This blog was originally posted on Public Health Insider.

People experiencing homelessness are particularly vulnerable to outbreaks of infectious disease. COVID-19 is the most recent and deeply concerning example of that threat. For a population with higher levels of underlying health conditions, less access to resources necessary to stay healthy, and a greater likelihood of living in congregate settings like shelters, this all adds up to an increased risk for infection and severe illness.

For these reasons, slowing the spread of COVID-19 amongst people living homeless and the service providers supporting them is a priority. Public Health – Seattle & King County keeps a careful eye on disease activity and testing efforts at local homeless service provider sites, to act quickly when needed.

Now, the public can see the status of those efforts on a new public data dashboard.

In recent weeks the rate of newly confirmed COVID-19 cases amongst people experiencing homelessness in King County has slowed significantly, and the overall number of cases in this population has flattened. Keeping these numbers low requires ongoing work – particularly by maintaining the “de-intensification” of congregate shelters, which creates extra physical space by reducing the number of people inside any given facility. Ensuring the use of cloth face coverings and adequate access to hygiene resources also make a big difference.

Slowing the spread of COVID-19 is a coordinated effort across the homeless service system, which includes shelters, day centers, encampments, permanent and transitional supportive housing programs, health care providers, outreach workers and people experiencing homelessness. In addition, King County’s Department of Community and Human Services and the City of Seattle’s Human Services Department are key partners in the effort.

“Local homeless service providers and outreach workers have substantially changed how they deliver services in order to protect their clients against COVID-19,” said TJ Cosgrove, Homelessness Response Chief for Public Health – Seattle & King County. “We’re grateful for their partnership, impressed by their rapid innovation and share their ongoing commitment to reducing the risk of threatening outbreaks.”

These collaborative efforts fall into three categories:

Making spaces safer

  • Supported the coordination of eight congregate shelter de-intensification sites by the King County Department of Community and Health Services and the City of Seattle, allowing shelter providers to meet social distancing recommendations while continuing to provide emergency overnight shelter.
  • Worked with shelters and hotel operators to transition 500 participants to hotel space – providing residents with safe space and hotel operators with income during a difficult economic time.
  • Provided over 200 hotel vouchers to move the highest risk individuals out of congregate settings before they get ill, protecting many of the most vulnerable members of our community.

Infection control, outbreak response and testing

  • Prevention and infection control teams have made 116 visits to homeless service provider sites to provide tailored guidance to meet best practice recommendations. They help sites prevent COVID cases before an outbreak has occurred.
  • As of July 7, mobile testing teams from Public Health – Seattle & King County and other community health care partners have conducted 215 testing events, with over 5,464 COVID tests administered, for people experiencing homelessness, providing testing to nearly half of all homeless service sites in the county.
  • Since March, ‘strike’ teams have conducted 118 visits to homeless service sites reporting likely cases. These clinical teams assess the level of contagion, coordinate testing within the facility, refer guests to isolation and quarantine facilities, and offer recommendations to contain the outbreak.
  • Isolation and Quarantine sites provide safe and comfortable space for individuals to recover from illness with access to medical care, meals and other support – including many people experiencing homelessness. These facilities have served hundreds of people since they were opened this spring.

Ongoing supplies and support for homeless shelter sites

  • Ensure homeless service sites receive priority access to personal protective equipment and hygiene and sanitation supplies, through a centralized ordering and distribution process.
  • Weekly calls and ongoing e-mail updates for homeless service providers, street outreach workers, and other stakeholders to share information and provide a space for feedback and strategy development.

Public Health is also planning additional efforts to slow COVID-19 in shelters. Proactive support for service sites will be increased to continue meeting recommendations for hygiene, physical distancing, and infection control. Clinical teams will be deployed for proactive testing for congregate shelters, encampments, and other homeless service sites that are at increased vulnerability for future outbreaks.