California grasps for coronavirus prevention among the homeless

On what would typically be a busy Thursday morning, beach town Venice in Los Angeles was mostly bare and silent. But the avenues of Third and Rose, which residents dub “Skid Rose” after Skid Row in downtown LA, were still ripe with body odor and activity. Tents and makeshift shelters jammed the sidewalks from block to block.

The city had closed down all the boutique shops in Venice and even the normally tourist-packed boardwalk. But for the homeless, not much has changed, except the city now allows them to leave their tents up during the day. (Before the coronavirus, the city banned tents between 6 a.m. and 9 p.m.)

The city’s order to self-isolate during the coronavirus pandemic is impossible for those living here. At large homeless encampments such as this one, the city has set up hand-washing stations, vermin-proof trash cans, and a mobile shower station. Every day, outreach teams check on individuals and offer services. That Thursday morning, outreach teams from St. Joseph Center and the Los Angeles Homeless Services Authority (LAHSA), two of LA’s lead homeless service providers, walked from tent to tent asking, “You experiencing coughing? Sore throat? Fever?”

One man lying in a 4-foot-high tent popped his head out when he heard the outreach team: “I shouldn’t be here.” He said his name is Kevin and he’s 45 years old. He lifted his T-shirt, and the team members gasped when they saw a yellowing gastronomy tube sticking out of his belly. Kevin then took off his baseball hat to reveal a sharp dent and a pingpong ball–sized lump on his head.

He said he was sleeping on the streets when someone hit him on the head, knocking him into a coma. He awoke in a hospital but left early after his insurance coverage ended—with the tube still in his body. He didn’t get the tube removed at a free homeless clinic because he was afraid of contracting COVID-19. He has high blood pressure and smokes regularly. When the outreach team asked if he’d be interested in relocating to a hotel room, Kevin nodded eagerly. “I’m not supposed to be here,” he repeated. Another service worker had taken his name weeks ago— and he still had not heard back.

As California continues its shutdown due to the COVID-19 pandemic, state officials are still scrambling to figure out safe options for the 151,000 homeless people in the state. With shelters becoming hot spots for coronavirus infection, governments are trying to move homeless people from crowded encampments into hotel rooms. Meanwhile, organizations that care for the homeless are having a hard time even keeping track of who needs what help with a virus that can silently spread from person to person.

State models estimate that 60,000 homeless people in California will contract the coronavirus and that 20 percent will need hospitalization. As of early May, Los Angeles County had counted 215 homeless people who had tested positive for COVID-19 and was investigating cases at 18 shelters. Most of the positive cases occurred in people living in shelters.

ON APRIL 3, GOV. GAVIN NEWSOM announced a program to relocate thousands of at-risk homeless people into hotel or motel rooms. Through Project Roomkey, the state secured 15,000 rooms with the goal of providing safe housing with wraparound services such as meals, 24/7 security, cleaning services, and medical checkups. Officials reserved the rooms only for individuals who show no symptoms but are high-risk, according to Centers for Disease Control and Prevention guidelines: They must be 65 or older, and/or have underlying health conditions such as severe obesity, diabetes, or severe heart or lung conditions. The state has called the program a success, but to date, only about one-third of these hotel rooms are filled. And there are no data yet showing the program’s effectiveness in preventing outbreaks among the homeless.

Still, local leaders have embraced the idea, especially after the Federal Emergency Management Agency agreed to pay up to 75 percent of the costs. Los Angeles County, where about 60,000 homeless people live, announced it would secure 15,000 rooms countywide, while San Francisco set its own goal of 7,000. Other states and cities are launching similar projects: New York City has announced plans to move about 30,000 homeless individuals into hotel rooms (with some pushback from Mayor Bill de Blasio, who says that goal is too costly). Connecticut Gov. Ned Lamont has ordered shelters to relocate more than 1,000 people into hotels; King County in Washington has moved 400 shelter residents into hotels; North Carolina is also planning to house about 16,500 homeless in hotel and motel rooms, trailers, and college dormitories.

Like the state, some local counties have had trouble filling the hotel rooms. So far, LA County has secured about 2,923 hotel rooms in 28 sites and has placed 2,282 individuals there—about half of them come from shelters and the other half from the streets. The county is far behind its goal of securing 15,000 hotel rooms by April 26. As of May 6, San Francisco has filled fewer than 3,000 of the vacant hotel rooms.

Not all hotel owners support the idea, and some question whether officials can use emergency powers to force hotels to accept certain guests. Governments say hotels should do their part to help the community during an emergency, especially since many luxury hotels have received tax subsidies. It’s a win-win situation, they say: Hotels get some revenue ($75-$100 per room) instead of making zero with vacant rooms. Currently, only about 30 percent of hotel rooms in LA are occupied.

Hotel owners worry about liability and insurance issues, and possible property damage. They’re also worried about how housing the homeless will affect their image and guests who are still paying to use the hotel. The Ritz-Carlton in downtown LA usually charges more than $500 a night for a standard room. Its property includes 224 condo units called The Residences, in which residents pay $1 million to $40 million to live on the 27th to 52nd floors that overlook the downtown skyline. A representative of the Homeowner’s Association of The Residences told the Associated Press that residents worry about safety, security, property values, and overall lifestyle should the hotel shelter homeless people.

One LA city councilmember, Mike Bonin, has said hotels refusing to house homeless people could be a “potential civil rights violation or a case of discrimination.” He co-authored a motion to investigate why hotels are resisting plans to house the homeless, focusing on hotels that have received public benefits. The City Council passed that motion on May 6.

But hotel operators aren’t the only ones resisting Project Roomkey. Several city officials have filed for emergency hearings with a federal judge, saying they were not included in county decisions. Many residents have protested outside local hotels, arguing that housing the homeless population in their neighborhood would place everyone there in danger of an outbreak.

