Seattle Was Struggling To Care For Its Unhoused Population. Then Coronavirus Arrived.

Advocates for the area’s homeless residents say the pandemic will worsen the crisis they have already been living through.

Jay Jarvis squints a little as he stands in the bright spring sunshine, in a south Seattle parking lot just a few blocks from the homeless encampment where he used to live beneath the roaring lanes of Interstate 90. He’s been housed for a little over two years now, but he remains a regular at a Sunday lunch put on here by the Rainier Popup Kitchen, a local volunteer group. His husband, who struggles with behavioral and mental health issues, still lives outdoors; these days, Jarvis describes himself as a “caretaker” for his spouse.

Already, Jarvis has seen how the novel coronavirus is changing everyday life: He hopes to become a social worker, and his courses at a local college are fully online now. He misses being in the classroom. “You can’t replace that,” he says. “Hearing other people’s ideas and thoughts—that was so fascinating, so interesting to me. That was the best part.”

Like perhaps everyone else in town, he is still adjusting to the new norms of social distancing and hasn’t figured out the art of gracious refusal just yet. “I’m going to hug anybody that hugs me,” he says, laughing. “Anybody that shakes my hand, I’m going to shake their hand.”

“I’m trying to be positive,” he tells me. “I’m trying to go about my business.”

This city was the first hotspot for COVID-19 in the U.S. As of Wednesday, there were at least 1,359 confirmed cases and 100 deaths in King County, which contains Seattle. But well before Seattle was consumed by frantic efforts to contain the disease, it was in the midst of a separate emergency: After New York City and Los Angeles, there are more people experiencing homelessness here than anywhere else in the country. Now, because of COVID-19, an area that was already scrambling to care for its unhoused residents will have to house them twice: once so they can socially distance, like everybody else. And then a second time, permanently, whenever this new crisis is over.

Of the changes Jarvis has noticed, perhaps the most jarring is how quiet the streets are when he’s making deliveries for Uber Eats, especially at night. With so few people out and about, he jokes that it can sometimes feel a bit like the end of the world.

“It’s just different,” he says. “Things are going to be—things are just different.”

As COVID-19 evolved into a pandemic, experts began issuing what are by now a familiar set of warnings: Wash your hands. Avoid crowds. Older people and people with chronic illnesses, who are most susceptible to infection, must be especially vigilant.

For housed people, following these guidelines means scaling up things they can already do: More hand-washing, more staying inside, and less interpersonal contact, especially with strangers. But for people experiencing homelessness, following this advice is more or less impossible. They may sleep in barrackslike shelters or cramped tents, and receive meals in congregate settings like soup kitchens and community centers. To charge phones, take showers, and obtain other essential services, they rely on access to the places that are closing all over Seattle: parks, libraries, and coffee shops. Personal hygiene is a challenge even when the local supermarket shelves aren’t bare of toilet paper, hand sanitizer, and soap.

Further complicating the public health response is the fact that the same demographic groups thought to be more susceptible to COVID-19 are also disproportionately likely to be unhoused. Conditions like tuberculosis and pneumonia, for example, are especially prevalent among people experiencing homelessness. “People are always kind of sick when they’re outside,” says Elizabeth Dahl Helendi, executive director of Aurora Commons, a “neighborhood living room” where unhoused Seattle residents can use the restroom, cook their own meals, and sit around the living room’s fireplace. A University of Washington study last year found that 32 percent of patients diagnosed with a specific viral respiratory illness at a Seattle hospital were homeless, compared to just 6.5 percent of all admitted patients.

The homeless population is older, too: One-fifth of unhoused people in King County are over 50 years old, according to the most recent census. Nationally, a 2019 study estimates that the number of people 65 and older experiencing homelessness will nearly triple over the next decade. The date on a birth certificate doesn’t always tell the story of how homelessness warps the aging process, either. “Younger people may have a chronological age of 40, but their physiological age is in their 60s because of health conditions,” says Barbara Poppe, former executive director of the United States Interagency Council on Homelessness.

Together, these compounding risk factors mean that COVID-19 is primed to spread rapidly within a community whose members have limited resources, sporadic healthcare access, and no safe place to stay. When your whole life takes place in public, there is no way to isolate.

Among Seattle’s unhoused residents, perceptions of COVID-19’s dangerousness vary widely. At the Rainier Popup Kitchen lunch on March 15, some worried diners asked volunteers for things like soap, hand sanitizer, and masks. “It’s scary, it really is. I’m just trying to be away as much as I can,” said Maria Voncluck. “They say it could spread real easy, from just touching hands. I try not to shake anybody’s hand or anything.”

