The public health practices intended to slow the spread of COVID-19 appear relatively simple. Cover your cough, sneeze into your sleeve, wash your hands frequently and distance yourself from others if you are displaying symptoms.

But for individuals living in shelters or residing in public spaces, following those precautions may be challenging.

“All the preventative measures that we tell people to engage in are just not as readily available for people experiencing homelessness,” said Cathy Alderman, vice president of communications and public policy for the Colorado Coalition for the Homeless. “There are major limitations.”

Health officials in Denver are distributing “care” packages to individuals experiencing homelessness that contain a granola bar, vitamin C and hand sanitizer, plus information sheets providing emergency contact numbers and a map of the city’s hand-washing stations. (Moe Clark, The Colorado Sun)

COVID-19 IN COLORADO The latest from the coronavirus outbreak in Colorado: MAP: Known cases in Colorado.

Known cases in Colorado. TESTING : Here’s where to find a community testing site. The state is now encouraging anyone with symptoms to get tested.

Here’s where to find a community testing site. The state is now encouraging anyone with symptoms to get tested. STORY: Governor says sending University of Colorado students home isn’t a safe option >> FULL COVERAGE

Health officials and shelters across the state are ramping up their emergency plans to ensure that homeless people, estimated at as many as 30,000 across Colorado, who are especially vulnerable during a disease outbreak, have adequate access to hand-washing facilities, medical assistance and spaces where they can self isolate.

The number of new cases of COVID-19, as the disease caused by the novel coronavirus is formally known, is climbing quickly in Colorado. Gov. Jared Polis on Tuesday declared a state of emergency, which gave the state access to federal funding. Significantly more cases are inevitable, Polis said, and public health officials now are focusing on slowing the spread of the illness to keep the state’s health care system from being overwhelmed.

By Thursday evening, the number of presumptive positive cases in Colorado had climbed to 49 since the state’s first reported case on March 5. There are 125,048 confirmed cases worldwide, according to the World Health Organization, and 4,613 individuals have died from the illness.

In Denver, where most of the state’s homeless population resides, health officials are working to ramp up their outreach efforts and install more public hand-washing stations. By the end of the day Friday, there will be 76 placed strategically around the city.

The Denver public health department is developing an inventory of public restrooms and businesses that allow people experiencing homelessness to use their facilities. The agency also is delivering wellness packages to homeless people that contain a granola bar, vitamin C and hand sanitizer, plus information sheets providing emergency contact numbers and a map of the hand-washing stations. There have been around 200 kits distributed since Wednesday.

Betsy Chanthapaseuth, substance use program supervisor for Denver’s health department, talks with a community member about preventing the spread of the coronavirus, and where to find resources and hand washing stations on March 12, 2020. (Moe Clark, The Colorado Sun)

“It’s really important that we are connecting people with services and training our service providers about what symptoms to watch out for so that they can try to connect people with medical services for intervention and for testing,” said Danica Lee, director of public health inspections for the Denver health department.

Lee said her department is focusing on overnight shelters, and in the past few days has been working to help service providers find critical supplies such as hand sanitizer. “We are hearing that the cost of hand sanitizer is going up tremendously for them and they’re having to reallocate funds or, in some cases, they are not able to access it at all,” she said.

Alderman said that as of Thursday, no individuals experiencing homelessness had come to their organization looking to get tested for the coronavirus. “But we fully anticipate that’s going to happen,” she added. “And at some point, we will be able to do testing on site when we have more tests.”

“We are hearing that there are some people that are feeling a little less inclined to seek shelter services because they’re fearful of being in places with a lot of people,” she said. “It’s going to be important for us to find some locations for people to isolate themselves if they start experiencing symptoms and don’t have a home to go to.”

In cities where there are high numbers of COVID-19 cases, such as Seattle, gatherings in public spaces, such as libraries, have been restricted. There have been discussions about similar restrictions in Colorado, but no orders have been issued.

Denver Health officials gear up to distribute wellness kits containing a small amount of food and water, hand sanitizer and information regarding the coronavirus to individuals experiencing homelessness on March 12, 2020. (Moe Clark, The Colorado Sun)

The Denver Public Library Main Branch is a frequent gathering place for people who are homelessness. On Wednesday, the library suspended all of its programming until April 12. However, its community resource team, which includes social workers, remains available by appointment.

“We will remain open to the public until the city says otherwise,” library spokeswoman Erika Martinez said.

The resource team helps individuals connect with services such as mental health, substance use, medical and housing, which now includes conversations about which shelters have rooms where people experiencing symptoms of the coronavirus can stay.

