Homeless Shelters Spared the Worst

Revealing a lot about the best ways to handle the pandemic, Miami-Dade’s homeless shelters have recorded remarkably few COVID-19 cases during the past eight months.

Remarkable, because when the virus started spreading in March, experts predicted that homeless facilities – along with jails and nursing homes – would be the hardest hit. And while they were right about jails and nursing homes, they’ve been proven wrong about shelters.

Locally, only four of the estimated 3,560 homeless people in the area have died because of the virus, according to Miami-Dade County Homeless Trust statistics through Nov. 11. And after 9,000-plus COVID-19 tests of the homeless and shelter staff, under 2% have tested positive.

“Hospitalizations have been almost nonexistent,” said Ron Book, Homeless Trust chairman.

But it was a long, tough road to get there.

“At the beginning, it was alarming,” said Antonio Villasuso, programs director of Miami Rescue Mission. “We made adjustments. We adapted. We overcame.”

Early on, there were horrific national examples. A San Francisco shelter had two-thirds of its residents test positive, reported Health Day News. In a Boston shelter, it was 36%.

“Many shelters are crowded, and social distancing can be difficult, if not impossible,” said Teresa Murray Amato, a New York emergency medicine leader.

What’s more, many of the homeless have underlying medical conditions that make them more vulnerable to COVID-19.

Earlier this year, while medical experts quickly raised alarms, President Donald Trump brushed off concerns. Speaking of the coronavirus on Feb. 10, he said that as soon as there was warm weather, “it miraculously goes away.”

In fact, leaders of four major Miami-Dade shelters and the Homeless Trust told this reporter that they decided to focus on the advice of scientists, not politicians.

“It was during the last week in February,” said Book, “we were directing our teams to follow what we were being told by the CDC. We were listening to Dr. [Anthony] Fauci. The Florida Department of Health. We were talking to a lot of people.”

“We jumped right in,” said Hilda Fernandez, chief executive of Camillus House. The first email of Miami-Dade homeless leaders seeking advice from health officials was sent Feb. 27 – three days before the first documented COVID-19 case in Florida.

First came meticulous cleaning.

“We bought pricy equipment, scheduled spray downs, wiping down surfaces, doorways, spraying the hallways,” said Fernandez, who also shared that Camillus House bought five ozone generators to purify air.

The shelters required social distancing, wearing masks, temperature checks and COVID-19 testing, as soon as test kits became available.

The first days were especially trying. In early March, said Book, a woman staying at Lotus House, a shelter for women and children, was asked where she’d been when she returned for the night. She said she’d had a day job cleaning a school in Bay Harbor.

“Neon lights went off,” Book recalled. The school had just been closed because an employee was one of the first in the county to get the virus. “We immediately isolated and quarantined her. She never got infected. She was fine. But we waited a full two weeks, till she tested negative.”

A short time later, at Chapman North, two male residents told a staffer on a Saturday night that they weren’t feeling well, with a cough and light fever. Book said a staffer immediately called 911. The two were taken to Jackson Memorial ER. One was admitted to the hospital. The other returned to Chapman and asked to be let in. Book was called at home. It was past 10 p.m. on a Saturday night.

“We were all flying by the seat of our pants,” Book said. Better to be safe than sorry, he decided.

“Luckily, the day before we had signed a contract with the Dunns Josephine Hotel in Overtown [to isolate homeless persons infected or potentially infected with COVID-19], less than a mile from Chapman North,” Book recalled.

But how to get the guy there? The staff lacked personal protection gear. Public and private ambulances refused to move him. The solution: A staff member walked on one side of the street, while the infected resident walked on the other side to the hotel.

Eventually, to quarantine infected residents and protect the most vulnerable, the Trust contracted with five area facilities, including the Dunns Josephine; Mia Casa, an assisted living facility in North Miami; two hotels near the airport; and another hotel in Homestead. About 200 homeless seniors – the demographic most susceptible to the virus – were taken from regular shelters and placed in these other facilities.

“I’m convinced that was one of the real keys [to our success] – getting those senior citizens out of harm’s way,” said Book.

By March 9, the Lazarus Project at Camillus House and the Green Shirts, the Trust’s outreach workers, were educating about 1,000 unsheltered homeless persons on the streets of the county. They distributed hand sanitizer and face coverings and provided information materials in three languages.

