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Isolation helps homeless people escape worst virus

OAKLAND, California – Underneath an overpass in downtown Oakland, Camilla Everette sleeps on a sofa, with a blue and white striped summer umbrella providing the only protection from raindrops falling from the concrete above her.

One of the first things Ms Everette sees when she wakes up each morning is a giant billboard featuring happy families wearing Christmas sweaters and felt-fringed Santa hats. There are glasses of red wine on the table in front of them and a ominous warning: “Do not invite Covid-19 home for the holidays. Wear a mask. “

Ms Everette’s living conditions and those of many others like her – the isolation and lack of indoor shelters – appear to have helped prevent the most dire predictions about the spread of the coronavirus among the homeless from occurring. achieve.

At the start of the pandemic, health officials were terrified that the virus would wipe out homeless Americans, the half a million people who live in shelters or on the streets. At the end of the year, these same specialists say they are relieved that street camps and homeless shelters have not suffered the same devastation as retirement homes.

Experts warn that the transient nature of homelessness makes it difficult to collect accurate data. And they remain anxious as overall rates of the virus have skyrocketed throughout the fall. A recent epidemic in a San Diego shelter has reminded that homeless populations, especially those housed inside, are still very vulnerable to the dangers of Covid-19.

“It’s pretty clear in protected settings that when infections get in, they spread very quickly,” said Dr. Margot Kushel, director of the Center for Vulnerable Populations at the University of California at San Francisco.

Still, researchers and public health officials across the country have been testing camps and homeless shelters, looking for signs of epidemics. And in places like Seattle and Los Angeles, those tests have revealed relatively low infection rates.

Seattle infectious disease physician Dr Helen Chu, who has one of the highest homelessness rates in the country, has helped run 2,500 shelter tests during the pandemic. Only 15 of the tests, less than 1%, came back positive for the coronavirus.

“I had assumed it would be terrible in the homeless population because of the way other viruses are circulating,” Dr Chu said. “It turned out to be about less serious than I would have thought.”

Experts say that among the reasons for the better-than-expected results are programs in California and New York, the states with the largest homeless populations, to provide thousands of hotel rooms for homeless people. shelter the most vulnerable. Hotel rooms are also available for homeless people who show symptoms or come in close contact with infected people.

Homeless shelters and settlements are “yet another powder keg for virus transmission,” said Dr Harrison Alter, acting medical director of Alameda County Health Care for the Homeless, across the country. San Francisco Bay. “But we have a system in place that so far – knocking wood – has suppressed viral transmission.”

Of the 3,200 coronavirus tests the organization performed in Oakland, 2.9% were positive.

On a recent morning in Oakland, Dr Alter led a team of outreach workers through homeless camps offering masks, soap, medicine and coronavirus tests.

They approached Jon Bartell Jr., who lives in a tent on the edge of a park.

Mr Bartell said he was not too concerned about the coronavirus as his situation allowed for almost full-time social distancing. He’s rarely indoors, avoids crowds, and stays away from public transportation. “I feel pretty safe in this park,” he says. “I don’t know anyone who has Covid – no one.”

In California, the vast majority of homeless people are homeless, a dismal and long-standing crisis that may have been protective during the pandemic.

“The ventilation is good and the exterior is safer,” Dr. Kushel said. “It’s a perverse advantage that so many people aren’t sheltered.”

Preparation also helped. In March and April, San Diego officials closed crowded shelters and converted the city’s convention center into a gigantic, socially remote dormitory. The occupants slept in beds six feet apart and were not allowed to eat in groups; the wearing of the mask was compulsory and strictly enforced. The oldest and the most infirm were given hotel rooms.

“We got together and said how to protect this population?” said Ashley Bailey, spokesperson for the city of San Diego. “We redesigned a shelter.”

From April to early November, regular tests revealed 27 positive results at the convention center. But after Thanksgiving, officials were blinded by an increase in cases: more than 150 shelter residents have tested positive. Indoor homeless shelters can appear resilient for months – then suddenly signal large outbreaks.

For decades, studies have shown that death rates among the homeless are three to eight times higher than those in the general population. The reasons are many, including drug use, lack of medical care and the wear and tear of life on the streets. Studies have also shown that the homeless tend to have higher rates of respiratory infections than the general population.

It is difficult to know for sure whether homeless people infected with the coronavirus are dying at higher rates than the general population. In California, where about 150,000 people are homeless, death certificates do not indicate whether someone was housed or not.

But tracking the health outcomes of homeless people in New York City is a little easier because a much higher percentage of homeless people live in shelters. And the data from there seems to show an increased likelihood of coronavirus deaths among the homeless.

At the end of October, 95 people living in homeless shelters had died from the virus in New York City, a death rate of 146 per 100,000 people. This is less than the 231 deaths per 100,000 in the general population for the same period.

But when the death rate for residents of homeless shelters is adjusted for age, which epidemiologists deem necessary because there are many children in shelters, the adjusted rate is 76 percent. higher than the general population. The calculation was performed by Dr. Chuck Cleland, associate professor of biostatistics at the Grossman School of Medicine at New York University. Epidemiologists say a higher death rate among the homeless could be due to limited access to health care and pre-existing conditions.

Overall, however, there are indications that per capita cases among New York’s homeless population have been lower than the city’s general population.

New York City has recorded 1,815 cases of coronavirus among the homeless, a rate of 180 cases per 10,000 homeless, according to city calculations.

The rate for the city’s general population is significantly higher: 447 cases per 10,000 people, according to a New York Times database of coronavirus cases across the country.

Los Angeles, which has the fewest homeless people in the country, has recorded 63 deaths from the virus among the homeless, according to the Los Angeles County Department of Public Health.

“This population, at least in Los Angeles, is not dying at an alarming rate from Covid,” said Dr Heidi Behforouz, a county medical official who focuses on homelessness.

Yet Dr Behforouz describes what she calls the collateral damage of the pandemic.

“We have lost so many people, not only to this virus, but also to loneliness and anxiety, fear and isolation,” Dr Behforouz said.

Los Angeles, San Francisco and other cities in California have reported huge spikes in drug overdose deaths among homeless people on the streets.

Even as concerns about infections persist, epidemiologists have recognized that distributing the coronavirus vaccine to homeless people will also present many challenges.

Although shelter workers were not explicitly cited for priority allocation, members of an expert advisory group to the Centers for Disease Control and Prevention recently said that local health districts have the discretion to view them as essential front-line agents.

This would put them in a priority assignment group with correctional officers, emergency workers and grocery clerks. When a California health official at the meeting asked about the eligibility of the residents of the shelters themselves, committee members said local officials had the discretion to vaccinate them simultaneously with workers.

But vaccinating the homeless who do not live in shelters worries health officials. Officials at the meeting feared that the homeless, who face physical and mental health challenges and generally resist government authority, may be particularly difficult to persuade to get vaccinated. Long-term planning for their vaccination must begin immediately, they insisted.

For Mrs. Everette, the main challenge of the days to come is to ward off the humidity and cold of the streets. She lamented that her favorite blanket recently disappeared.

“I might not have a building with a roof over my head, but this is my home,” Ms. Everette said of her couch and personal items lying on the sidewalk.

Jan Hoffman contributed reporting from New York.

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