Lessons from how we prevented COVID-19 from ravaging our homeless clients


Food distribution during the covid crisis (Photo: Ed Reed / Mayoral Photography Office)

COVID-19 has taught us painful lessons about inadequate disaster preparedness and a vulnerable healthcare ecosystem. Amid access barriers, insufficient resources and a limited federal response, a virus of moderate virulence and lethality has wreaked appalling havoc – more than 140,000 Americans have died from COVID-19, including more than 700 workers of health. Local suppliers and governments had to scramble and improvise to handle the onslaught to avert an even worse disaster.

At the Center for Urban Community Services, one of New York City’s largest homeless healthcare providers, we’ve been successful in jamming and improvising effectively for our clients and staff. Our clients’ infection rate remained below 5%, well below the estimated infection rate of 15-20% for New York residents. We have also been successful in keeping the infection rate of our staff low and more importantly we have had zero staff fatalities.

As COVID-19 cases continue to increase in the southern and southwestern United States, and in anticipation of the flu season, which we fear will only exacerbate the pandemic, the lessons of the Spring in the northeast may dampen a possible second wave of coronavirus. Here is what we learned:

Communicate, including your ignorance.
Effective action always starts with accurate, relevant information that people trust. A crucial ingredient in gaining confidence is also being open about your ignorance. One of the first challenges of COVID-19 was that so much was ignored in early spring about how SARS-CoV-2 transmits, causes disease, and leads to death – we didn’t really know how what we were up against.

It was difficult to strategize to reduce transmission when you didn’t know how the virus was spreading, and it was difficult to screen people when you didn’t know which symptoms were reliably correlated with infection. Plus, the lack of testing meant we didn’t even know how widespread the problem we were facing was. The first thing to be frank about, then, is what you don’t know.

During March and April, we communicated frequently with our customers and staff about our plans to try to keep people safe, but also about our commitment to change course as new information and new understanding unfolded. were developing. An important example is the changing understanding and recommendations regarding the value of face masks. At first, we recommended not to wear a mask but to change gears, as evidence has accumulated on the effectiveness of the face covering. However, because we prepared people for the course changes, our clients and staff adopted the mask easily and quickly.

Another example of ignorance that we have allowed ourselves to be open to is the lack of clarity on the symptoms of COVID-19 and the relative importance of asymptomatic and presymptomatic spread.

Realizing this confusion over these issues made it impossible to reliably identify people who may be contagious at any given time has profoundly influenced our strategy in a way that we believe has kept our infection rate at a low level. Since we realized that we couldn’t completely prevent contagious people from being in our workplaces, we transformed our programs and operations to make them safe even if people were contagious.

We have eliminated as much “close contact” between customer and staff as possible. A contagious person cannot infect you if you keep your distance, avoid prolonged interactions, and wear a mask. We believe that our workplaces are currently safer than people’s homes.

Get ahead of the problem and be careful.
By the time there was a first confirmed case of COVID-19 in New York City, we had been following developments in China and Italy closely and had already started educating our staff and customers on the seriousness of the situation. Raising awareness of the seriousness of the crisis prepared our team to rapidly develop protocols that we ended up executing long before city and state began issuing directives.

We had decided how we were going to respond to the closure of the New York City school system and the stay at home order before these measures went into effect. Considering how quickly SARS-CoV-2 can spread, we believe this foresight and rapid mobilization prevented a major outbreak in our agency.

In mid-March, we moved most of the staff to remote work, a big challenge for a customer-facing service provider. Much of our medical team has moved to staggered two-week rotations to limit the number of providers who would risk exposure at any one time while ensuring our clients have access to needed care. Acting quickly and decisively, with the well-being of healthcare workers at the heart of every decision, minimized the number of clinicians infected and allowed us to continue providing care to people.

While the prevalence of COVID-19 in New York is currently quite low and the city has moved into Phase 4 of reopening, we recognize that this is a fragile state of affairs and that we cannot Lower the guards. Our protocols continue to be informed by the assumption that anyone you might interact with could be contagious. SARS-CoV-2 can spread easily and the number of cases can quickly increase exponentially. We go ahead assuming that can happen at any time, and we believe this is the only conservative assumption until there is an effective and widely available vaccine.

Be flexible.
A significant and unforeseen early challenge of this pandemic has been the shortage of personal protective equipment (PPE) – just as toilet paper has disappeared from stores, so have face masks from our suppliers. To meet this unprecedented challenge, the Center for Urban Community Services formed an informal team to become hunters and importers of equipment. For example, we replaced purchasing agents who did not have such experience.

This team has worked with different organizations as part of a national, and in some cases international, effort to obtain face masks for frontline workers in our outreach teams and our shelter and housing programs. People across the country have supported this cause, sending hand-sewn face masks not only from New York and the state, but also from as far away as Alaska, California and Washington state.

As a result of this effort, the Center for Urban Community Services was able to distribute more than 8,000 face masks to frontline staff and our homeless clients. Our investment in this effort has created new supply chains to ensure we have enough PPE to protect our staff and customers in future outbreaks.

To anticipate
Although New York City is enjoying a brief respite, it wouldn’t be wise to get complacent. COVID-19 is invading much of the country and people travel to hot spots in New York City every day. The onset of the flu season will almost certainly worsen whatever COVID-19 is prevalent in the city this fall and winter. Safety and preparedness for COVID-19 have become integrated into everything we do – this must be a part of our new normal – so that we can keep people safe and continue to provide the care and services that are so crucial for our customers.

As scientists and doctors learn more and COVID-19 has become less of a mystery, it has become clear that good old-fashioned basic public health measures can reverse outbreaks and control the spread of SARS- CoV-2. Social distancing; testing, tracing and isolation; hand hygiene; and the wearing of masks are unsophisticated interventions well within the capacity of a country with the political will to fund these efforts.

Right now, there are dozens of examples of entire populations of people who, with clear and consistent communication and leadership, are happy to work together to protect everyone. A coordinated effort by government and citizens to employ simple, straightforward tactics could allow this country to enjoy a semblance of normalcy – being with loved ones, going to school, helping neighbors – until an effective vaccine could finally put an end to this pandemic.

Dr Van Yu is the Chief Medical Officer at the Urban Community Service Center. On Twitter @CUCSnyc.

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