“This is more than we expected,” said Dr. Jim O’Connell, president of the Boston Health Care for the Homeless Program. “Asymptomatic propagation is something that we have generally underestimated, and it will make a big difference. “
O’Connell said Thursday that health workers across the country have been looking for signs and symptoms in the homeless. While Boston has aggressively tested residents of a second shelter after the asymptomatic results, the city is considering what to do next, he said.
“All of these things that we recommend for social isolation, you can’t do when you go into a shelter,” said O’Connell. “I think it’s a real failure on our part, and we need to fix it quickly. “
Washington, D.C., for its part, has taken note.
“It caught us off guard”
O’Connell’s program, which provides medical care in Boston’s homeless shelters, set up a rigorous screening system about three weeks ago. Each person who entered a shelter was tested for fever and asked if they had any other symptoms associated with Covid-19.
Then, two weeks ago, the Boston Healthcare for the Homeless Program noticed that a small group of people had tested positive for the coronavirus in a shelter in the south of the city. To be safe, they coordinated with the state government to carry out universal tests on the shelter population for two nights. According to O’Connell, of the nearly 400 guests tested, 146 tested positive for Covid-19.
“It caught us off guard, but the even more surprising discovery is that we screened them all, and none had fever, and very few had other symptoms,” said O’Connell.
There was also a small group that was found in another shelter, which is home to 450 men, and tests were done Thursday evening, said O’Connell. They were able to get quicker tests from the state to do the tests quickly, but officials don’t know if they will find the same situation in this shelter.
O’Connell said local and state government is working with the CDC on how to do this. He said collaboration between different partners is necessary because “the problem is with the size of this virus” – and he noted that even with all this help, they might not be able to solve the problem.
In a statement to CNN, the Centers for Disease Control & Prevention confirmed that they were consulting on the epidemic, but said the local state health department was in charge. The CDC did not address the fact that everyone who tested positive was asymptomatic.
New York focuses on temperature controls
O’Connell said that in the Boston shelter system, about 2,000 single adults regularly attend the larger shelters. As of Thursday, about 1,000 people have tested so far, and 250 people have tested positive.
In New York, which has between 55,000 and 60,000 people in shelters each night, there were 537 cases of Covid-19, including 33 in total on Thursday, according to the city’s Department of Social Services. The ministry says its current screening policy includes questions about the symptoms and self-reporting of any illness.
Citing “the challenges of testing,” New York remains focused on “a mitigation strategy,” prioritizing care for the most urgent patients. Those with mild symptoms, including the homeless, are advised to avoid asking for tests, said city health officials.
The city “aims to put in place temperature controls” among the homeless, said an official.
Kiana Davis, policy analyst at the Urban Justice Center’s Safety Net project, says that while New York tries to check the temperature, it doesn’t happen consistently across all shelters.
“Some shelters have thermometers to check people’s temperatures, many don’t,” Davis told CNN.
The city’s social services department also noted that it was trying to move people away from larger accommodation centers so that better social distancing could be practiced. Davis noted that while the city has opened 6,000 hotel rooms to help the homeless socially distance themselves, people often still share rooms and can potentially spread the virus.
In Washington, 88 people tested positive and five died on Thursday, according to the city’s Covid news page. The total homeless population was just over 6,500 in January 2019, according to the Interagency Council on Homelessness in the United States. The Washington screening process, like Boston, requires temperature control and self-reporting of any other symptoms.
Go ahead in Boston
Since the start of the epidemic, Boston Healthcare for the Homeless has followed CDC guidelines for who can get tested – those who have symptoms and have a fever. Officials are still testing people who are symptomatic in all shelters, but are now concerned that there is no way to effectively stop the spread without testing everyone.
Meanwhile, the program has made a concerted effort to keep people who test negative as far away as possible. All those who tested negative at the first refuge were taken to the University of Suffolk dormitories so that they were no longer exposed.
O’Connell pointed out that all of these guidelines for isolating yourself and protecting yourself from the virus are essentially useless when you are homeless, and it is the responsibility of others to protect these vulnerable people.
Last week, Boston Mayor Marty Walsh and Massachusetts Governor Charlie Baker announced that the Boston Convention Center will provide 500 beds for the homeless as part of the temporary health care facility being installed at this location. O’Connell said there were 60 people there on Thursday.
Hollie Silverman and Sarah Jorgensen of CNN contributed to this report.