What Do You Do During a Stay at Home Advisory, if You Don’t Have a Home?

These past few weeks have certainly been challenging. Seemingly overnight, public schools and universities closed, non-essential businesses were moved online, and Cambridge municipal buildings shut their doors for the foreseeable future, all in attempt to flatten the curve of COVID-19 transmission. Perhaps the most drastic change was when Governor Charlie Baker issued a Stay at Home Advisory, which was recently extended to May 4th. At our last meeting, the City Council heard directly from Claude Jacob, the City’s Chief Public Health Officer, just how necessary this swift action was: “This is my third visit to the City Council in as many weeks, and as of this afternoon, the case count in Cambridge stands at 79 individuals, with one reported fatality as of this past weekend. That number was 7 when I was here two weeks ago.”  And, as that number has already increased to 119 positive cases within the past four days, the need to stay home and away from large groups is clear. But what do you do during a Stay at Home Advisory, if you don’t have a home?  How do you self-isolate, if you sleep within several feet of someone else at a homeless shelter?

For our homeless residents, this public health crisis poses an especially high risk. Someone experiencing homelessness is more likely to be hospitalized, to need intensive care, and to die from COVID-19 than their housed counterparts. Certain common factors among homeless individuals, such as being older, having underlying health conditions, lacking access to hygienic materials, and more mean this already vulnerable population is in great need of support. The graphs below illustrate the specific risks our homeless population face when compared to the general population:

Source: “Estimated Emergency and Observational/Quarantine Capacity Need for the US Homeless Population Related to COVID-19 Exposure by County; Projected Hospitalizations, Intensive Care Units and Mortality” by Dennis Culhane, Dan Treglia, Ken Steif, Randall Kuhn, and Thomas Byrne, March 25 2020.

The threat posed by this high level of susceptibility extends beyond our homeless population as well. As Risa Mednick, a tireless advocate for Cambridge’s vulnerable residents, eloquently put it in a recent communication to the City Council (which included the above referenced report), 

“The basic needs of our most vulnerable community members must be addressed first ‐‐ safe, warm quarantine space with easy access to running water, soap, bathrooms, showers, and qualified care. Without these measures, the ripple effect of infection among service providers across many systems (from frontline nonprofit workers to municipal employees to law enforcement officers) could be devastating. It is clear that the collaboration of the private and higher education sectors in our community is critical at this moment. The Cambridge nonprofit organizations providing congregate living, overnight shelter, and day shelter options do not have a way to access additional space without intervention.” 

For these reasons, the City has announced that the War Memorial Recreation Center will be used as an emergency homeless shelter during this pandemic.

Located at 1640 Cambridge Street, the War Memorial was determined to be the best, and the only site readily available for an emergency homeless shelter. Pinpointed by an Emergency Task Force, the War Memorial Center meets requirements for both physical space as well as activation time, already serves as the City’s designated site for emergency preparedness activities, and is approved by the Red Cross, making it well-suited to fit the needs of our homeless residents. 

Depending on a residents’ health, they will be placed in one of three distinct service sections of the shelter: a main area for non-symptomatic residents, a quarantine section for those displaying symptoms as they await testing, and a self-isolation area for individuals who have Coronavirus. The unique layout of the War Memorial will ensure these three groups do not intermingle, so that those without symptoms can be protected from COVID-19, and those sick or with symptoms have access to the private bedrooms and bathrooms to prevent further spread. 

Medical staff will be available for everyone sheltering at the Recreation Center, ensuring those quarantining or isolating are cared for, and early signs of transmission are detected. Private security will be employed within the shelter, while the Cambridge Police Department will work to prevent any disruptions to the surrounding neighborhood, and there will be a hotline for adjacent residents for any questions and concerns. As the War Memorial is a part of the Cambridge Rindge and Latin Schools campus, City staff has worked with Harvard University and the Massachusetts Institute of Technology to secure classroom space for students, should schools reopen before the end of the academic year.

Those residing at the shelter will be offered day programming by Bay Cove Human Services, encouraging them to stay in shelter, and out of harm’s way, during daytime hours. The shelter will additionally serve as an overflow space for other homeless shelters. The CDC and FEMA are recommending 100-110 square feet of space be allotted per bed, meaning a large reduction of available beds in existing shelters, which were previously highly concentrated to maximize capacity. Opening this additional shelter will help ensure this vulnerable population can responsibly social distance, while continuing to access the services they need.

In times like these, it is heartening that our City is dedicated to protecting and supporting this vulnerable population during their time of need. The findings of one report, “Estimated Emergency and Observational/Quarantine Capacity Need for the US Homeless Population Related to COVID-19 Exposure by County; Projected Hospitalizations, Intensive Care Units and Mortality” by Dennis Culhane, Dan Treglia, Ken Steif, Randall Kuhn, and Thomas Byrne, demonstrate just how necessary this response is. This report estimates that 40% of the country’s homeless population could be infected with Coronavirus at the peak of the crisis. As Cambridge currently has 407 homeless residents, with 81 unsheltered, and 326 in shelters, it is imperative that we flatten the curve of transmission before that estimate becomes a reality for our community. Our healthcare system is already overwhelmed, and additional stress caused by inaction could prove disastrous, if not deadly. Allowing homeless residents to access shelter and practice social distancing is a proactive way to prevent further infection, which is the vital key to solving this public health crisis.

As Dr. Assaad Sayah, Public Health Commissioner and the CEO of the Cambridge Health Alliance, noted during our last City Council meeting, “These are unprecedented times, and we are doing unprecedented work. This work is absolutely critical, not only for the health of the individuals in question, but for the health of everybody in the City of Cambridge.” Stopping the spread of COVID-19, both among our homeless population and the entire Cambridge community, starts with providing this vulnerable group with access to housing, healthcare, and day programming. I am hopeful that, with this creation of an emergency homeless shelter, our most vulnerable residents will be better served, and the entire City will be set on a path towards recovery.

Opening this emergency homeless shelter is just one of the many ways in which the City is supporting our community during the COVID-19 pandemic. To learn more about resources that are available to you, click here.