While millions of Orange County residents hunker down at home to slow the spread of coronavirus, there’s a group of people who don’t have that option.
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Homeless people – nearly 7,000 of whom were counted in OC last year – are more elderly than the overall population and have been sheltered by the hundreds in dense spaces in Orange County. That proximity and older age creates a higher risk of coronavirus spreading if it were to make it into a shelter – and of homeless people dying from it.
“The homeless shelters are major issue of concern for us, in terms of spread,” said Dr. Paul Yost, a medical doctor and the chairman of CalOptima, the county’s health insurance plan for low-income residents.
“The health of the homeless is related to them not having a home and being exposed to the elements,” he added. “And when you’re also exposed to a virus with a mortality rate of between 1 and 2 percent…that’s completely devastating. And you add to that that many homeless have other medical conditions that make them really vulnerable.”
“I think that things are gonna get worse before they get better,” Yost added.
At least 400 homeless people have been packed into a county walk-in shelter in downtown Santa Ana, known as the Courtyard. The concrete open-air shelter sits in a former bus terminal directly under the main offices of the county Health Care Agency, which is coordinating the health response to coronavirus in Orange County.
There have been no publicly known cases of coronavirus among homeless people, though there have long been concerns that the close proximity of homeless people to each other in the streets, and in overcrowded shelters, would spread an illness quickly.
“Once a couple of [homeless people] get the virus, it’s gonna spread pretty quick through [the homeless community],” said Paul Leon, a former public health nurse with the county who founded the nonprofit Illumination Foundation, which runs a shelter in Anaheim as well as recuperative care centers.
“In the street, when they do get sick, they’re just gonna go in” without calling ahead, he added, which can risk spreading coronavirus further.
“Hopefully we’re gonna move pretty quick” to open a couple facilities, Leon added.
County officials this week, following up on a statewide program announced by Gov. Gavin Newsom, have apparently been negotiating with motels to use them as temporary shelters, while also working to relocate up to 80 homeless people who are elderly or have compromised immune systems from shelters like the Courtyard to recuperative care.
County officials have been publicly warned over the past year about the risks of infectious diseases spreading if homeless people’s health isn’t looked after.
“San Diego [County] has 100 deaths, with a hepatitis A outbreak which accounted for 40 of those deaths,” U.S. District Judge David O. Carter told Orange County officials at an April 2019 federal court hearing about homelessness.
“The experts are giving consistent advice. Social distancing, minimal contact, self-isolation…We need to take immediate steps to save lives by moving high risk individuals into private rooms and putting health care at each site daily,” said Brooke Weitzman, a lead attorney for homeless people in Orange County.
“The [shelter] providers cannot continue to do their best to keep 50-450 people inside without adequate support or resources. The high population shelters are effectively petri dishes putting all residents and staff in danger.”
The county currently uses the two National Guard armories – in Fullerton and Santa Ana – as cold-weather shelters through April 15, with a total of 400 beds. But as the National Guard prepares to have troops deliver food and other supplies across California, the state militia has signaled it may need its armories back.
It’s unclear if the county has a backup plan for those 400 shelter beds if this happens. County officials this week asked Gov. Gavin Newsom’s office to let the shelter use continue at the armories.
“The County is currently evaluating all available options should the National Guard be mobilized by the Governor,” county officials said in a written response when asked if there’s a plan.
Meanwhile, county officials said they have been trying to find local motels whose owners will let them be used as temporary homeless shelters during the pandemic. Many motels and hotels have seen steep declines in occupancy over the closure of Disneyland and other tourism travel.
County officials did not answer questions Friday about how many hotel and motel beds it was seeking, and whether the locations are spread throughout the county or concentrated in a particular area.
“The County is working with the State government and other stakeholders in the vetting of State-identified resources including hotel/motels rooms, trailers, and state funding to address homelessness,” county officials said in their written response to question they answered.
“As these conversations continue, the County has identified and is implementing short-term strategies to provide alternative placements for sheltered individuals who are ages 70 and older and/or those that have severe underlying health conditions,” it added.