Voncluck is among the lucky ones, relatively speaking: The Downtown Emergency Service Center, one of the city’s major shelters, is paying for her and a few dozen other vulnerable people to isolate in a motel a few miles north. She says she’s doing her best to wash her hands more often, and is trying—like everyone else in Seattle, and with varying degrees of success—to remember not to touch her face.

Voncluck is happy to be inside, and says the environment at the motel is far less chaotic than the communal living situations she’s used to. A case worker brought her her medication, and the shelter has been dropping off bags of food for her and her roommate, to try to limit their need to leave the building. But she isn’t sure how long she’ll be able to stay there, and the intertwined uncertainties of housing instability and a rapidly spiraling pandemic are not lost on her. “After that, where are we going to go?”

Other attendees at the lunch had barely heard of the virus or were more scornful the hysteria unfolding around them. “People should quit being so freaked out,” said John Redd, who lives in a nearby shelter. “I think it’s ridiculous that people are almost promoting it, because it’s being so overadvertised.” Dahl Helendi says she has heard a similar sentiment from some of her regulars at Aurora Commons, who dismiss the disease as “just like the flu.”

Advocates caution that among people experiencing homelessness, skeptical responses to COVID-19 are likely the byproduct of a well-honed sense of cynicism. Those used to navigating a world of sudden encampment sweeps, byzantine anti-camping ordinances, regular loitering arrests, and other efforts to criminalize poverty are hardly predisposed to trusting the government or doing what it says, even in an emergency.

Besides, if you’re struggling to survive daily, a potentially deadly pandemic is less a novel existential threat than just another challenge to deal with, says Andrew Constantino, site coordinator for Georgetown Tiny House Village. “‘If we were camping downtown or in the woods, what are we going to do? Wash our hands more? Where?’” he asks, describing the mindset of many residents. “‘Are we going to avoid being around other people or self-quarantine? Where?’ The denial of concern is like a layer of protection against reality.”

At his village, where people live in 8-by-12-foot sheds arranged in rows on vacant lots, Constantino has doubled down on existing cleaning protocols and canceled regular weekly meetings. A springtime gardening event planned with a local neighborhood association isn’t happening, either. He’s gently encouraging residents not to hang out around one another, “which is hard with the weather being nice,” he says. And visitors, even family members, are no longer allowed inside; volunteers have to drop off donations outside.

All of this, Constantino freely admits, is awkward and disruptive, especially when it comes to overhauling the community’s social norms on the fly. “Usually I’m pretty free with my person, giving someone a hug, shaking their hand,” he says. “Now I’m trying to be a little more careful, because I wouldn’t want to be the vehicle that transfers it.”

City-sanctioned encampments like tiny houses, in theory, could reduce the odds of exposure and allow otherwise-unhoused people to isolate or quarantine themselves. “You’re not going to infect other people like if you were sleeping next to them on a mat, or on a bed next to somebody else,” says Sharon Lee, executive director of the nonprofit Low Income Housing Institute, which runs a dozen villages in the area. As a direct response to COVID-19, the organization opened an additional tiny house village, expanded an existing encampment, and opened a facility in the city’s Bitter Lake neighborhood, making room for a total of 100 additional individuals.

The large communal shelters, though, remain the most efficient method of getting people off the street. More than one-third of King County’s unhoused population lives in emergency shelters, according to the most recent data, compared to about 3 percent in tiny house villages or other sanctioned encampments. And the infrastructure available at shelters is designed to provide a bare minimum of day-to-day care, not respond to a global health crisis. Interim guidance from the Centers for Disease Control and Prevention recommends placing shelter beds at least three feet apart, and six feet apart for anyone experiencing respiratory illness symptoms. The county health department, meanwhile, recommends six feet of clearance regardless.

More often than not, this space simply does not exist. “Very few shelters have individual rooms, or the ability to put beds three feet apart,” says Barbara DiPietro, senior director of policy for the National Health Care for the Homeless Council. “They are used to sheltering people. We need to quarantine or isolate them. Those are two very different things.”

Administrators of these facilities, as a result, are facing a tradeoff: The more room they carve out in the name of social distancing, the fewer people they can accommodate. Last week, the Seattle Times reported that the Union Gospel Mission’s men’s shelter had to turn away 92 of the 177 people it typically sleeps. A few blocks away, the Downtown Emergency Service Center’s main shelter cut its nightly capacity in half, from 258 to 128, says executive director Daniel Malone. To compensate for the lost real estate, it spread out across more facilities, housing clients like Voncluck in motels and setting up 150 beds in an unused event venue made available by the Seattle Human Services Department.

