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How does COVID-19 threaten the health of Napa's homeless?
Public health

How does COVID-19 threaten the health of Napa's homeless?

From the Complete coronavirus coverage from the Napa Valley Register, St. Helena Star, and The Weekly Calistogan series

As many Napans scramble to fill their pantries with non-perishables, stockpile hand sanitizer and self-quarantine, hundreds of individuals currently experiencing homelessness are fundamentally unable to take these prescribed precautionary measures.

“The main thing is a lack of options. If you can’t afford food, how will you afford hand wipes or hand gel? And how are you going to stay out of a crowded soup kitchen if that’s the only meal you’ll have all day?” said Elise Riley, a professor at the University of California, San Francisco whose research specializes in the spread of infectious diseases among the homeless.

Napa County declared a public health emergency Thursday, joining the list of 33 other California jurisdictions that have decided to free up funds and resources to accelerate the response to the coronavirus. Out of the nine Bay Area counties, Napa is the only one to have zero reported cases of the virus as of Monday morning.

COVID-19, a novel strain of the coronavirus family, has infected upwards of 127,000 people and killed more than 4,700 at last count, according to Johns Hopkins University. In California alone, there have been more than 335 cases and six deaths as of Sunday, the live tracker shows

Homeless individuals are some of the most vulnerable to this virus and, really, any illness that requires an already-compromised immune system to work overtime, according to experts.

“A lot of people experiencing homelessness are contending with not just one, but multiple pre-existing health conditions --everything from infections to malnutrition. That not only increases susceptibility to additional infections, but can compromise how a person’s body responds once infected,” Riley said.

They also lack the ability to self-quarantine, which means they could more rapidly spread the virus. And they are regularly exposed to potential environmental pathogens based on the sheer fact that they live on the streets, the very place that most people are being told to avoid, experts say. They can't shower, regularly wash hands or clean the surfaces around them, all fundamental to the recommendations put forth by public health agencies. 

Simple ailments like a cold or a regular flu can escalate quickly, added Jennielynn Holmes, chief program officer of Catholic Charities of Santa Rosa, who says she sees homeless people become sicker quicker even during the typical ebbs and flow of more common illnesses.

Once individuals do get sick, Riley says there are “a lot of barriers to getting healthcare.”

“It’s not only a matter of insurance, but more immediate problems like transportation to get across town for a medical appointment. Then there’s the problem of what to do with your belongings when you’re gone to the medical appointment,” she said. “If you live on the street, there’s no safe place to store your possessions, and they could be gone by the time you return. That’s a big reason to stay where you are.”

Shelters

Catholic Charities operates two shelters in Napa for people experiencing homelessness, the Rainbow House for families and the Nightingale Center for people transitioning out of the hospital. Nightingale residents are of particular concern given their high-risk status as formerly hospitalized, Holmes said.

There are 323 homeless people in Napa, according to the 2019 Point-In-Time count, a county-wide effort to count all homeless individuals on a single night. However, some expert say that number’s likely higher when the definition of "homeless" is broadened to include those living with family and friends, moving in and out of shelters or the housing insecure.

Federal agencies have told homelessness service providers to plan for an uptick in shelter occupancy rates.

Shelters present an opportunity for vulnerable individuals to seek safety and health resources, but the communal environments also present a challenge to preventing the introduction of the virus, given the number of people who use the facilities and those who come and go on a regular basis.

“We’re trying to be proactive and preventative. We’re increasing cleaning in our facilities and providing additional guidance around how individuals can take proactive measures,” Holmes said, adding that they’ve also added additional questions to their standard screening procedures for tuberculosis and other communicable diseases to ensure the virus isn’t introduced to a shelter environment.

NEWS, a local nonprofit that operates a shelter for domestic violence victims, is asking staff to be more cautious with hand-washing and cleaning. Leadership has encouraged staff to be “aware of the symptoms and willing to stay home if they have any,” said Karen Calhoun, spokesperson for NEWS. She added that all employees will receive full sick leave benefits.

Information

Another key issue is accessibility to information. Those who aren’t housed don’t have ready access to the same media or mainstream information as people who are housed, Holmes said. Agencies are working to rectify that access gap by doing direct outreach in these communities.

“Informational flyers from the CDC website have been printed and sent to all Abode offices and sites throughout the five counties in which we work,” said Chris De Benedetti, the public information officer for Napa County’s homeless services provider.

Holmes echoed the importance of this effort. She said work to provide instructions on how people can reduce the spread as individuals is “empowering” because it allows them to play a role in their well-being.

Government measures

Measures are being taken at the local and county levels across the West Coast to specifically protect this vulnerable population.

Sonoma County has implemented more intensive protocols for cleaning homeless facilities. San Jose announced a ban on all homeless encampment cleanups during the outbreak. Seattle spent $4 million to purchase a motel that could be used to quarantine positive-tested homeless individuals, among others. 

San Francisco, where there are 18 confirmed cases, has taken some of the most drastic measures. Mayor London Breed announced a plan to roll in RVs for homeless people infected, asked hotels to offer vacant rooms for individuals who need to self-quarantine, and has requested $5 million to fund a regular deep clean of all the city’s shelters and supportive housing buildings as well as increase the frequency of meal offerings within to try to encourage people to stay indoors.

For its part, Napa County has tracked the progression of the virus in nearby counties, and it’s following the guidance provided by the state, said Noel Brinkerhoff, the public information officer for the county.

California’s Business, Consumer Services and Housing Agency issued a statement to cities, counties and other service providers who serve the homeless population on how to best prepare for the “increased risk of COVID-19 infection and greater potential to increase COVID-19 transmission” among such individuals. Recommendations include installing mobile hand-washing stations, providing prevention supplies and creating a clear protocol for what to do in the event that a symptomatic person is identified.

Though much of the present focus is on how to address this immediate crisis, the vulnerability of those experiencing homelessness will not end once the threat of COVID-19 is reduced. These individuals are three to four times more likely to die than people who enjoy safe and secure housing, according to Holmes. Deaths commonly arise from something otherwise treatable like a common cold or basic flu, but these individuals lack basic access to self-care interventions like clean water to wash hands or a roofed home to avoid environmental exposures.

“If you look at homelessness in its purest state, it’s a health emergency. People are dying unnecessarily because they don’t have access to basic needs,” Holmes said. “This is definitely a bigger issue our community needs to look at in terms of housing as a health right and housing as a best treatment practice.”

Editor's note: Because of the health implications of the COVID-19 virus, this article is being made available free to all online readers. If you'd like to join us in supporting the mission of local journalism, please visit napavalleyregister.com/members/join/.

You may reach Carly Graf at cgraf@napanews.com; 713-817-4692; or via Twitter @carlykgraf.

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City of Napa reporter

Carly Graf covers Napa city government and community issues. She received her master’s degree from Northwestern University in Chicago. She most recently worked for a news outlet in Buenos Aires, Argentina.

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