“Additionally, [medical] tents, cots, blankets, privacy dividers, handwashing stations are in the process of being deployed to shelters to support the implementation of state guidelines, including creating social distancing and creating areas for quarantine and isolation.including hotel/motels rooms, trailers, and state funding to address homelessness.”
One of the top areas of health concern for homeless people has been the Courtyard shelter, where about 400 people sleep each night across the street from the county’s new $300 million administration building.
County officials on Friday apparently were setting up a temporary structure outside to separate homeless people who’ve become ill, which federal health guidelines recommend during the pandemic.
Homeless advocates and health officials have said shelters that social distancing and dividers between beds are better at slowing the virus’ spread than leaving people no option but to be the streets. And shelter or housing with individual rooms, such as recuperative care, is considered even better at slowing the spread.
“I wish everybody could be in recuperative, because they’re single rooms,” said Leon.
“Our clients have mental health issues, so it makes it harder” for people to stay inside because many people don’t want to, Leon said. But, he added, they’ve “become more cooperative” as the virus’ health risks become more well-known and as other services and have closed in Orange County.
“90 percent of the people, complete cooperation,” Leon said.
Beds at the La Mesa shelter in Anaheim, run by the Illumination Foundation , are separated by 8 to 10 feet as well as physical dividers, Leon said. Federal health guidance for slowing the spread of coronavirus recommends at least three-foot separation between beds at homeless shelters, and efforts to have people keep six foot distance from each other as much as possible.
At the Courtyard shelter in Santa Ana, 18 elderly people aged 70 and above had transferred to recuperative care as of Friday afternoon, said Doris Starling, who runs the shelter and has become friends with many homeless people there.
“I’m trying to get my most vulnerable out. Then we’re gonna have a tent [for] the [people] that are left that are old and sick and have problems,” Starling said.
The expansion of space would provide “a little more room for people, and then they’re not on top of each other,” she added.
At a time first responders are at risk from the virus, county health teams and firefighter paramedics are generally not coming into the Courtyard shelter and are instead met outside, she added.
In “really really serious” cases, firefighters will come into the shelter but “have to put on their hazmat suits before they come in. It’s challenging. But the care and safety of these people is my top priority.”
The Courtyard is the only walk-in shelter at the county, and already is frequently over-capacity.
“I have a group of people at the front door every day, because there’s no place else to go. No place else to go. Pretty sad,” Starling said. She said she’s hoping officials find a gym or other temporary place to shelter half of the people at Courtyard.
“Right now they’re safe and secure, they’re eating and they’re being taken care of. And we’re trying to find ways to help them,” Starling said. “These are seniors. These are not alcoholics, These are not drug addicts…some of them do not have family.
Staling said one 88 year-old woman at the shelter, who has been there for 2.5 years, doesn’t want to leave Starling’s side because “she doesn’t want to be by herself,” Starling said.
Leon, who has been critical of the county in the past, credited officials with moving quickly to try to secure shelters amid the coronavirus pandemic.
“On this I have to admit, they’re accessible. They’re really moving to do the right thing. And they actually hired a bunch more people…they answer the phone,” Leon said, estimating that a minimum of 800 additional shelter or housing beds are needed.
One of the top concerns of health officials in OC, and across the globe, has been limiting the virus’ spread so cases don’t overwhelm hospitals, as has happened in Italy and in Wuhan, China.
To prepare for a wave of people being hospitalized with coronavirus, state officials have been moving to set up the shuttered St. Vincent Medical Center in Los Angeles as an initial “surge” hospital for coronavirus cases, with additional hospitals in Southern California potentially coming online later specifically for coronavirus patients.Advocates have been imploring county officials to add shelter and housing capacity so people can be safer by being physically separated.
High-density shelters “are potential clusters for the spread of COVID-19,” said Mohammed Aly, an attorney and advocate for homeless people, adding that hospitals could be overwhelmed if the virus spreads in a shelter.
“People need to be moved out of those [high density] shelters…to protect vulnerable [people],” he added.
“I know that we can get through this. I know that we have the resources, the ability, and hopefully the willingness to address these problems.”
Nick Gerda covers county government for Voice of OC. You can contact him at firstname.lastname@example.org.