Helen’s Place, a Kirkland women’s shelter conceived before the pandemic and finished last August, has never seen a world without COVID-19. The main room was originally intended to double as a dining room and, at night, a place for walk-ins to sleep on mats on the floor.

But that’s not the case today. Most women sleep in semiprivate wooden cubicles in the next room with lockers for their things. Masks are required everywhere but those cubicles and the bathrooms. Less than a third of the women at the shelter have been vaccinated, staff said.

Q Fernandes, a housing case manager, has decided that no matter how policies at the shelter change, they will never take their mask off at work.

“It’s a personal decision that I have made because of the vulnerable population I serve,” Fernandes said.

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

There is no telling when any of this will change. After months of persistent outreach and vaccination clinics at shelters, many nonprofits are reporting that only between 30% and 50% of their residents have received vaccines, according to staff at the King County Regional Homelessness Authority and two shelters. (According to the state Department of Health, 71% of King County residents 16 and up have received at least one shot.)

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As of Aug. 13, the county had administered more than 5,800 vaccine doses in homeless shelters, day programs, service sites and permanent supportive housing for formerly homeless people.

But that doesn’t mean nearly 6,000 homeless people have been vaccinated — almost 4,000 of those doses were Moderna and Pfizer. Public health officials couldn’t say by publication time how many homeless people have gotten both doses, or how many of those were formerly homeless people who have been housed.

At last count in January 2020, there were almost 12,000 homeless people in King County; that was before the pandemic and was likely an undercount even then.

“Our department vaccination teams and partners have already visited key shelter and encampment sites twice, with those who are interested and less reluctant to be vaccinated likely covered by now,” James Apa, a spokesperson for Public Health — Seattle & King County, said in an email.

As the delta variant has accelerated the spread of the coronavirus through the unvaccinated population at large, there have been close to 90 coronavirus cases in August associated with homeless populations or the people who work with them in King County, according to an online public health dashboard.

During a tour of a Sodo Salvation Army shelter last week — another shelter created since the pandemic started, where large canvas partitions separate each bed — Marc Dones, the head of the King County Regional Homelessness Authority, asked about the shelter’s vaccination rate (roughly the same as Helen’s Place, 30%) and expressed concerns about getting those numbers up to the 50%-60% acceptance range.

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“To be clear, I’m not saying, like, I know yet what to do — I’m just saying we need to have a plan,” Dones said to the Salvation Army staff present.

At a weekly COVID-19 homelessness response meeting between nonprofit and public employees, the mood was one of fatigue and frustration as shelter and meal program staff asked public health workers if things were bound to change any time soon. County employees said they’d considered downsizing the isolation and quarantine hotels for homeless people exposed to the coronavirus who needed a place to stay at the beginning of summer, when case numbers were low. Now, that wouldn’t be happening.

“I wish we weren’t in this position right now, 18 months in. It’s rough,” said Rachel Gunsalus, a program manager at the public health department.

Jody Rauch, a nurse and clinical quality lead for the Healthcare for the Homeless Network who has led the charge in coordinating pandemic response, said that public health leaders are having conversations about how to increase uptake.

“We are going into another fall and winter, and that is daunting,” Rauch said. “I almost want to cry right now.”

Some hope to see another fall clinic drive, said Dan Wise, director of homeless services at Catholic Community Services, one of King County’s largest shelter operators. This month, Wise’s family shelter emptied out entirely because of an outbreak of 13 cases of the coronavirus.

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“Our workforce that’s been with us throughout the pandemic is fatigued. This has been really emotionally distressing; they’ve seen so many of their colleagues and so many of our unhoused neighbors get very, very sick,” Wise said. “[But] if we did another push for vaccines, they’d 100% rally behind that.”

The public health department has been offering $25 gift cards to homeless people who come to the downtown and Eastgate health centers, but in order not to be too coercive to people who don’t have much money, they use them “as a draw to get people in the door and engage in conversations, but it’s not contingent on them receiving the vaccine,” spokesperson Apa wrote in an email.

Dr. Helen Chu, a UW Medicine researcher who’s funded by the Centers for Disease Control and Prevention to study vaccine hesitancy in the homeless population, said that while high rates of mental illness, distrust of the government or the health care system may complicate the push to vaccinate, an incentive as simple as a place to stay while recovering from any vaccine side effects could change some people’s minds.

“It’s going to be hard for a person who’s homeless to be sick for two days after they get that vaccine dose,” Chu said.

But Dennis Culhane, a national health and homelessness researcher and professor at the University of Pennsylvania, says more drastic measures need to be taken nationwide — mandating vaccines for all shelter staff and residents.

“The workers are at risk, the other clients are at risk — these are people who are without choice in the matter,” Culhane said. “They don’t have a choice but to go to shelters, unless they’re going to risk their health and safety outside.”

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Alison Eisinger, the director of the Seattle/King County Coalition on Homelessness, says she’s close to believing there should be a vaccine mandate across all populations, but she doesn’t support a mandate “that’s based on what people’s class is.”

“The point of shelter is to welcome people in, not to add barriers,” Eisinger said. “We may think people need a COVID-19 vaccination before anything else. They may think that they need a safe place where they can sleep for more than two hours in a row.”

Right now, the best ingredients for higher rates of vaccination seem to be stability for homeless people and persistence from health care providers. At King’s Inn, where a group of homeless Native American people moved from the street, the Seattle Indian Health Board was able to get more than half the nearly 70 residents vaccinated — but it took weeks.

“It was kind of a long game — they wanted to know why we were there, what we were doing. They wanted to ask a lot of questions about the vaccine itself,” said Shawn Thurman, a nurse with the health board. “Sometimes it took two, three, four visits before they came around.”