This past week, the US Interagency Council on Homelessness released their latest webinar discussing pandemic planning implemented by Birmingham, Detroit, and New Orleans. They cover tactics used as well as lessons learned since March.
Birmingham is the largest city in Alabama and has been hit by COVID-19 very hard. In the past two weeks, 30% of the total COVID-19 cases have been detected. They continue to face a surge of cases, a similar reality to many US states. The homeless network in charge of pandemic planning includes all partners: local governments, hospitals, Continuum of Care, service providers, and community leaders. The homeless leaders in Birmingham note that this isn't perfect but has allowed for local prioritization and coordination across several systems.
Birmingham utilized three testing strategies as the pandemic unfolded. In early March, the Health department was restricted to only testing homeless individuals who were symptomatic of COVID-19. The initial testing strategy provided a very important lesson, homeless clients are wary of the health department. This knowledge resulted in a significant increase in onsite care and outreach. Many of the clients responded better to faces that they already knew. When facing moderate community spread, the testing strategy shifted. Jefferson County began to partner with other community testing sites, and expand their tests to individuals symptomatic and asymptomatic who had potential exposure. In the past few weeks during substantial community spread, Jefferson County has utilized facility-wide testing in shelters and other congregate living facilities. This includes testing all guests and staff members. During this process, Jefferson County noted that it is important to finalize plans for when the test results come back positive, as well as being prepared for the results to be delayed.
For the newly sanctioned emergency shelters, Jefferson County emphasized how critical communication is. They participated in daily calls with all partners. During the pandemic, Jefferson County has been lucky, and none of their shelters were closed. The services provided were cut significantly, requiring that resources be redirected to other programs. Significant changes were made to shelter operations after HUD and CDC guidance released to shelter facilities. This included: regular symptom checks, physical space restrictions, and a reduction of shelter capacity. For alternative shelter options, Jefferson County was able to fund a hotel/motel program through the county health department, faith community, private funders, and local foundations. These facilities are being staffed by CoC, which is working to provide essential health care as well as case management. Jefferson County also built tented quarantine and isolation facilities. These spaces were donated and are being funded through a health department contract. The facilities are limited to 8-10 beds and the max stay is around 10 days.
There has been a pointed initiative for outreach as increases within the unsheltered community have been noticed in Jefferson County. They have been focused on providing life-sustaining services and permanent supportive housing. Jefferson County has also increased the amount of communication provided to those living outdoors. This includes a new texting service, increased outreach to vulnerable individuals, and partnerships with the public health department to deal with other issues like Hepatitis A. Part of this outreach has manifested as increased exposure for sanitation stations. Jefferson County is provided portable toilets and hand-washing stations in carefully selected locations: camps of 10 or more individuals where communication has already been established. They have also been refusing to clear encampments without a clear plan from the service providers, and Birmingham PD. While many of the camps have not been cleared, there has instead been an increase in outreach: that emphasizes prioritizing unsheltered individuals in the CV re-housing plan.
Detroit, Michigan was the second city highlighted in the USICH webinar about their pandemic planning. The homeless leadership in Detroit noted that the city's population is very unique: 79% of individuals living in Detroit are African-American. This has proved to require innovative thinking, as communities of color are being hit particularly hard by COVID-19. Some COVID-19 specific strategies that have been used are creating policies and procedures for interim shelter sites, as well as lifting the 90-day shelter time limit. Communication and coordination have increased significantly in the form of daily calls, weekly webinars, and situation reports. Detroit has also developed an isolation and quarantine strategy of separating individuals based on care needs. The first shelter type is for symptomatic individuals awaiting test results, the second type is for COVID-19 positive individuals, and the last is high-risk individuals waiting to be referred to permanent supportive housing. Health screening and testing strategies that have been utilized include employing public health nurses, regular testing schedules, centralizing supplies, and PPE distribution.
Detroit has been very savvy in developing strategies that work well for their client base. Some of these include portable showers, client incentives, telehealth funding, and hazard pay for staff. These new ideas have come through trial and error, and they have learned valuable lessons along the way. The primary being that: the outreach programs until this point has been subpar. There wasn't a unified vision that made it difficult to respond to a global pandemic. For Detroit, COVID-19 highlighted a need for landlord recruitment and support for these landlords. They also realized that not a lot of philanthropy was pointed at homelessness, COVID-19 has provided the push needed to learn how to best utilize private and public dollars. Detroit's main takeaway has been to look at what is broken in the system and use the abundance of resources to figure new solutions and break away from the status quo.
The final city to explain their COVID-19 response was New Orleans. Like Detroit, the majority of the population is black, and about 75% of the total deaths come from the black community. They, however, were in a better position than other places in the country. New Orleans already had hotel infrastructure in place due to Hurricane Katrina. They realized that almost no one will turn down a hotel room, but people can be resistant to being placed in a shelter. Their hotel program is working in conjunction with its rapid-rehousing infrastructure. This system has allowed them to move 712 people experiencing homeless into PSH. They have also significantly increased their outreach to those within the unsheltered community. The goal for New Orleans going forward it to dedicate ESG rapid-rehousing resources for a "Safe at Home RRH program" that moves people into housing.