Tag: Jeff Duchin

Health, homelessness, human services, King County

County’s COVID Response System Was Ill-Prepared for Major Homeless Shelter Outbreak
Image via City of Seattle.

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.

“The optimal strategy is [for shelter guests] to isolate and quarantine in a safe and separate facility from others, but that’s just not possible right now.”—King County Public Health Officer Dr. Jeff Duchin

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.

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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.” Continue reading “County’s COVID Response System Was Ill-Prepared for Major Homeless Shelter Outbreak” →

Addiction, Featured, Health, homelessness, Mayor Durkan, Mental Health

Emergency Orders, School Cancellations, and Planning for Those Who Can’t “Quarantine At Home”

 

Don’t panic, but also, sort of panic.

That was the message during a press conference on new state and local orders to contain the COVID-19 epidemic this morning, when Governor Jay Inslee and King County Executive Dow Constantine announced that all large group events are effectively canceled. Inslee’s order bans all gatherings of more than 250 people, including family gatherings, in King, Pierce, and Snohomish Counties; the county’s order, which was signed by King County Public Health officer Dr. Jeff Duchin, bans gatherings smaller than 250 people unless the organizer can guarantee that they are following every CDC recommendation to contain the spread of the virus. Later in the day, Seattle Public Schools announced it was closing schools starting tomorrow, and the Seattle Public Library board was meeting to discuss potential closures.

Meanwhile, King County Department of Community and Human Services Director Leo Flor told me that a motel in Kent purchased by the county to house patients who can’t be quarantined at home (including both people without homes to go to as well as those who share their homes with vulnerable people) just accepted its first patient, a King County residents. The county, he said, is still working out plans to redistribute people currently living in close quarters in shelters, both by locating large indoor spaces like the Seattle Center Exhibition Hall, where the Downtown Emergency Service Center shelter moved some residents on Monday, and by distributing motel vouchers to people who are not infected but are especially vulnerable to the virus.

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So what do you need to know? Here are the basics, along with a few more specific details about planning for people experiencing homelessness, who are highly vulnerable to the novel coronavirus because of preexisting health conditions, substandard living environments, and lack of access to quality health care.

• Gatherings of 250 or more people will be prohibited until at least the end of March in King, Pierce and Snohomish Counties, an order that Gov. Inslee said would likely be extended and expanded to include more parts of the state.

The goal here is to slow, not prevent, the spread of the illness so that hospitals aren’t slammed with thousands of new cases all at once. “We do not want to see an avalanche of people coming into our hospitals with limited capacity,” Inslee said.

“We recognize that isolation and quarantine are going to be difficult settings for the people in them to be in, and the ability to provide behavioral health on site or by telephone to anybody who’s in one of those facilities is one of our top priorities.” — Leo Flor, King County

Inslee emphasized that the law is “legally binding on all Washingtonians,” but said he did not anticipate having to use state police or the National Guard to enforce it. “The penalties are, you might be killing your granddad if you don’t do it,” Inslee said.

• Gatherings of fewer than 250 people are also prohibited in King County, unless the organizers abide by guidelines established by the Centers for Disease Control to prevent spread of the virus, including social distancing (the CDC recommends six feet), employee health checks, access to soap and water, and other sanitation measures. “Temporarily banning social and recreational gatherings that bring people together will help to ensure that a health crisis does not become a humanitarian disaster,” Constantine said. “Below 250, we thought people, business owners, could take measures to keep people apart,” Inslee says. However, “We do not want to see people shoulder to shoulder in bars from now on. That is just totally unacceptable.”

Duchin said the new rules would allow some flexibility for groups where maintaining six feet of distance is impossible, and Constantine added that the county will be issuing additional guidelines for “restaurants,  grocery stores, and other institutions,” and that enforcement would be complaint-based. Continue reading “Emergency Orders, School Cancellations, and Planning for Those Who Can’t “Quarantine At Home”” →