government isn’t going to come save us. The only people that are going to save us is us. No one saves us but us, it’s just that simple. Community has to save community. That’s the only way it’s going to work, because no one else cares.”

Greene’s outreach work may have picked up during COVID, but he’s filling in a gap that has widened during the pandemic. 

One man Greene served on Tuesday, Rick, has been living in a camp near downtown Louisville for two years with his wife, sustained by vehicles baring clothing and cans of portable heat. But, the 64-year-old who declined to give his last name, said he’s seen fewer coming to the camp since COVID started. 

“It’s been really bad. Everyone’s shied away and scared to come because of the virus,” he said. “It’s all changed. And it’s really hard to get the things that we need as far as clothes and stuff like that.”

Harris, with the Coalition for the Homeless, said outreach groups are still going out, but some are not able to serve as much as they used to, because they’re keeping their volunteer pool small to avoid exposure. 

The pandemic has complicated things for all types of homelessness service providers, according to Harris. The situation needs to stabilize for the Coalition and its organizations to get back to their root work: Ending homelessness. But, Harris does not think that can be done until a vaccine is distributed to everyone.

“I think that has to happen first and until people feel like they can go out again, it’s going to be really hard to focus on anything else,” she said.  

The hands of Marty Keck, 58. Keck, who became homeless during the pandemic, said he would probably take a vaccine if offered.

VACCINE DISTRIBUTION

There is no special vaccine prioritization for those who are homeless. Not in the federal government’s distribution suggestions and not in the state’s. There are categories that people who are homeless could fall into, such as essential workers, those with certain diseases and older citizens, but there is no special designation for them. 

The closest thing is a prioritization for people living in congregate settings, such as shelters, who will be vaccinated in Phase 2, said Mendel: which comes after essential workers but before healthy individuals ages 16 to 39. 

Price said she is disappointed that people who are homeless are not in the first tier, which is reserved for health care workers and those living in long-term care facilities. 

Mendel said prioritization is a balance of who is more likely to be exposed and who is more likely to have a worse reaction to COVID-19. She also said that “ensuring equity in vaccine distribution” is one of the local health department’s goals. 

“We’re just limited by amount,” she said. 

Harris said that she’s trying to be patient, and she understands that there isn’t enough vaccine to go around at this point. In the meantime, the health department is prioritizing people who work at shelters, she said. 

“That’s why I think it’s a good compromise, to go ahead and at least get the staff vaccinated, so that there will be shelters to stay open for the people that need to be vaccinated,” she said. 

Harris also said she expected people who are homeless to be lower on the prioritization list because the government needs time to figure out how to make sure they receive their second dose.

Mendel said that the health department is “really looking forward” to a vaccine being approved in the United States that only requires one dose. That would be ideal for vaccinating people who are homeless. Small vaccination sites at community centers, possibly including shelters, will also help vaccinate those with the least access, including people who are homeless, said Mendel. Currently, there is only one, mass vaccination site in Louisville. 

Keck said he feels comfortable with his place in line for a vaccine. He’s heard advice from some people not to take it, but he says he probably will. 

The man who LEO spoke to who lives in an abandoned home said he wants to take the vaccine, too, but he feels as if poor people are a low priority. 

“Truthfully, you feel that we’re the last on the line to get it,” he said.