Advocates say they worry single individuals experiencing homelessness, many of whom are older and suffering from chronic illnesses, are particularly high-risk when it comes to coronavirus.
The fourth bullet on D.C.'s official coronavirus web page encourages people to "stay home when feeling sick." But what if you don't have a private place to call home?
As the spread of the disease continues, the area's homeless service providers and advocates are also starting to prepare for the effects that an outbreak could have on the people they serve.
Central Union Mission's emergency men's shelter at the corner of Massachusetts Avenue and 1st Street Northwest houses between 170 and 200 people a night in a dormitory-style setting. Its president and chief executive Joe Mettimano said quarantining someone inside the building is not an option.
"It may seem pretty heartless to say, 'Well if you're sick, don't come to the shelter,'" Mettimano said. But, he added, concerns about coronavirus could lead his staff to ask people experiencing concerning symptoms to go get medical treatment away from the shelter.
Shelter staff are monitoring guests for symptoms and encouraging people to self-report if they're not feeling well. But in the event of an outbreak, Mettimano said he would need help from the D.C. government and area hospitals to treat and house the sick, as well as to make sure that they are connected with food and other services they depend on the shelter for.
D.C. Mayor Muriel Bowser said in press conferences on Monday and Tuesday that the city had secured a lease for a potential quarantine facility that could house up to 50 people. Bowser declined to share further details about the location.
In a conference call briefing with service providers on Wednesday, Laura Zeilinger, the director of D.C.'s Department of Human Services (DHS), said that shelters and other service providers would not be expected to quarantine people on-site. DHS, along with D.C. Health, would be "collaborating to ensure that we're providing quarantine."
"If you have a client in one of your programs and they believe that they have been exposed or they may be showing symptoms and they go to a health care provider, they will not be sent out into the public or to a congregate setting," said Zeilinger.
Zeilinger wrote in an emailed statement to WAMU that her agency has stepped up its efforts around coronavirus. DHS has increased street outreach to people experiencing homelessness to provide them with hand sanitizer and is working to bolster sanitation and hygiene supplies, including hand washing stations, at shelters and locations where food is served.
In the Wednesday briefing, Zeilinger said DHS would also set up a form for providers to indicate their needs for supplies. But she acknowledged that there are shortages in the global supply chain around certain sanitizing products and protective equipment like masks.
"I don't want to set an expectation that we will be able to meet every supply need of every organization in the community," Zeilinger said. But, she added, "we are very willing to help and problem solve together."
Zeilinger said the agency will soon be sending out guidance to shelter providers around cleaning, operations and addressing the situations of clients who may experience symptoms associated with COVID-19.
If risk levels increase, Zeilinger said, the agency will share additional information about how shelters can modify protocols. The agency met with a group of shelter providers on Friday to discuss how they could continue operations.
"I was impressed of the sort of breadth of [DHS's] planning process," said Amber Harding of the Washington Legal Clinic for the Homeless, who listened to the Wednesday briefing. "They seemed to be considering a lot of the things that have been causing anxiety in the community."
The Community for Creative Nonviolence (CCNV), which runs the city's largest low-barrier emergency shelter, could not be reached for comment about its efforts by deadline. Its shelter is located on the 400 block of 2nd Street Northwest and has 800 to 1,000 beds. Catholic Charities DC, which runs five low-barrier shelters in D.C., declined to comment, citing the fact that they take their guidance on coronavirus from DHS.
Eric Sheptock, a housing advocate who currently stays at the CCNV men's shelter, said as of Tuesday night he had not seen additional hand sanitizer or access to cleaning products.
"The only hand sanitizer I see is what I use on my job," said Sheptock, who works at an event rental company. Sheptock said that from what he has seen, shelter staff do not seem to be taking extra precautions around hygiene, though guests seemed to be keeping abreast of coronavirus developments by watching the news.
Sheptock is worried that if an individual experiencing homelessness in D.C. does come down with COVID-19, the disease caused by the new strain of the coronavirus, it could spread quickly through the community.
"A lot of people have the misconception that homeless people are solitary people, but that's not true," Sheptock said. "We're actually very communal, and you have crowded shelters where the beds are two, two and a half, three feet apart ... And people travel from the shelters to the soup kitchens, and then they go from the soup kitchens over to [day programs]."
