The process to enter and exit The Salvation Army’s COVID-19 care wing at its Sodo shelter is serious. People entering through the plastic drapes have to put on hand sanitizer, gown, gloves, N95, surgical mask, face shield. Leaving is a carefully choreographed dance, so the skin doesn’t touch the outside of the gown or gloves: remove the shield first, then gown, and finally gloves.
But inside, the vibe feels less serious.
People lounge on beds and look at their phones. It’s silent except for the hum of the HVAC system in the pipes above. Gowned and shielded staff — who are required to be vaccinated in this wing — sit at computers or walk around checking on everyone every 30 minutes.
While every patient inside has tested positive for the coronavirus, none is symptomatic, and if someone begins consistently coughing, staff members call an off-site nurse.
During previous surges, sick shelter residents had the option to stay at a King County isolation and quarantine hotel with nurses on-site. But as the omicron variant drives infection rates in Seattle and nationwide higher than ever before, shelter providers like The Salvation Army have been dealing with outbreaks mostly on their own.
“Just like other providers have seen, it’s become extremely difficult to get people into I and Q because they’re facing their own challenges,” said Simon Foster, director of Seattle social services for The Salvation Army, referring to isolation and quarantine.
But in those county hotels with medical staff and services where nonprofits would normally send their positive cases, scores of rooms have been sitting empty for weeks.
The King County government, which has until this year managed to keep a lid on massive outbreaks and deaths among homeless people, largely threw up its hands last month as the coronavirus spread through the homeless population.
The dashboard that has tracked COVID-19 cases in homeless populations for almost two years has been dark since Jan. 4. Many homeless shelters in King County have seen half their residents become infected in the last few weeks, a shelter doctor said, but there is no current official count. The entire west wing shelter in the King County jail had to be shut down because of a COVID outbreak.
“I don’t believe that we’re ever going to be able to keep up with the number of cases that occur,” Dr. Jeff Duchin, with Public Health – Seattle & King County, said at the beginning of January, as public health officials told shelters they would essentially need to figure out how to isolate their positive cases on their own. “The sheer number of people who become infected will overwhelm the ability to move everyone into a separate isolation and quarantine setting.”
Last week, someone died in a county isolation and quarantine hotel. The last time that happened was April 2020.
“Dealing with the infection rates of Omicron has been a struggle for everybody across the nation, and all of our systems are stretched. We are no exception,” Semone Andu, regional health administrator for Healthcare for the Homeless Network, said in a statement. “We have individuals who have hardly taken days off in two years. Our staff continue to do this work, without rest, because they are committed to supporting our most vulnerable people.”
Here’s how it worked, for the most part, in 2021 when a person without a home tested positive for the coronavirus, didn’t need hospital care, but couldn’t isolate safely: A case manager, outreach worker or shelter employee would call a public health line, and run through the person’s symptoms and how long they’d been sick. If the infected person qualified, that person would go to one of a few facilities available with medical care and separation between residents, including a motel in Kent the county bought early in the pandemic for this purpose.
As omicron spread, the county converted a hotel in Auburn for this purpose, raising the number of available isolation and quarantine beds to 179.
Local hospitals filled up, however, and the hotels went into “contingency mode,” Chase Gallagher, a spokesperson for County Executive Dow Constantine, said in an email.
“That means that these [isolation and quarantine] facilities transition from focus on helping control the spread of COVID to serving as a safeguards against the collapse of the hospital systems,” Gallagher said.
That required the county to “quadruple” staffing ratios at the shelters because residents had severe medical issues but couldn’t go to a hospital.
Public Health couldn’t staff every room in the hotels and the bar to get into one of the beds rose. Staff at homeless nonprofits, who’d struggled in the past to get people into isolation and quarantine, found it even harder. Some said they spent hours trying to get one or two people into isolation and quarantine rooms, to no avail.
“I count out I and Q. That’s not even an option,” said Dawn Whitson, a system coordinator for Evergreen Treatment Services’ homeless outreach arm, in mid-January. “I won’t waste my time with it until I hear something back from Public Health [about the guidelines]. They’re very time-consuming and I won’t even try.”
Meanwhile, as mid-January approached there were more than 60 empty rooms in Kent and Auburn.
Shelters are also likely filled with many unvaccinated residents. Though the King County Regional Homelessness Authority sent out a survey on vaccination rates in shelters, few shelter operators have responded, according to a spokesperson. The authority’s best guess is that around 55% of shelter residents are vaccinated.
That would roughly match up with a vaccine study done in King County shelters a year ago about vaccine acceptance, which found 53% of respondents would get the vaccine but 17% were still considering it.
While Public Health has again loosened the guidelines, they’re still facing workforce troubles, Gallagher said.
Some hospitals have also struggled to find places for COVID patients to go if they don’t have a home but aren’t sick enough to stay. The county said it would pay for hotel rooms for any homeless people with COVID, and circulated a list of hotels created by the regional homelessness authority. So far, the county has paid for 80 hotel vouchers, Gallagher said.
But Public Health stopped circulating that list after health care and homeless providers said it wasn’t helpful. The general manager of a Comfort Inn said he had no idea how he got on the list, or why he was suddenly bombarded by calls from hospitals this month.
“Why are they asking me for rooms?” said Jason Kim, manager of two Americas Hotels, who also was added to the list and has gotten calls. “They got them. It’s not even full over there.”
One hospital social worker said that since none of the hotels on the list had rooms, she had to let people leave the emergency room and go who-knows-where.