By Erica C. Barnett

On the morning of January 3, hours before an emergency winter weather shelter at Seattle City Hall was scheduled to close, King County Regional Homelessness Authority director Marc Dones and interim Seattle Human Services Department director Tanya Kim showed up to City Hall with an urgent mission: To move as many of the shelter’s COVID-positive guests into private spaces where they could isolate until they were no longer sick.

The task was daunting. King County’s Department of Community and Health Services operates just 179 isolation and quarantine beds, spread between two hotels in Auburn and Kent, and those are reserved for people with the highest risk of complications from COVID.

“I was concerned about community spread,” Dones recalled. “If these are folks who are experiencing unsheltered homelessness, and they come in for the weather, [we don’t want then to] go back to an encampment or meet up with a friend” after being exposed to COVID.

Over the course of a long morning and afternoon, many of the infected shelter guests did make it to hotels, including 16 rooms leased by the Low Income Housing Institute, where LIHI director Sharon Lee said they were able to stay and recuperate for at least 10 days. A smaller number moved to rooms at one of the county’s official isolation and quarantine sites, which admitted a total of 74 people (from anywhere in the county, not just shelters) between Christmas and New Year’s Day. And an unknown number of infected people went back out on the street.

Moving as many people as possible into hotels was “a hail Mary at,like, 7am,” Dones said—one that neither the city nor the county planned for in advance. “Access Transit picked up some folks over the course of the day. The HOPE Team staff were were able, once they got vans, to get people to where they needed to be. And Tanya and I were the on-site staff, keeping folks fed, getting them badged in [to City Hall] to go to the bathroom, all the things.”

By all accounts, the joint effort by HSD, shelter providers, King County, and the regional authority prevented many of those infected at City Hall from going directly back onto the street—a positive outcome for both individual and public health. But the fact that this outcome required a heroic, last-minute effort illustrates the fragility of King County’s system for responding to COVID outbreaks among the region’s homeless population.

Seattle hadn’t planned to open an emergency shelter at City Hall; in all its pre-winter weather planning, the city assumed it would need just two shelters—one run by Compass Housing in Pioneer Square, the other run by the Salvation Army at Seattle Center—to handle the demand. This assumption was based on experience; historically, people living unsheltered have preferred to wait out subfreezing temperatures in their tents rather than risk losing all their possessions to sleep on a cot in a crowded shelter that they are forced to leave at 7am. Nonetheless, after days of temperatures in the teens and 20s, the two shelters were maxed out, and the city contracted with the Urban League to open a third location.

CDC guidelines for congregate (mass) homeless shelters call for maintaining at least six feet between shelter guests at all times, including while guests are asleep, although King County Public Health guidelines acknowledge this may not be possible during emergencies. At peak, between 60 and 70 people were sleeping on cots in the lobby of City Hall. During the day, shelter guests moved to the Bertha Knight Landes Room, an enclosed meeting room with an official pre-pandemic capacity of 200.

It’s unclear exactly how many people were infected during the outbreak, but reports from people who were physically present or who tried to help infected people isolate after the shelter closed on January 3 suggest the number was at least in the dozens, including five of the six Urban League staffers who worked at the site. (The Urban League did not respond to a request for comment.) King County Public Health confirmed the five staff infections but would only confirm one case among shelter guests. This may be because people who stay in homeless shelters, unlike staffers, are not routinely tested for COVID exposure, so their infections do not always show up on official tallies.

Current King County COVID guidelines call for anyone staying in a shelter who develops COVID symptoms to “shelter in place” by moving to another area of the shelter or, if possible, into a designated room for COVID-positive shelter guests. The county recently reduced the isolation period for COVID-infected shelter guests and staff from 10 days to five, and eliminated the quarantine period completely for fully vaccinated people. These new guidelines are in keeping with a recent (and controversial) CDC update, but are out of sync with King County Public Health’s official guidelines for people in congregate settings, including homeless shelters, which call for 10 days of isolation for people with COVID and two weeks of quarantine for those exposed to a COVID-positive person.

The highly transmissible omicron COVID variant has dramatically increased the demand for the county’s limited supply of official isolation and quarantine beds, which include on-site, 24-hour medical staff, behavioral health care providers, and other services.

“This omicron surge is overwhelming the number of  available spots we have in [isolation and quarantine] facilities,” King County’s public health officer, Dr. Jeff Duchin, said. “We’re working to actively acquire more spaces in those facilities, but I don’t believe we’re going to ever be able to keep up with the number of cases that occur. … The optimal strategy is isolate and quarantine in a safe and separate facility from others, but that’s just not possible right now.”

In fact, under current King County guidelines, isolation and quarantine beds are only available to those who are over 50, immunocompromised because of an underlying condition like cancer or untreated HIV, or experiencing “moderate” symptoms such as vomiting, chest tightness, or “profound fatigue and muscle aches.”

“Due to the extent of the current surge and staffing shortage, we will not have sufficient capacity to accept all of those who need to isolate or quarantine,” King County Public Health spokesman Gabriel Spitzer said. “We are moving forward with prioritizing medically staffed [isolation/quarantine] beds for COVID-positive individuals who do not have a safe place to isolate and who are at high risk for severe illness or hospitalization.  We are also implementing shelter-in-place strategies and providing hotel vouchers to low-risk individuals.”

But Dones said that last option has already started to disappear, as hotels that previously served as unofficial isolation sites have begun turning homeless guests away. “Their staff started saying, ‘This is not what we signed up for,'” Dones said. “Last Friday [January 7], I started getting multiple calls from providers all over the county saying, ‘they’re telling us no, they’re telling us no, they’re telling us no. By that evening, I would say that 20 or 30 people probably were not able to be effectively transition” to hotels because the hotels did not want to accept sick guests.

Dones said that as hotels become less available, “I think we have to look at opening additional spaces” to serve the need and prevent COVID from spreading unchecked inside shelters themselves. “We cannot have shelters close. So we are going to have to figure out some path to creating more more space for folks experiencing homelessness who test positive.” One example is the Salvation Army shelter in SoDo, where a formerly vacant area, known as Bay A, was recently converted into a special “COVID care” area for people with COVID symptoms or a positive COVID test.

It’s possible that the latest COVID surge has already peaked, but thousands of new cases are still being reported every week. So far, King County Public Health has not indicated that they plan to open any additional isolation and quarantine sites. “I think we’ll see, in many settings, that the sheer number of people will overwhelm the ability to have everyone move into a separate isolation and quarantine setting. The bottom line is that people will need to do the best they can under very difficult circumstances,” Duchin said. “It’s a very difficult situation for everyone.”

At a meeting of the KCRHA’s governing board last week, Dones said that they plan to make a budget request in the future for “some sort of emergency fund [with] broad flexibility” to use for emergencies like the City Hall shelter crisis earlier this month. Dones said the authority is also establishing a “pooled staffing system” that would allow staffers at homeless service providers (like,  the Downtown Emergency Service Center or LIHI) to fill in at shelters operated by different providers (like the Urban League) in an emergency. Recently, they said, some shelters have been forced to operate with a single staffer—an untenable situation.

“All of our systems, which have been historically underfunded, are now cut to the bone on staffing,” Dones said. “People should know—this is serious. This is a very dire situation that we are in.”