Plus, Sheptock added that "at a lot of the shelters ... they don't make hand soap available to you," and guests are asked to bring their own.
Susie Sinclair-Smith, the CEO of the Montgomery County Coalition for the Homeless (MCCH), told WAMU on Wednesday that cleaning supplies were already proving to be a challenge at the emergency shelter her organization runs. The shelter houses about 140 people every night. Sinclair-Smith said they were working with the county government to find more supplies, but their current cleaning supplies will likely last them less than a week.
Sinclair-Smith said the Montgomery County shelter is following guidance from health officials and would be setting up new hand-washing stations so that guests can immediately wash their hands upon arriving at the shelter, and before leaving the shelter.
Sinclair-Smith also added that a client of MCCH has a janitorial job at the Village at Rockville, a retirement community where a confirmed coronavirus patient interacted with individuals on Feb. 29. The MCCH client is not currently experiencing symptoms, Sinclair-Smith said, but the agency has arranged for them to stay at a motel out of concern about potential exposure.
"I've been thinking a lot about the whole public health dimension of our work, and really instilling preventive measures in what we do," Sinclair-Smith said.
Sinclair-Smith has also put together a business continuity plan, and staff at her organization are equipping themselves to work from home so that they can continue operating in a worst-case scenario. MCCH provides services to 1,700 Montgomery County residents.
Apart from close living quarters in shelters, Mettimano said, another challenge is the fact that many of the people who stay at the Central Union Mission shelter are already suffering from chronic respiratory illnesses.
Mettimano said those underlying health issues could make it hard to diagnose possible cases of COVID-19 to begin with, and they could also make the disease harder to fight.
"Just living on the street, trying to survive day to day when you're dealing with cold weather, hot weather, food insecurity, health issues, mental illness, addictions, there's already a range of challenges," Mettimano said. "When you throw something else like coronavirus in the mix, it should make us all stop and pause and say, 'OK. What are we doing as a society to really address homelessness in a meaningful way?'"
Sheptock, too, believes there is a larger lesson here.
"If [the city] had ended homelessness or even greatly reduced it, then we wouldn't have as many big communal shelters as we have to begin with," Sheptock said.
D.C. closed the D.C. General family shelter, which once housed more than a thousand people at once, in 2018. The city has been opening smaller family shelters to replace it. D.C. has also been using motels along New York Avenue as emergency shelters for families, but the city plans to end this practice by the end of the year as new shelters open.
The District has reported a significant drop in family homelessness in recent years. But advocates have criticized the "rapid rehousing" vouchers used to house a majority of families exiting shelters, saying that they set families up for failure because the subsidy runs out after a year.
Plus, "there are more than three times the number of homeless kids in schools than there are in shelters, which means we have a huge hidden family homelessness problem in the city," said Harding of the Washington Legal Clinic for the Homeless. Many homeless families, Harding said, are living doubled up or tripled up in homes, also in tight living quarters — which would also make "social isolation" difficult.
Harding said she has learned throughout her career that "communal spaces are just not healthy." It's a fact that Bowser acknowledged when she closed D.C. General, Harding said. But those efforts haven't translated into the single shelter system — not, she added, because the city isn't taking the problem seriously, but because these shelters serve such a large number of people.
Zeilinger acknowledged last year that the city has more work to do when it comes to single adults experiencing homelessness. Data from an annual census of the homeless population show a likely increase in the number of newly homeless single adults in the city. The count found that on a single night in January of last year, 6,521 people were staying in shelters, temporary housing or on the street.
Mettimano at Central Union Mission said some community members have recently expressed interest in dropping off supplies like hand sanitizer and wipes. He said he welcomes those donations, along with regular cash donations.
And though they're preparing for the worst, Mettimano said the focus at the shelter right now is on following basic guidance from the Centers for Disease Control and Prevention and other government agencies. That means keeping the space sanitized, encouraging hand-washing, monitoring people for symptoms and discouraging residents from sharing cigarettes or water bottles.
"The men here are just as sensitive to it and concerned as everybody else," Mettimano said. "And hopefully that will translate into them taking the same kinds of proactive measures that other folks are doing right now such as washing hands, using paper towels to open doors, whatever that may be."