The homeless population is testing positive for the coronavirus in disproportionate numbers compared to the general population – but not in the way many feared.
While homeless shelters and encampments seem like they would be natural breeding grounds for infectious diseases, local officials have reported that the unhoused population appears to be faring well in terms of combating a disease that has exponentially increased in Bexar County in the past month.
Some officials credit the well-coordinated efforts between the City of San Antonio, Haven for Hope, and other homeless service providers aimed at stemming the spread relatively early.
“Of the many dozens of residents that have been tested [at Haven for Hope], the positive rate so far is only about 1 percent,” said Kenny Wilson, Haven’s President and CEO, who noted he couldn’t provide the data to support his claim because of privacy concerns and incomplete information. However, he did say roughly 10-12 residents and about the same number of staff have tested positive since the pandemic reached San Antonio in mid-March.
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Other shelters and homeless encampments across San Antonio also have avoided outbreaks more than four months into the pandemic, said Melody Woosley, director of the City’s Department of Human Services (DHS).
“There hasn’t been that we know of … any kind of an outbreak or a major spread in one of the shelters,” Woosley said. “I think it’s pretty amazing, actually.”
In contrast, of the thousands of tests performed in Bexar County during the past seven days, about 22 percent came back positive, according to the City’s COVID-19 data dashboard.
Homeless shelters, typically indoor facilities managed by nonprofits, have obvious challenges in managing a pandemic as they often are crowded and many unhoused people are older and have underlying health conditions. Encampments are often found outside in fields or under bridges and have different challenges such as access to medical resources.
“People in encampments tend to be a little bit younger” Woosley said, and are therefore less likely to develop severe symptoms or complications.
The nature of the virus – which can be spread before an infected person shows symptoms – presents unique challenges for public health officials in terms of testing and contact tracing, especially when it comes to the particularly vulnerable homeless population.
It’s possible that shelter or encampment residents have the virus, but aren’t showing symptoms, Woosley said. “It’s really no different than the rest of the population. There are people walking around who have it and don’t know it.”
Homeless people are typically tested if they show symptoms or have been in close contact with someone who has tested positive, she said, noting it was similar to broader community testing protocol, but can be harder to find those individuals if they’re not at a shelter.
Haven for Hope, the city’s largest homeless shelter which operates a sprawling campus just northwest of downtown, was one of the last major shelters in the state to stop taking in new residents in March when cities started implementing stay-at-home orders. Early on, it began taking temperatures of all staff and residents as well as quarantining those who felt sick or showed symptoms. It partnered with nearby Margil Academy to serve as an overflow area for Haven’s crowded, outdoor courtyard.
“We have re-opened intake on a very limited basis,” Wilson said, noting that the facility was, as it typically is, at capacity when the pandemic hit with roughly 1,700 residents. Now that has subsided to 1,100 to 1,200.
When a resident gets sick or shows symptoms, they’re taken to an “isolation unit” – a large room with 25 beds – and tested on-site by CentroMed, which operates a clinic on Haven’s campus. Most positive cases are sent to a hotel the City has rented as part of its emergency response to the pandemic. It houses anyone who has tested positive or are suspected to have the virus but don’t have other options for self-isolation. A larger 300-room hotel houses homeless individuals who are older or who have underlying health conditions.
“It’s allowed us to keep anybody sick away from the campus and keep from spreading that infection,” said Wilson, who recently tested negative for the virus after previously feeling ill.
Before the pandemic, the City had launched a comprehensive planning process to mitigate homelessness. Much of that work has been put on hold, but the coronavirus has brought with it valuable lessons about the systems in place (or not in place) to keep residents off the street.
The hotel is also a proving ground for “permanent supportive housing” which gives people a place to stay with wrap-around mental and physical health services.
“We’re having discussions about what we’re learning from all this,” Wilson said. “We have been saying for years that permanent supportive housing is important … the hotel is a beautiful example of that.”
The CentroMed Sarah Davidson Clinic at Haven has tested 1,463 patients – a vast majority of them non-homeless as the clinic serves the broader community, too. Of these 183, or 13 percent, have returned with COVID-19 detected.
The City does not keep a separate running total of results for homeless individuals, Woosley said.
CentroMed doesn’t either, said Delma Ochoa, CentroMed’s director of Homeless Services, “[but] I feel very comfortable saying that the vast majority [of positive] cases are of community, non-homeless individuals.”
The clinic began testing for the coronavirus on June 5, taking over that work from Haven’s staff. The San Antonio Fire Department’s Mobile Integrated Health Unit – a kind of clinic-on-wheels – has continued to provide testing off-site where needed such as other shelters and encampments.
“Being the medical home here at Haven, we have historically been involved in the intake process of all individuals that come onto the transformational [residential] side of the campus,” Ochoa said. Now that role has intensified alongside the public health emergency. It’s ramped up testing and its telehealth offerings.
She’s pleased that outbreaks haven’t yet occurred within the homeless communities and attributes that success to the strong partnerships among service providers. CentroMed participates in weekly teleconferences with the South Alamo Regional Alliance for the Homeless, SAMMinistries, Haven and several other groups to coordinate resources and assistance.
“That’s a reason why up until now we haven’t seen such scary outbreaks,” Ochoa said.