At Philadelphia’s homeless shelters, COVID and cold are making for impossible dilemmas

The omicron surge has hit Philadelphia’s homeless shelters hard, with quarantine sites full, staff out sick, and shelters balancing the needs of medically vulnerable residents and COVID-positive clients who also need shelter.

City officials say they’re doing their best to expand quarantine sites — where COVID-positive people can recover — while dealing with an intense cold snap this week that’s made it even more crucial to get people inside.

But advocates and shelter staffers say gaps in the city’s quarantine system have made their jobs harder at a time when they’re short-staffed and trying to protect clients who have nowhere else to go.

The intensity of the omicron surge has made the situation even more dire, said Max Ray-Riek, a member of ACT UP who helped to organize a demonstration this week where activists called city officials to demand more quarantine spaces.

“Last year when we were talking about outbreaks in every shelter, we were talking about two, three, five people sick in a shelter. Now it’s 35 people getting sick in a shelter,” he said. “And they say omicron is milder. It’s not if you’re unvaccinated or have preexisting conditions. Folks in the shelter system are more likely to have preexisting conditions and have overall had less access to vaccines.”

» READ MORE: COVID isn't the only factor overwhelming Philadelphia hospitals.

Michael Hinson, the president and chief operating officer of SELF Inc., the largest emergency-housing organization in the city, said that last Thursday, 36 people at a single SELF site tested positive, leaving staffers scrambling to find scarce placements for them. It’s almost impossible to safely quarantine at some SELF sites, he said. Even if COVID-positive residents can isolate together in their own room, they might not have access to their own bathroom or showers.

The city’s quarantine and isolation site in Center City is currently full with 131 residents, said Liz Hersh, who heads the city’s Office of Homeless Services. That site is intended for people who test positive for COVID and are experiencing mild or no symptoms — and who live in shelters where they can’t isolate.

The city is also operating COVID prevention spaces for shelter residents who haven’t tested positive but who are at more risk from COVID because they are older or have chronic health conditions, Hersh said.

There are about 150 beds of this kind, Hersh said, and the city is planning to add 40 more soon. They’re also hoping to open another 40-bed “COVID isolation recovery site” for homeless men who test positive for COVID, but they ave been unable to find staffing yet, Hersh said.

But last week, Hinson said, the city’s quarantine site wasn’t answering phone calls about his COVID-positive residents. The site stops screening new patients at 4 p.m. and is closed on weekends. His staff found another shelter that could take some residents, but 16 remained at SELF.

Staff reluctantly told the remaining 16 COVID-positive residents that they had to find other accommodations or go to a hospital — then decided they couldn’t just send clients away. Over the weekend, they worked overtime to care for the remaining positive residents. Fifteen residents were able to get into the city quarantine site Monday evening, Hinson said. One man ended up at a hospital anyway — he has diabetes but didn’t have medication to take to the quarantine site with him and was denied entry, Hinson said.

Hinson said the city needs more staff and more capacity at its quarantine sites so they can take in residents after hours. He also said shelters must be given more staff or more training so they can take care of quarantining residents.

“I understand that everyone’s hit with omicron, and it’s hard to staff things. But I feel like we knew that the COVID [quarantine sites] being hard to access after-hours were a problem during delta and during the very first wave,” Ray-Riek said. “And omicron is not going to be the last highly contagious variant that causes a quick spike.”

In the face of its own staffing issues, he said the city should consider simply renting hotel rooms for quarantining shelter residents and get reimbursed by the federal government.

“This is an incredibly solvable problem,” he said. “During the first round of COVID, we made quarantine spaces available — we had more than we needed. And then we watched omicron come.”

In a written statement, city spokesperson Sara Peterson said that the city has taken steps to address the issue but that the quarantine site “will never be open 24 hours, seven days a week.” The city has prioritized residents at congregate shelters, which include some SELF facilities, and has added transportation and staff to “allow for more admissions throughout the day.”

Recently, the city has shortened quarantines at its COVID isolation site; release is now contingent on being asymptomatic and taking two negative tests on the fifth and sixth days of quarantine, Hersh said, compared with the previous 10 to 14 days of quarantine for site residents.

“That test for discharge has really created a lot of space,” she said. “And if those folks come out, they’ve already had COVID, and test negative on two occasions and have no symptoms, they’re presumed to be immune, and can be placed anywhere.”

Hinson added that a testing shortage at the shelters themselves is making the environment that much more dangerous for residents and staff. OHS can’t test every shelter resident regularly because of that shortage, Hersh said; instead, new residents are tested when they arrive.

“You have to just assume we’re all positive and infectious whether we know it or not,” Hersh said, “because we can’t test all the time.”

Hinson said that’s a gamble his shelter residents can’t afford, especially in facilities that don’t have the space to quarantine residents effectively.

“They have to do more around providing safe spaces for people who have COVID. The answer isn’t to say to SELF, in a site where all your bathrooms are shared, where you have one space for people to eat, where all of your showers are shared, ‘You have to keep people who are COVID-positive.’”

For residents, the latest surge has just compounded the uncertainty of life in a shelter. Sean Mahoney, who’s been homeless for about four months, said he had been staying at Sunday Breakfast Mission, a Center City shelter, late last year when staff there identified an outbreak.

“They said, ‘If you go out, you can’t come back in for two weeks,’” he said. (Under OHS policy, shelters that identify a COVID case must close admissions for 14 days.)

Mahoney had tested negative. But he suffers from PTSD and worried about how a lockdown — inside with more than 100 other people — would affect his mental health. “With my PTSD, I prefer being outside unless it’s super freezing,” he said. He decided he’d rather take his chances on the street.

The frigid weather this week has further complicated the situation.

“Our policy is not to turn anyone away, regardless of COVID status,” Hersh said. “Freezing to death is a bigger problem, in all likelihood, than the odds of getting COVID.”

When the quarantine and isolation site is at capacity, she said, shelters can institute “cohort isolation,” rooming COVID-positive residents together, away from the rest of the population. During the “code blue” — periods of extreme cold when OHS opens additional shelter beds — “we are asking our sites for flexibility,” Hersh said.

Hinson says shelter officials are often balancing the city policies against the reality of caring for vulnerable people with few staff and resources.

“What do you do about a person who is having a mental health challenge and can’t commit to wearing a mask indoors? What do you do about that when you’re not testing people?” he said. “What do you do when the quarantine location is closed in the evening, and people test positive, and they have no place to go but in a shelter?”