In some ways, it was surprising that Spokane's homeless shelters weren't hit with COVID-19 outbreaks sooner.
"We were expecting that congregate settings and shelters would be one of the first impacted by COVID because of the amount of people in one space not necessarily having their own space to isolate," says Kylie Kingsbury, homeless outreach coordinator for the Spokane Regional Health District.
But shelters were largely able to stave off any outbreaks until November and December, when spread of the virus spiked throughout all sectors of the community with Halloween and then later holiday gatherings contributing to the problem.
Kingsbury and others involved in the shelter system say outbreaks were avoided for so long partly with help from lessons learned from norovirus and hepatitis outbreaks over the last few years. Those brought challenges of their own, but also improvements to many facilities including increased hand washing and sanitizer stations.
"It's kind of great that it's taken so long to have such a big impact in the shelter setting," Kingsbury says. "I think that's reflective of a lot of our shelter providers and how on top of prevention they were and I think also partnerships with the city and health district."
The previous illness outbreaks also helped staff get trained to recognize symptoms of different conditions and isolate people as needed, and made it easier to implement isolation and contact tracing this year with the pandemic, says Dena Carr, who took over in July as director of House of Charity, a downtown shelter.
Since November, a handful of the 14 shelters that have been working with the health district have seen outbreaks, when two or more cases are connected in the same place, Kingsbury says. Some of the sites have seen dozens of cases connected to the same outbreak, with the largest so far affecting 59 people tested at the same shelter over the last month.
Each outbreak is unique, Kingsbury says, and the health district has helped facilities adapt their plans as needed.
Family Promise's Open Doors, which provides shelter for families with children, had the earliest outbreak of more than 30 positive cases in early November. They opted to move people out of the shelter who had tested negative and isolate people in the shelter who'd tested positive, before later reopening for more normal operations.
"[With] the Family Promise outbreak, at the very beginning it was by far more positive than there were negative, so it made more sense to move the negative people out and keep a semblance of normal life," Kingsbury says. "But in our low-barrier sites we want to move the positive people out as soon as possible, and that's generally what happens."
Indeed, with the more recent outbreaks, as people test positive, they're able to go to one of two county isolation facilities that are available for any county resident who can't isolate at home — not just those who are homeless. Those are located at My Place Hotel or the Catholic Charities Immaculate Heart Retreat Center. Afterward, the health district helps coordinate their return to the shelter they came from.
Thankfully, weekly testing, testing on demand and isolating those who are positive appears to be working, with staff at different shelters reporting it's helped quickly address outbreaks at their facilities.
"Whatever we're doing, it's working for the moment," says Mike Shaw, CEO and founder of the Guardians Foundation, which operates the Cannon Street warming shelter. "We're happy about that."
HOW TO MANAGE AN OUTBREAKEarly on in the pandemic, Spokane's homeless shelters got to work spacing out their day-use areas and beds to ensure at least 6 feet of social distancing. They implemented mask policies, and for a while, the health district led a team that screened every person who entered the shelters each night to check for fever and COVID symptoms such as a cough or difficulty breathing. Those who had symptoms could get tested and transported to isolation if needed.
But once COVID community spread started running through the Inland Northwest like wildfire, the testing process was changed.
Now, most low-barrier shelters are having nearly everyone rapid-tested on a weekly or twice-a-week basis, with the health district providing on-call rapid testing seven days a week if someone has symptoms and needs testing.
At the Cannon Street warming center, Shaw says his staff members — many of whom became familiar with testing at the Spokane Arena temporary shelter space this summer — have been able to isolate people in a trailer on site as needed until they can be tested.
"If someone has a 103 fever, we can put that person into isolation," Shaw says. "Just this last week, I was pretty seriously symptomatic on New Year's Day and the health department came and tested me and the people who had contact with me."
Thankfully, his results were negative, but he was encouraged to get tested again this week.
Cannon has had a total of 31 people test positive during its outbreak, which started just 10 days after the warming shelter opened on Nov. 19, Shaw says. The 72-bed shelter saw about 22 cases in the initial spike that first week, he says, which rapidly dwindled to just one or two cases here or there since.
As of Jan. 4, there have also been five cases at the Union Gospel Mission Men's Shelter, and two at the Catholic Charities Family Warming Shelter, Kingsbury says.
Meanwhile, at The Way Out Shelter on Mission Avenue, operated by the Salvation Army, an outbreak was discovered among asymptomatic guests when they started doing mass rapid testing on Dec. 14, according to Salvation Army staff. With several asymptomatic positives discovered that first day, people were moved to isolation, and with continued testing, the outbreak has affected a total of 59 people at the shelter, which has beds for 102 adults (both men and women). As of Jan. 4, 17 people were isolated as part of that outbreak.
"Staff have received additional training regarding the proper use of face coverings, cleaning procedures, and enforcement up to and including removing guests who refuse to properly wear a face covering," writes Salvation Army Spokane spokesman Brian Pickering.
The House of Charity has been housing 140 people between its main shelter (men only during the pandemic) and overflow isolation space for women (about 35) in some apartments owned by Catholic Charities; it has seen 47 cases since its outbreak started in mid-November.
Thankfully, when those who are positive go to isolation and come back, they have some level of immunity and can be used as sort of a buffer inside the facility between longer-term guests and newer guests who haven't been tested as many times, House of Charity Director Carr says.
Testing isn't mandatory, so no one is being forced to take a test, but interestingly, most community members experiencing homelessness are participating when asked, Kingsbury says, in part because of the trust built up with the health district team not just over the summer, but during their efforts to address the hepatitis outbreak during 2019. Carr echoes that.
"It was really a pretty easy transition to go from working together with the health district to mitigate hepatitis A to working collectively as a team to address the need that COVID presented," Carr says. "Our patron population is slow to trust people. ... That health department team, really, they are pros at engaging in a respectful and dignified way with folks, so that has gone a long way I think in them gaining traction."
Kingsbury hopes the next step in tackling COVID will be helped by the work the health district already did in getting hepatitis vaccinations distributed through the shelters as well, with that work ending in early 2020.
"We're really excited for when [COVID vaccination] comes, and a lot of community members in the shelters are already asking about it, which I think is awesome," Kingsbury says. "That was lucky timing because the immunization team did a lot of outreach and building rapport and trust in vaccines." ♦