The progressively strict rules governing gatherings, activities, and movement are taking a toll on the city’s most vulnerable community. Mason Lowe, deputy director of the Pike Market Food Bank, describes his unhoused clients as a “really resilient bunch.” But when it comes to COVID-19, they seem “kind of resigned,” he says—“Like, ‘Hey man, what are you gonna do?’” As of last Friday, the food bank’s affiliated senior center was allowing unhoused members to congregate during the day; now, it’s providing to-go meals for everyone.

Lowe says he’s doing his best to stay flexible, and to adapt to the ever-shifting guidance from public health officials. But with the state now under a stay-at-home order from Governor Jay Inslee expected to last at least two weeks, the social safety net here seems to disappear a little more each day. Across the city, meal services—especially those run by volunteer groups unable to meet stringent sanitation requirements—are shutting down, and even larger organizations with institutional support are limiting the services they provide. In the Pioneer Square neighborhood, where many of Seattle’s shelters are located, the streets are largely empty of everyone but those with nowhere else to go.

For those experiencing homelessness and housing instability, the pandemic will have a profound effect on their lives regardless of whether they contract the disease, at once making it harder for many to leave homelessness and pushing more people into it. This month, a temp agency scheduled Lisa Whitaker, who lives in a downtown shelter, for a four-day dishwashing shift at the Washington State Convention Center. The sudden spate of event cancellations, though, left her without the check she had been counting on.

The next day, she went out in search of flagger jobs, turning “STOP” and “SLOW” signs at construction sites all day. Again, no luck. “There’s no work,” Whitaker told me. “They’re not putting people out. People aren’t working.”

With most businesses in the state shuttered through at least the end of March, Edmund Witter, senior managing attorney at the Housing Justice Project, says he’s already hearing from laid-off workers worried they’ll be unable to make rent. Hotel occupancy rates are below 10 percent, according to the Wall Street Journal. One of the area’s most successful chefs, Tom Douglas, shut down a dozen of his restaurants temporarily after business fell by as much as 90 percent. Governor Inslee’s order extends well beyond the hospitality sector; it applies to everything from gyms to beauty salons to bowling alleys to tattoo parlors.

“The economy is contracting before our eyes, and it’s going to have a huge ripple effect,” Witter said. “It’s going to send a lot of people to evictions who don’t normally go to them.”

The pandemic is also likely to stunt efforts to meet the needs of people that—even under ideal, pre-COVID-19 circumstances—are laborious, expensive, and only marginally successful. In 2019, the annual King County point-in-time survey found that the number of people experiencing homelessness decreased slightly for the first time since 2012. This year, for the first time ever, the city budget earmarked more than $100 million for services related to homelessness. “When this kind of disruption happens, people don’t get their insulin, their asthma inhalers, their medications,” says DiPietro. “We have the potential of compromising medical care across all of our patients.” For people undergoing mental health treatment, the stress of events like this one can cause symptoms to reappear; for those battling addiction, it can trigger relapse.

If an outbreak does occur within the homeless community, it may prove difficult to even identify, let alone stop. People won’t necessarily know when someone is sick enough to be quarantined, or be able to distinguish COVID-19 symptoms from those of the flu and of other, more familiar conditions. They may not know where to go for treatment, or be able to enter designated hospitals without exposing others in the process.

Even the infrastructure being hastily built to slow the virus’s spread leaves out those without a home. “Drive-through operations are problematic for people who don’t own a car. Do you walk through?” asks Amy Hagopian, who directs the Community Oriented Public Health Practice at the University of Washington. “The world isn’t set up to take care of poor people.”

Indeed, advocates concede it is possible that a COVID-19 outbreak is already underway. The limited availability of testing means that oftentimes, neither unhoused people nor service providers really know whether they’re putting others at risk. Just this week, the county public health department began making free walk-in testing available to members of these groups after receiving from 4,000 sample collection test kits from the federal government. It also announced that 45 hospital beds would be set aside for unhoused people to recover from COVID-19 infections; that same day, there were 141 new confirmed cases in King County. A spokesperson for the public health department said they are “continuing to survey priority community needs for testing and coordinating with partners to address critical gaps.”

Last Wednesday, Dahl Helendi made the difficult decision to close the Aurora Commons living room after determining that guests and staff couldn’t be kept safe under the regular drop-in format, where every stray cough is a nagging source of anxiety. “It feels like the energy has shifted,” she said. “A week for COVID is like a month. Everything changes so fast.”

They are still handing out food and supplies at the door, and allowing people to use the restroom one at a time. They’re also taking information about where everyone is staying; if they have to shut down altogether, they plan to at least make strategic drops of supplies around the neighborhood.

“This could just be a tragedy for this population,” she said. “I’m terrified of that. And I don’t know how to stop it.”