“Those are the kinds of conversations that we’re having with them to figure out what the backup plan is,” Martinez said, “because clearly, they have to go somewhere.”

MAP: Where Colorado’s coronavirus cases have been identified

Even when there’s not a global pandemic, homeless shelters struggle to meet demand

Funding is one of the biggest concerns for many organizations working directly with homeless people, Alderman said. “We need dedicated resources to make sure nobody gets left out of the response process.”

As of January 2019, Colorado had an estimated 9,619 people experiencing homelessness on any given day, according to the U.S. Department of Housing and Urban Development. Public school data reported to the U.S. Department of Education that during the 2017-18 school year, over 20,000 public school students were homeless over the course of the year.

“So we estimate that there are about 30,000 people statewide,” Alderman said.

MORE: School districts across the state — including Denver, Boulder, Aurora and Jeffco — announce closures in response to coronavirus

Currently, homeless individuals are not considered high risk for contracting the coronavirus because they aren’t typically doing international traveling, Alderman said. “But once we start having more community spread, they’re going to be at higher risk because they can’t isolate.”

She said getting tests available in Colorado and identifying alternative spaces for homeless individuals will be critical.

Lee, from the city health department, said the state has some single-resident units that were made available during an outbreak of Hepatitis A last year that sickened about 300 people statewide. But they are assessing if they need more.

A community member rides by Colorado’s Coalition for the Homeless on March 12, 2020. (Moe Clark, The Colorado Sun.)

“We’re certainly looking at larger-scale resources so that we are prepared if we do have to isolate a larger number of people,” Lee said. “If we’re seeing widespread community transmission, then that’s one of the options we were evaluating.”

Alderman is also worried about staffing.

“As a health care provider, we are also trying to figure out how to make sure we have the appropriate staffing levels that can help manage people coming in but not expose staff to high risks of virus exposure,” Alderman said. “And that’s going to be an evolving plan.”

“And hopefully we won’t have to stop providing services, but certainly in some instances, we know that we may not be able to operate on a regular schedule,” she said.

As coronavirus hits Colorado’s high country, a homeless shelter reaches capacity

When Polis made his emergency declaration on Tuesday, he said the coronavirus outbreak “will get worse before it gets better.”

“At this point, we can confirm community spread in the high country of Colorado,” Polis said. “And we are still investigating and have not yet confirmed community spread in the Denver metro area, we are acting and treating it as if that is already occurring.”

In Pitkin County, where there were 10 confirmed cases on Thursday, the area homeless shelter, in a Catholic church in Aspen, is not accepting any new clients.

Gov. Jared Polis gives an update about the extent of the coronavirus in Colorado during a news conference on March 11, 2020. (Moe Clark, The Colorado Sun)

“We continue to serve existing, local clients,” the Winter Overnight Shelter at St. Mary Catholic Church posted on its website. “We are taking emergency measures to shelter the most vulnerable, existing, local clients overnight.”

Coronavirus “hasn’t been an issue for us yet, but it’s just a few miles down the road,” said Rose Verheul, executive director of the faith-based Haven House in Montrose County, which offers transitional housing to families. “So we are taking every precaution.”

The Haven House house, which is already at capacity, is limiting donations and visitors and sanitizing the shelter twice a day. “If someone is sick, they aren’t to come out of their rooms without a mask,” Verheul said. “We’ve been stocking up on everything we need. We’re prepared.”

MORE: Inside the Colorado State University lab that is trying to develop the world’s first vaccine for COVID-19

But other shelters are concerned about dwindling supplies.

Rene Palacios, director of emergency shelter services for the Denver Rescue Mission — which operates a handful of sites in Colorado, including an overnight shelter and a community center in Denver — said his main priority at the moment is keeping facilities as clean as possible. Recently, they’ve increased their sanitation practices at the Lawrence Street Shelter to hit high-touch surfaces once every hour.

But they are running out of sanitizer. “We’ve got about a week’s worth, after that we are out,” he said. “We do have an order in, but it’s backordered from our supplier right now.”

Palacios is providing face masks to anyone within the facilities who wants one, and is telling staff to take necessary safety precautions. But he’s waiting on updates from the city and state for more instruction.

At the Denver Rescue Mission, Palacios said people are worried, but remaining calm.

“They are concerned, of course, but I haven’t heard of anyone that is actually scared,” Palacios said. “We are talking this seriously and making sure everyone follows the necessary procedures. If this goes on for an extended period of time…we are going to need help.”

Our articles are free to read, but not free to report Support local journalism around the state.

Become a member of The Colorado Sun today! $5/month $20/month $100/month One-time Contribution

The latest from The Sun