Test kits were hard to come by in the early days, but by mid-April, outreach workers were testing the unsheltered, said Clarissa Hazel, program supervisor for the Lazarus Project.

“We’d take them to the nearest wash station,” test them, offer showers and clean clothes, she said, and added that warnings about the virus were well received. “We already have a relationship,” so the advice wasn’t coming from strangers. Shelter leaders overall agreed that residents were generally accepting of the new regimen.

Symeria Hudson, chief executive of the Chapman Partnership, said, “We constantly communicated and followed CDC guidelines. We didn’t have any issues at all at either campus. No issues at all. No mask, no service. We let them know. Everybody wants to be safe.”

A key factor in maintaining safety is that people generally don’t just stroll into a local shelter and ask to stay the night. The Trust screens potential shelter residents at a separate location, including testing for the virus, before they’re able to enter a facility.

Hudson said Chapman was boosted by its volunteers providing hand sanitizers and such. Volunteers also used the internet to read to children and provide virtual yoga sessions. And while some shelters have reduced capacity in order to create more distance between beds in dormitories, Hudson said, “Early on we worked with the CDC about communal settings and the best way to set out dormitories with head to toe sleeping arrangements. We got a diagram from the CDC for best distancing. We have not had to reduce the 800 beds we have on the two campuses.”

Camillus House, which has three large dorms, decided at the height of the pandemic last spring that it needed to be strict about comings and goings. Residents were allowed out for specific reasons, only – such as a doctor’s appointment or court date. They were required to show a pass to get back in. 

“It was an extreme measure,” said Fernandez. “It was controversial, but people understood.”

When residents complained about not being allowed to go to a convenience store to buy cigarettes and snacks, Camillus House created an in-shelter commissary to sell those items at cost. The facility also offered movies and bingo, with proper social distancing.

In May, recalled Fernandez, “a woman wanted to be home for Mother’s Day.” The staff explained that if she went and returned, she would be risking her own health, as well as that of many in Camillus House. “She understood and we moved on.”

When the county reduced restrictions, so did Camillus House, offering more frequent passes.

“The bottom line – we had to adjust, and we have adjusted,” said Fernandez. 

The result: The shelter went more than two months without a positive case.

Lotus House, which serves more than 500 women and children in smaller living units rather than dormitories, was more flexible with residents.

“They’re free to come and go during the day,” said Constance Collins, Lotus House president. “We do have a 9 p.m. curfew. We do know that there are extremely high levels of stress – just to walk around the block can do a great deal. We did increase our mental health supports during the pandemic.”

Continuing, Collins added, “We try to educate people. To live in this shelter a mask is required. We have a culture of mask-wearing even among our children. And 99% of people comply with that.”

At Miami Rescue Mission, policies of masks and distancing met with some pushback.

“Some have been very grateful, and some have been upset,” said Villasuso. “We try to work with people. We try to educate people.”

The organization set up tents in the parking lot to accommodate distanced diners.

At Lotus House, staff extended dining hours to make up for social distancing. When day care and summer camps closed down, they stepped up activities for kids, but as schools reopened this fall, the shelter expected students to attend in person. Mothers need the break school hours bring for their own training and job-hunting.

“It’s not really optional for us to do on-line schooling.” Collins said.

Elsewhere in the United States, the response of homeless shelters has been generally successful in recent months – far more successful than the country as a whole, which has seen marked increases in recent weeks in many areas, especially in places where people feel they are making political statements by not wearing masks and ignoring social distancing.

Researchers say it’s hard to track health records of the homeless because hospital and death certificates don’t reveal housing status, but throughout the nation, shelters appear to have performed well by strictly following scientists’ guidelines.

Some big cities, including New York, have used hotels to quarantine the most vulnerable. San Diego used its massive convention center to house up to 1,200 at safe distances.

“Nobody wants to declare victory because we’re not out of this yet,” said Hudson. “But we make sure we follow best practices.”

Nationwide, it’s estimated that 10 million people are behind on their rent or mortgages, suggesting the ranks of the homeless could soar.

“I think the demand in the coming year [will be] off the chart,” said Collins.

Said Book, “We are frightened by the path of what the future holds. … Thousands of people [could be] evicted. Our community will suffer immeasurably. I don’t have a good answer, but we’re working on it every day.”