Every morning, after waking up on a mat at St. Martin de Porres homeless shelter, William Smith, 67, exercises his lungs by holding his breath — first for five, then 10 seconds.

By that point, he’s winded: Smith says he has chronic obstructive pulmonary disease, a chronic lung disease obstructing air flow to his lungs. He has tubes in both nostrils that snake down and connect to an air concentrator on wheels, which he carries behind him. He’s had pneumonia for the last two months.

This week, the shelter nurse told him he’s “real susceptible” to the novel coronavirus COVID-19, which has killed 16 people so far in Washington state as of Saturday morning.

“That’s always going to be in the back of my mind now,” Smith said.

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Every night at St. Martin de Porres shelter, 212 men over the age of 50 pack in to sleep on mats on the ground 6 inches apart. Many clients here have underlying medical conditions like Smith’s, and during the day the shelter serves as a kind of medical respite for people who have nowhere else where they can go and recuperate.

St. Martin de Porres is not alone; in a 2019 survey of almost 1,200 homeless people in King County, 27% said they had a chronic health problem. As of the end of January, almost 3,800 single adults or heads of households in King County were older than 50, according to the county’s Homeless Management Information System — close to 30 percent of the total in the database.

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This is already a very sick population that’s been growing sicker as the homeless population in America gets older, many experts agree. The average single homeless person is 60. The life expectancy for a homeless person who makes it to age 50 is only 64, according to Dr. Dennis Culhane, a researcher at the University of Pennsylvania who’s studied the aging homeless population (in America, overall life expectancy is 78.7 years).

The number of homeless people age 65 and over will triple over the next decade, a factor that will require homeless shelters to start providing even more medical care.

“We are already up to our knees in this elderly homeless phenomenon,” Culhane said. “Obviously the coronavirus just amplifies the fact that we have this very vulnerable elderly group.”

Couple this large homeless cohort with the fact that shelters are a “fertile ground” for transmission of infections like COVID-19, according to Dr. Stephen Hwang, a researcher on homelessness and health at the University of Toronto. Shelters like St. Martin de Porres could be even more susceptible than places like the Life Care Center, a long-term care facility that has been the epicenter of the COVID-19 crisis in Washington.

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“People clustered together in potentially crowded indoor facilities,” Hwang said. Shelters are “sites where infection can spread quite rapidly, as they can in other settings like nursing homes.”

At another large shelter that serves many older, chronically homeless people, the Downtown Emergency Services Center (DESC) has for more than a year seen a growing number of clients showing up with debilitating, chronic illnesses.

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People staying at DESC exhibit symptoms similar to those of the coronavirus “every day,” said Dan Malone, DESC executive director. “We just would have no way of knowing if these are COVID-19 symptoms.”

Seattle city government opened Exhibition Hall Monday as an overflow shelter, identifying healthier clients who could move there from more crowded DESC shelters, in a move a city spokesperson said was designed reduce crowding and get sick clients away from congregate settings.

A city release said there are no known cases of COVID-19 among the homeless population at this time.

Researchers aren’t sure what would happen or how many could die if coronavirus made its way into the homeless population: In the late ’80s and early ’90s, tuberculosis had a deadly resurgence in New York City’s homeless shelters, killing around 1,700 from 1987 to 1994 (including people who weren’t homeless). In many ways coronavirus would be a “novel experience,” Hwang said.

St. Martin de Porres is taking steps to stop any spread of germs, cleaning surfaces with a bleach solution every two hours, and providing face masks to anyone with a persistent cough. Coronavirus fact-sheets are plastered on every wall. Staff are prepared to isolate stayers if need be: In December, when several men at St. Martin de Porres caught the flu, the T.V. room was designated as a “flu room” and infected people slept in there.

But for many other clients, the coronavirus doesn’t present anything much more dangerous than what they typically deal with as homeless people.

“I’ve held community meetings with the clients to discuss concerns and how we’re address this and the things we’re doing to keep them safe,” said Jennifer Newman, program director at the shelter, which is run by Catholic Community Services. “And I have not had any feedback from clients that they’re any more concerned than they are about the flu or any other contagious virus that comes thru the shelter.”

St. Martin de Porres client Jerry Kies is 76 and not too bothered by coronavirus scares: He has been in and out of the Seattle VA medical center recently for multiple heart issues — he was just there last week, he said.

“They’re blowing it way out of proportion,” Kies said. “I understand it’s dangerous, but I understand I feel safer in here than I am out there.”

Project Homeless editor Vianna Davila contributed to this report.

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