Homeless Deaths Are Spiking in Orange County


The Courtyard, a homeless shelter, in Santa Ana's Civic Center on March 18, 2020.

There’s been a marked jump in homeless deaths in Orange County, spiking in April to their highest level in years with a similar deadly trend extending into May, according to coroner data obtained by Voice of OC.

With lab tests still pending for most of the deaths, officials say it’s still too early to know what exactly is causing the spike, and how much of the jump in deaths – if any – is from the coronavirus pandemic.

Orange County Health Care Agency officials say they do not know how many homeless people have been tested for COVID-19 because they do not receive that information. In Orange County, tests in March and most of April were largely limited to people who obtained a doctor’s order for one.

But one thing is clear – April was the deadliest month for Orange County’s homeless in at least five years, according to the coroner data.

“That’s not unexpected. And it’s tragic,” said Paul Yost, a doctor who chairs CalOptima, Orange County’s public health insurance plan for people with low or no incomes, including those without homes.

“Homeless are absolutely our most vulnerable population, especially when it comes to infectious diseases,” Yost said.

The 34 deaths in April were nearly double the previous monthly average of 18 deaths per month during the prior 12 months. And the higher deaths trend has been continuing into May at the same weekly rate as April.

Officials at the Orange County Health Care Agency said they will be examining the coroner data for answers about why more homeless people have been dying.

“The OC Health Care Agency’s (HCA) Research team is actively reviewing all COVID-19 deaths reported to our Public Health Services division by matching those that occur in Orange County to the State’s master death file, which includes more information about each decedent, including possible [medical conditions] that may have put them at higher risk for developing serious illness from the virus,” said Jessica Good a spokeswoman for the Orange County Health Care Agency, in a written statement Friday to Voice of OC.

Regarding the coroner data, she said Friday that Dr. Curt Condon, a researcher with the Health Care Agency, “hopes to receive that data soon and lead a thoughtful analysis with his team.”

Condon received the coroner data Monday morning and most of the homeless deaths in April are still under investigation, so the reason for the increase remains known, Good said in a follow-up message.

In addition to any direct impact of the virus itself, the pandemic has cut off some access to core health needs like food, public restrooms and hand washing in ways that can harm homeless people’s health and make them more at risk of dying from health conditions they already have, according to service providers and advocates.

“It’s really sad,” said Paul Leon, president and CEO of the Illumination Foundation and a former public health nurse at the county, of the increase in homeless deaths.

While people were sheltering in place in April, “people that weren’t connected to shelter were starving,” Leon said.

Leon said that in April he saw a homeless man in a wheelchair who appeared to be too weak to eat a box of food someone had given him.

“Nutrition is huge. If you’re on the street, you’re barely hanging on. If you stop eating, you’re going to die in a matter of weeks,” Leon said.

Many community and faith-based food services at encampments stopped from mid-March until the end of April, Leon said, amid concern about the virus.

“It was scary in April, because you didn’t quite understand how contagious it was,” Leon said.

Brooke Weitzman, an attorney representing homeless people in federal court, said many of the ways homeless people accessed hygiene have also been shut down.

“In the course of this shelter in place order, we have seen some substantial changes that disproportionately impact the unsheltered community,” Weitzman said.

“The CDC is saying the number one thing you need to do is maintain [your] hygiene, washing your hands. We’ve taken away their access to do that. We closed public restrooms. We have closed restaurants where they used to go. Many homeless individuals were able to shower [at] public camp sites, or low cost gyms…and the gyms are closed. So we took away the opportunity to shower, we took away the place they could, when they had some money, through work or social security…go get a campsite for a few nights,” she added.

“Many individuals supplement their money by panhandling or recycling. You can’t do those things because people aren’t going out…homeless people realize there’s a huge increase in risk if they go dumpster diving [during] COVID,” Weitzman said.

