After few reports of COVID-19 in Seattle’s homeless shelters earlier this summer, August has seen a spike focused mainly at Harborview Hall, a shelter on First Hill.

On Aug. 11 alone, 15 cases were reported in King County, the third-highest number counted among the homeless population in one day since the onset of COVID-19. The two highest daily spikes were both reported in April.

It’s potentially a bad omen for the fall, when cold weather will encourage more people to stay at shelters rather than outside, and make leaving windows open to ventilate a room less of an option.

The Seattle Times’ Project Homeless is funded by BECU, The Bernier McCaw Foundation, The Bill & Melinda Gates Foundation, Campion Foundation, the Paul G. Allen Family Foundation, Raikes Foundation, Schultz Family Foundation, Seattle Foundation, Starbucks and the University of Washington. The Seattle Times maintains editorial control over Project Homeless content.

The Harborview Hall shelter, which is run by the Salvation Army and is across the street from Harborview Medical Center, has seen 27 cases since the beginning of August.

One of the diagnosed cases, a man in his 70s, died on Aug. 7 at a hospital. Captain Felicia Grant, head of the Salvation Army’s Seattle social services, said the man died of lung cancer, but the King County Medical Examiner later confirmed COVID-19 as one of the causes of death and said he had “underlying conditions.”

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Grant said the shelter has been working to stem spread — isolating people who test positive in county facilities, asking guests to take their temperature before entering, setting up industrial fans — but the facility doesn’t have air conditioning or good ventilation.

“The building — there’s only so much we can do because of its limitations,” Grant said. “We have our front doors open … the windows throughout the property open to create airflow, and we have since the outbreak … scheduled an industrial hygienist to come in and aid us.”

A smaller cluster of five cases popped up Aug. 14 at a shelter run by SHARE/WHEEL at St. John’s United Lutheran church, according to Public Health — Seattle & King County.

King County officials and shelter providers have worked to try and limit the spread of COVID-19 among the area’s homeless population. Those efforts include moving shelter beds into temporary facilities to spread people out, putting hundreds of people up in hotels, and deploying mobile testing sites at shelters, resulting in 11,520 tests since March 1.

Michael Durham, technical assistance manager for the National Health Care for the Homeless Council, said earlier this month that Seattle has had one of the most progressive responses to COVID-19 for people living homeless. In addition to making more room in shelters, the city also has deploy additional hand-washing stations and some mobile showers.

Living outside often puts people at risk for disease transmission and violence, but in the midst of a pandemic, it may often actually be “the safer option in terms of risk for transmission,” Durham said.

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“A homeless shelter is the worse place to be if you’re thinking about infectious disease outbreaks,” he said. “A lot of shelters have decompressed, meaning they’re spreading beds apart, but it’s still a risky place to be for transmission of COVID-19.” 

Like the general population, homeless communities face new concerns with colder weather and the flu season approaching, and public health officials say they are keenly aware of the challenges.

More people will be knocking on doors of shelters, said TJ Cosgrove, head of Public Health — Seattle & King County’s homeless response. And since flu season will hit in the middle of a potential COVID spike, shelter workers and health-care providers will need to know quickly whether someone with symptoms has the flu or has COVID, he said.

“Right now we’re doing a great job, I believe, bringing COVID testing to people,” Cosgrove said. “We need to do an equally great job of bringing flu and other disease testing out there as well.”

Earlier in the summer, COVID cases in the homeless community appeared to be staying low, despite a larger uptick in the general population. But some wondered if it was just a matter of time before the novel coronavirus began to spread.

“I think initially in the pandemic there seemed to be a lag time between the more general community spread of the virus before we started to see it spreading among people experiencing homelessness,” Downtown Emergency Service Center executive director Daniel Malone said in a late July interview.  

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Malone credited the work local governments and providers for dampening the impact of the virus. But he wondered if the numbers showed “another lag before it starts to hit people experiencing homelessness more significantly.” 

July also saw the area’s first reported COVID outbreak at a homeless encampment. Six people were sickened at an encampment near South Park, and a Neighborcare Health outreach team identified challenges in getting hygiene resources to the group quickly. Officials set up hygiene stations two weeks after the first case was identified. 

It’s unclear what the fall will bring for homeless populations, said Dr. Stephen Hwang, a researcher on homelessness and health at the University of Toronto who also serves in Toronto’s homeless shelters. But Hwang believes what’s most likely is that COVID-19 among homeless people will mirror COVID-19 among the general population.

His reasoning: Toronto, which has almost 9,000 homeless people at last count, took an approach similar to Seattle’s, depopulating shelters and putting 2,000 people in hotels. But Toronto is seeing infection rates in shelter screening drop to nearly zero. Hwang attributes that more to Canada’s aggressive approach to the coronavirus than to anything the shelter system did.

“I would be much more concerned if I were in the U.S. given the higher community rates,” Hwang said, “just as I would be much more concerned about outbreaks this winter in long-term care facilities or outbreaks this fall in schools.”