MEANWHILE, MANY HOMELESS activists and organization leaders are particularly concerned about people living in shelters, saying congregated settings where people sleep in close quarters and share communal meals are “a powder keg” for outbreaks.

Several shelters across the country have reported confirmed cases of COVID-19. In San Francisco’s largest shelter, the Multi-Service Center South (MSC South), where 340 residents once slept on bunk beds placed 2 feet apart, more than 100 residents and staffers tested positive. That created some panic—the city quickly evacuated the shelter and moved the residents into hotel rooms, while crews in hazmat suits deep-cleaned the facility. But 10 days later, the shelter reopened and accepted about 110 guests, this time making sure people stay at least 6 feet apart. At a shelter in Boston, 147 of the 408 people there tested positive—the majority of them asymptomatic.

The fact that some people who have the coronavirus are asymptomatic challenges shelter workers deciding where to place someone who walks in, said John Ashmen, president of Citygate Network, a network of faith-based shelters: “You have no way of knowing whether someone who walks into your place without symptoms might be contagious. The ideal is to test them right there before they enter. But there are not enough tests to go around.”

In LA, outbreaks of COVID-19 among the homeless first erupted at the Union Rescue Mission (URM) in Skid Row. URM’s first case hit on March 28, when one resident staff member, 56-year-old Gerald Shiroma, went to the hospital and needed a ventilator. He died on April 8. Shiroma first arrived at URM suicidal and seeking recovery from addiction. While living at URM, he proclaimed faith in Christ. After he graduated from the program, URM hired him as a driver to pick up food from donors.

“In the 128 years [Union Rescue Mission] has been open, we’ve never faced anything as serious and frightening as this.”

Shiroma’s death sent the rescue mission rushing to lock down two floors for quarantining; transform the boardroom, the staff cafeteria, and two staff restrooms into isolation rooms; and procure lots more personal protective equipment and medical supplies. County officials ran more testing on both symptomatic and asymptomatic people at the shelter, and the city set up a pop-up testing site in Skid Row. So far, more than 90 people in URM have tested positive and are now in isolation. From its daily tally of 1,000 residents, URM is now down to about 350: It evacuated hundreds of existing guests into other quarantine facilities and for a time was no longer admitting anyone new.

That’s a hard pill to swallow for URM’s chief executive Andy Bales, who doesn’t turn away a woman or child needing a bed. Leaving vulnerable folks on the streets goes against his core value. Hundreds are still sleeping in close quarters in Skid Row. Even with the offer of hotel rooms, Bales said, some residents are reluctant to leave URM—rescue missions such as URM provide services that hotel rooms, even with an on-site staff, cannot: community, spiritual guidance, counseling, prayers, hope, peace, and comfort during a particularly scary time.

For Bales and his staff, the needs are great: URM used to have 183 staff members. Now all the older folks or those with underlying health conditions work from home, leaving only about 80 staffers on site. The number of volunteers has also dropped drastically—that means fewer people in the kitchen, serving food, picking up food and donations, and tutoring kids.

“It’s a severe hardship we’ve never seen before,” Bales said. “We’ve been through World War II, the Great Depression, the Recession … nothing comes close though to this. In the 128 years URM has been open, we’ve never faced anything as serious and frightening as this.”

BACK IN VENICE, THE OUTREACH TEAM is also doing its best to keep people on the streets safe. That Thursday morning, five outreach workers, including one volunteer physician, roamed the streets for about three hours, handing out homemade masks and snack bags and recording names and dates of birth of those who qualify for Project Roomkey. Mateo Villasenor, an outreach worker at St. Joseph, told me that within the first two days of the program launch, he was able to place 14 people into hotel rooms. St. Joseph currently manages two hotels with 178 beds total. The first 133 beds filled up quickly, and they expected the rest to fill up within days.

Not everyone seems to treat the pandemic as urgently as they do: Some homeless individuals don’t show up even when there’s a room available for them. “I’m not sure why,” Villasenor said. “I’d think it’ll be a priority for them to pack up quickly. But for some reason, they were not able to pick up and go right there and then.”

Most of the people on the streets don’t meet the qualifications for Project Roomkey, but many expressed interest in moving to a shelter or housing under certain conditions: They didn’t want to move too far away from Venice. When Villasenor asked one 51-year-old man with a gray beard if he was interested in moving into a hotel, he looked back at him for a moment and said, “Uh, possibly. Depends on where it is.”

That was a common response I heard, even among those who are clearly suffering. One 55-year-old man named Luigi needed to get fresh gauze for his right leg. For four years, he has suffered from cellulitis—a potentially life-threatening bacterial skin infection. When a physician unraveled his old bandages, he revealed red, raw, swollen flesh on Luigi’s lower leg. Both of his legs were swollen and cracked, with skin peeling off in a weblike pattern. He most likely got infected when bacteria entered his flesh through the flaking skin. “I never had this until I became homeless when I was 51,” Luigi told me. “Can’t get that hot water to wash, you know?”

Depending on his health conditions, Luigi might qualify for Project Roomkey—but the outreach team has no way to contact him: He has no cell phone or email address. He says he’s open to shelter options—“as long as it’s not too far.”

While the outreach team was talking to another homeless man, someone approached saying an old man in a wheelchair nearby looked to be in bad shape. Villasenor promised to check on him, but as the team passed dozens more people to get there, they checked on each older or frail-looking individual.

Another half-hour passed before a security guard biked over and told the outreach team that the old man in the wheelchair had disappeared: “He just said, ‘I ain’t waiting,’ and he’s gone.” The outreach team members looked at each other, feeling bad—perhaps they should have rushed to that man first. But the streets have no shortage of people in need. They will try again tomorrow.