“There’s not the source of food, of water, of safety that those people traditionally use to keep themselves fed, keep themselves safe, keep themselves clean. Those are gone. So on top of all this increased risk, on top of being unable to access basic hygiene, to maintain adequate nutrition, there’s also COVID.”

As for shelters, she added: “We know that we are in this environment now where congregate living, where leaving people in the street, has become dangerous to the entire society. not just for the people outside, but for the health care workers [and everyone].”

Coronavirus has spread most quickly in institutional living environments like nursing homes, jails and homeless shelters, where people traditionally are in close contact with to one another and with staff members.

Nursing and medical care homes have been hit particularly hard, with over 500 confirmed infections of residents and staff and 23 confirmed deaths as of Thursday. There’s also been outbreaks at Orange County jails, with more than 200 confirmed infections of sheriff’s deputies, other jail staff, and inmates.

Leon said a COVID infection spread quickly at one of Illumination Foundation’s shelters in Los Angeles.

“Definitely that would be a problem. And that one would be a problem. We’ve already found in LA that once somebody gets it contracted, it is crazy. It’s almost like a fire,” Leon said.

His organization currently is OC’s lead provider for Project Roomkey, the state program for sheltering high-risk homeless people at motels during the pandemic, which is administered by the county and paid mostly by federal emergency and stimulus funds.

OC Health Care Agency officials said Monday they do not have data on the number of homeless people who have been tested for COVID-19 in Orange County.

“We don’t track number tested in general because we don’t have [the] ability to track that data,” said Marc Meulman, chief of operations for public health services at the OC Health Care Agency, in an emailed answer to questions.

Homeless people, he added, “can be tested in a variety of settings where they seek healthcare, and housing status is not part of communicable disease reporting.”

So far, 22 homeless people have tested positive for COVID-19, including 2 living in shelters, Meulman said.

It’s hard to know how many homeless people have COVID and die from it when testing isn’t widely available to homeless people, said Weitzman.

“If we haven’t tested them, we can’t run around pretending like they’re not sick,” Weitzman said.

In the year leading up to April, about 18 homeless people died each month on average, according to the Orange County coroner data for the year leading up to April

In April, 34 homeless people died, a nearly 80 percent jump from a typical month.

The higher deaths trend has been continuing in May at the same rate, according to the data. In the first week of May, at least 8 homeless people died, the same as April’s weekly rate.

“We have had only one confirmation of a COVID-19 death of a CalOptima member experiencing homelessness from the Coroner and that was back in March, however over 50% (14 of the 22) of all outstanding homeless death cases in April are either pending or have no cause of death,” said CalOptima spokeswoman Bridget Kelley said Friday in an emailed response to questions from Voice of OC.

“We have no idea if they will eventually be determined to have COVID-19 as it is not clear at this time. The Coroner’s Department will have that updated information.”

To reduce the spread of COVID-19 among homeless people, county officials said they’re working to shelter homeless people in motels, under the state’s Project Roomkey effort.

“The [OC Health Care Agency] is working in support of Project Roomkey, the Governor’s initiative to provide safe isolation capacity for people experiencing homelessness in California in order to protect this vulnerable population and the community as a whole from the spread of COVID-19,” said Good, the Health Care Agency spokeswoman.

A total of 178 homeless people were staying in the Project Roomkey motels as of last Monday, according to the county. The most recent point-in-time count found almost 7,000 homeless people in Orange County, about 4,000 of whom were unsheltered.

As more and more people lose employment and housing gets more crowded, Leon said his organization is already seeing signs that there could be a wave of newly homeless people in the coming months.

“Our numbers almost tripled in April” of people calling for help who were on the verge of homelessness or experiencing homeless, Leon said.

Before April, the Illumination Foundation received anywhere from 48 to nearly 80 phone calls per week from people seeking help, he said. “For April it jumped up to almost 200.”

Nick Gerda covers county government for Voice of OC. You can contact him at ngerda@voiceofoc.org.