WORCESTER MEDICINE
COVID-19
Helping the Homeless During the Pandemic Erik Garcia, MD
T
o be homeless is to be vulnerable and that’s never been
starkly demonstrated than during COVID-19 times. Social distancing and voluntary self-quarantine – now familiar methods for protecting self and others (1) – are often not possible when you have no place to call your own. Homeless people face a choice: exposure to the virus or exposure to the elements. In early March, I was struck by the contrary observation that COVID-19 began as a disease of relative social privilege, infecting those who travelled internationally (2) or interacted with those who had. The Biogen Conference in Boston resulted in the first “superspreading” event in Massachusetts, resulting in over 90 documented cases. Before long, virus bearing the same genetic markers would enter Boston’s homeless shelter population and become linked to 40% of all COVID-19 infections in the Boston area. (3). It was during this window of time in early March that Worcester chose to act. Worcester’s response to COVID-19 and homelessness focused on the SMOC shelter at 25 Queen Street, the only open access emergency shelter in Worcester. Built as a 23-bed rapid rehousing facility in 2013, the population swells to five times that capacity in the winter and spring, frequently topping 130 individuals plus staff. The resultant overcrowding puts residents at particular risk for COVID-19 infection – with no capacity for social distancing and often lacking basic sanitation supplies. To address this threat, Dr. Mattie Castile and City Manager Ed Augustus brought together leadership from UMass Memorial, St. Vincent’s and the Family Health Center in a collaborative effort I haven’t seen in my nearly 30 years as a physician in Worcester. The response was two-fold: Open three satellite shelters – each with a 25-bed capacity – to limit overcrowding at the SMOC shelter, and open a COVID-19 shelter to house patients under investigation and to quarantine COVID-19 positive homeless persons. Family Health Center’s Adam Bliss NP and I ran the shelter with a group of amazing volunteers, providing food, shelter and medical respite 24/7 throughout the month of April. The crucial support has to be credited to the Worcester EMS, though. Under the leadership of John Broach MD, they performed weekly testing of all shelter residents on site and established a transportation “hot line” helping me shuttle those who tested positive to the shelter. We initially housed patients at the vocational high school but had to scramble to move into the DCU in week two, when 53 patients tested positive, far outstripping capacity there. In three hours, we dismantled half of the field hospital set up in the DCU by the Army Corp of Engineers and converted it into a 60-bed capacity shelter with separate housing for men and women, a dining and common area and a medical station. That month would see a total of 99 residents – 45% of the SMOC shelter population – test positive and stay with us and our volunteers. more
Part 3
We would have three overdoses (all revived), one wall collapse (no injuries), two COVID-19 negative “guests” who heard that we ran a nice shelter and snuck in, and one COVID-19-related death. Adam would gain 30 lbs (which he has since lost) and I would develop GERD, which is finally resolving. No volunteer would get infected, and we would all come to appreciate the importance of strong city leadership and its role in fostering collaboration among the Medical Community of Worcester. We also learned and reinforced some difficult lessons throughout this process. The burden of transporting patients fell entirely on the Worcester EMS as the private ambulance services found no profit in the task. We were constantly pushing back against efforts to legally enforce mandatory quarantines directed solely at homeless persons. And most importantly, we saw the need to providing safe, accessible housing options for homeless individuals, as nearly half of the shelter population would become infected with COVID-19 despite all of our efforts. As fall’s approach becomes more evident on my early morning jogs, I see the need to change our current reliance on a single 23-bed facility to house hundreds of Worcester’s homeless residents without having to rely on emergency measures, but I am warmed by the knowledge that our city’s health is in the hands of organizations that will rise to meet the needs of our most vulnerable citizens. + references:
1. Physical distancing, face masks and eye protection to prevent person to person transmission of SARS-CoV-2 and COVID-19: a systemic review and meta-analysis. Chu DK, Akl EA, Duda S, et al. Lancet, 2020. 2. Evidence for Limited Early Spread of Covid-19 Within the United States, January-February 2020. Morbidity and Mortality Weekly Report, June 5, 2020/69(22)680-684 3. Phylogenetic Analysis of SARS CoV-2 in the Boston Area. Prepublication release, August 25,2020. Erik Garcia, MD, Assistant Professor in the UMass department of Family Medicine and Community Health and the Medical Director of the Homeless Outreach and Advocacy Project, Family Health Center
NOVEMBER / DECEMBER 2020
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