Updated April 29, 2020
We are grateful to be part of a community that values public health expertise. The efforts of so many to follow ‘stay at home’, hygiene and social distancing guidance is making a big difference for DESC clients and the community as a whole.
Some very good news
Thus far, with one exception, we have avoided clusters of COVID infections in DESC programs. DESC operates 20 places where people reside either permanently (13 supportive housing buildings) or temporarily (six shelters and the Crisis Solutions Center). We have had people with COVID in five of those 20 residential locations so far. All but one had only one or two residents with positive COVID test results, without evidence of further outbreak.
Instances of COVID among people who are homeless is definitely increasing in our region and at DESC, but we have avoided significant clusters of outbreaks for the most part. As of today, we know of 27 DESC clients with a confirmed positive COVID test. Four clients were in two of our emergency shelters. Two of our supportive housing buildings have had positive cases, as has the Crisis Solutions Center. Ten behavioral health clients not staying in a DESC residential site had positive COVID tests.
27 cases of COVID is not a negligible number, but it compares against more than 3,000 current clients across all DESC programs.
How have we avoided outbreaks in almost all sites? We can’t be certain why, and it could be due to chance alone. But we have quickly put in place a robust, public health-oriented, set of actions that we think is contributing to lower bad outcomes than would otherwise be happening. These actions include:
- Actively identify and follow up on possible COVID cases. An internal COVID team comprised of DESC medical and program leaders meets seven days per week to actively identify possible COVID cases, and quickly arrange for testing, quarantine, and preliminary contact tracing. This team is essentially an internal DESC public health unit, and has reoriented the work of some of DESC’s medical staff, who normally provide psychiatric care.
- Arrange for as much testing as we can get. Our main testing partners are Harborview Medical Center, Seattle Flu Study, King County Public Health, Neighborcare Health, and Swedish Medical Center. Together, we have managed to get many hundreds of clients tested across nearly every DESC program site. We are a long way from doing the routine, universal testing the CDC advises for homeless service settings, but as supplies open up, we’re grateful to excellent partners working with us.
- Dramatically improve physical distancing among our clients. We reduced numbers in congregate settings, spreading clients out across additional spaces, and ultimately moving entire congregate shelter operations to a hotel so clients can stay in individual rooms. We have also curtailed group services of all kinds. We still have about 250 clients staying in congregate locations we’d like to move to individual rooms, but the improvements we’ve made are encouraging.
- Support our clients to be able to “stay at home.” Like all of us, DESC housing tenants and shelter guests typically go out into the community to get their medicines, meals, etc. To avoid unnecessary trips and group gatherings, we have been delivering meals and medicine directly to clients at their apartments/rooms or sleeping spaces three times a day so they can stay in and not be in close contact with others. We’ve increased daily meal service by 450%, thanks to help from partners FareStart, OSL-Operation Sack Lunch and Food LifeLine.
- Clean, disinfect, and use PPE (and “PPE”). Stepped up protocols for regular cleaning and disinfecting of high-touch surfaces and common areas have been in place since the beginning of the crisis. We struggle to get full medical PPE, but now have a supply of surgical masks, face shields, and goggles for staff. Thanks to dozens of volunteers, we also have cloth masks for all clients and are encouraging their use.
- Rapid referral to isolation and quarantine sites, followed by blanket testing. Upon finding that a client has a positive COVID test, we arrange to have that person isolated at a County facility until they can safely return. Isolating people with COVID is important, given the medically frailty of many of the people living in our programs. We work with King County Public Health for broad follow-up testing of clients and staff in the facility, seeking to determine if a cluster of cases may already be present.
And more, but those are most of the main areas of additional activity. Our work is challenging on a good day, so implementing so much change so fast has taken everything we have. Even with all of these efforts, we have been touched by COVID. But, our quick and dramatic steps to implement these prevention and response measures have been crucial to the success we are having.
Now for some hard news
Two DESC clients have died from COVID, and we have one DESC service location with a cluster of positive COVID cases.
One of our permanent supportive housing program sites developed a cluster of eight positive COVID cases among clients thus far, plus one staff person. Nearly all of the regular staff for this program needed to go out on quarantine for two weeks because they had enough close contact with one or more of the clients with a positive test. Covering the operations during this time has been done by a variety of other staff from across DESC.
A healthier future
DESC has long been an organization that is difficult to categorize. Inarguably we are a health care provider, evidenced by the doctors and nurses we have on staff. But most of our work, while squarely focused on improving the health of our clients, is not the direct provision of health care services. We spend most of our effort addressing the basic needs of people in order to improve their circumstances. Those efforts in fact have the largest effect on the health of our clients. It is the way we say in words and actions that our clients matter and deserve better than they have been getting, that we are able to help them across a spectrum of recovery.
This crisis has accelerated our thinking about changing how and in what settings we serve our clients. Congregate settings have long served a purpose to get many people into a safe, dry environment where care can be provided. But the drawbacks have always been apparent. It’s really hard to cast off the stress of homelessness when you are always in the same space with others who are also struggling. The introduction of this virus has highlighted another drawback to congregate settings: you can’t achieve optimal separation of people in shared spaces to prevent the spread of COVID.
We have relocated our most densely-populated congregate shelters into a hotel building, thanks to support from local government partners. And, the initial effects have been profound. First, no new COVID cases have emerged. But every bit as important is the difference that could be seen immediately upon moving 200 people from congregate bunk rooms to the hotel rooms. The new space is calmer and quieter, clients are reporting lowered stress, and staff are reporting less tension among clients and that many people show a greater openness to exploring additional services including behavioral health care.
For so many reasons, including the current COVID public health crisis and the ongoing public health crisis of homelessness, it is critical that we find a way not to return to the status quo of sheltering people in densely-packed settings where people have no real ability to decompress.
Taking these actions has cost DESC a lot
Virtually all of our staff have had to make major changes to the work they do and the settings in which they do it. That puts extra strain on people who also have to deal with the same societal upheaval and uncertainty as everyone else. Most of our staff are doing work that is truly essential to the wellbeing of not just our clients but the community at large. However, because our staff aren’t always thought of as “health care” workers, they don’t get the same level of recognition and appreciation as other essential workers. So, we have been especially appreciative of the notes, comments, cupcakes, and pizzas that have come our way.
We are also spending much more money than normal to carry out all of our work. Fortunately, we have received very generous financial support totaling around $2 million to help with our substantial additional costs. This funding is a true lifeline to us, and will keep us going through May.
To be honest, we’re pretty anxious about what happens after May. All signs point to the need to continue the additional work we have taken on. Our clients will still be among the most vulnerable in the event they become COVID-positive, and to help the community avoid new outbreaks of virus transmission we need to make sure people are not in close quarters.
The large majority of our extra spending thus far is being covered by one-time private donations made by our wonderful supporters large and small. We will need new, sustained funding to continue the services we deliver. We will also need a public/government commitment to take the lessons from this crisis without reverting back to some of the approaches that put people’s health and well-being at risk.
Public health is one of those mostly invisible parts of our societal infrastructure that usually isn’t much thought about until moments like these. Totally necessary, but so much of what it does to protect us isn’t known because it keeps bad or worse things from happening. To be effective, public health needs to be funded adequately, before a crisis hits. And DESC and other organizations need to be understood as key components of a public health system that can respond appropriately to community needs. At DESC we are trying our best to follow public health principles, and it appears to be paying dividends. We have far to go still, but can see a brighter future.
Please help us make sure we can sustain our current activities and garner the public resources needed to cement the gains we have been able to make in the beginning phase of this great crisis.
Thank you for your continued support of our important work.
Our previous updates available here.