At a Virginia homeless shelter, the Covid pandemic never stopped

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Every night, as the temperature plummets and dozens seek shelter at Arlington County’s largest homeless shelter, staff go through the same drill as they have for the past three years: before anyone gets a bed, they’re tested for the coronavirus.

On Wednesday, the shelter’s usual one or two Covid cases landed early. As more people arrived, more cases followed. By the end of the night, staff said, a dozen people had tested positive. Everyone had to be quarantined.

The shelter had an outbreak.

At the facility, which is run by non-profit organization PathForward, the year is ending much like it began: with an outbreak of disease that is pushing an already burned-out staff to the limit. But now many of the resources PathForward once relied on to contain the virus are gone.

Covid raced through a homeless shelter. To contain it, they took everyone to a motel.

The outside world has made strides, but those living and working in shelters are meant to shelter the most vulnerable in the region still fighting Covid day by day. They’re testing, enforcing mask-wearing, and trying to keep infection rates down while the shelter’s winter population explodes. What they really need is a chance to breathe, assess, and try to anticipate the next crisis. You didn’t get it.

“It feels like we’re back to where we were before,” said Betsy Frantz, PathForward’s president and chief executive. “We never really recovered. With hypothermia [season] I was about to start when I spoke to a salesperson and he said, “You don’t seem ready yet. You don’t seem where you normally are.” And the reality is that we’re just exhausted. There is an overwhelming, an exhaustion because you can never stop. There’s this feeling of ‘when is it going to end?’”

Since the pandemic began, homeless service providers have struggled to balance the continued care of clients with a range of needs — physical or mental illness, substance abuse, unemployment — and keeping people safe in community settings where infectious diseases are spreading rapidly can.

During the coldest months of the year, PathForward, like many shelters, expands to accommodate those who typically sleep on the streets. Extreme cold can almost double its population. Meanwhile, the facility’s medical recovery wing cares for patients being treated for cancer, undergoing dialysis and receiving therapy for debilitating neuromuscular disorders.

“It just all adds up,” said Kasia Shaw, PathForward’s registered nurse and senior director of medical services. “We’re still enforcing certain rules to keep people safe, like masks in common spaces, but it’s getting harder and harder.”

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Traders enter the building with their faces unpainted. Customers used to not wearing masks outside are reluctant to have to put one on. Everyone, Shaw said, is “burned out on Covid”. It’s hard to blame them, Shaw said; so is she.

But Covid no longer threatens alone. The deadly virus is now part of the so-called triple epidemic hitting the country this winter, along with the flu and the respiratory syncytial virus, better known as RSV.

“We can test them for Covid and for the flu, but we can’t test them for RSV,” Shaw said. “People are letting their guard down and all it takes is that one exposure to have an outbreak in here.”

The Virginia Department of Health defines an outbreak as three or more cases reported at the same time at the same facility. In the early days of the pandemic, facilities implemented a strict safety protocol to avoid one. Now, as the Covid-19 pandemic With inches approaching its fourth year, staff said it instead feels like outbreaks have become inevitable.

Some counties have partnered with nearby hotels during the pandemic to accommodate sick people who have nowhere else to go. But most have seen those costs skyrocket and the number of hotels willing to participate has dwindled.

“Even in counties where they still have contracts with hotels, like Fairfax, it’s harder to isolate people there because room rates fluctuate,” said Megan Hansen, program director for New Hope Housing’s Residential Program Center in Arlington , another shelter for homeless adults. “On a three day weekend like this the rooms are so much more expensive and hotels would prefer to reserve it for a person who will be buying lemonade or paying for extras, not one of our customers.

“In 2020 we have helped keep some of these hotels alive. Now we basically have to beg for a room.”

Amid another outbreak in early 2022 spurred by the highly contagious Omicron variant, PathForward moved all of its customers to motel rooms at a nearby Days Inn to allow the virus to dissipate and staff to have time to clean and disinfect the shelter . Until the summer, PathForward continued to quarantine its Covid-positive customers in the rooms there.

Moving coronavirus patients off-site meant staff at the shelters might not have had as much contact with infected customers during the worst of the pandemic, Hansen said. But now that accommodations are reorienting themselves to quarantine Covid-positive customers in their facilities, the risk of exposure has increased.

Hansen expects this to continue in 2023. In fact, this is part of her speech to potential new hires.

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“In the past, if we had a person with Covid, we would send them to the hotel, they would recover and we would bring them back as soon as they were healthy,” Hansen said. “Now we’re really transparent with our staff that if a customer has a communicable disease – Covid, monkeypox, RSV, we’re putting them here.”

To accommodate the influx of people seeking shelter during the coldest nights of the year, PathForward and New Hope Housing have worked together to move people from the cold-weather shelter into the county’s residential program once beds become available. For the first time in months, Hansen said, every bed in the residential program is occupied.

At PathForward over the past week, the number of Covid-positive customers has threatened to overwhelm the cold-weather shelter and dwarf the number of people who haven’t had the coronavirus. So, Frantz said, the staff decided to do something unusual.

Instead of housing all Covid-positive people in isolation rooms of one or two people, they turned the large cold-weather shelter in the facility’s converted office space into a group quarantine area and moved customers who tested negative to smaller rooms that had previously been used to isolate the sick. Any additional residents who do not fit into the small spaces will be placed on cots placed in the on-site classrooms.

“It sounds easy to say, ‘Oh, we’re just going to flip the floors,’ but the amount of work that goes into doing it isn’t easy,” Frantz said. “I saw [my staff’s] faces. I see the exhaustion there.”

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As with other high-intensity front-line jobs — like healthcare workers, teachers, and nursing home staff — Frantz has seen burnout workers sidelined. With every new outbreak, she said, Frantz worries about the mental health of the workers who have to route PathForward.

She has tried to offer what she can: A day off that anyone can take as they please; extra pay for working through a health crisis — even if the federal emergency fund for such increases has dried up; Christmas gift cards and personal notes to each employee expressing their gratitude.

“I’m losing staff and they’re changing jobs completely. I will ask her, “What is this? The money, right?’ And they’ll say, ‘No, I’m done. I’m just done,'” said Frantz. “Honestly, everyone needs a week off from sleeping. But I do what I can because we are open 365 days a year, 24 hours a day.”

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In late November, the US Centers for Disease Control and Prevention reduced the number of mandatory quarantine days in community residential facilities from 10 to five.

This, Shaw said, was a relief. Reducing the number of quarantine days, she thought, could make room and maybe bring the shelter out of the crisis faster.

But that was before Wednesday’s cascade of positive cases.

“I’m just trying to figure out how we’re creating a safe new normal,” Shaw said. “Every time I think, okay, let’s take a break, it’s like we’re getting an influx of cases and it’s back into reactive mode where we just have to focus on testing and keeping people safe . I don’t know when this will end, but I’m ready to be there.”

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