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1/I have spent part of my time assisting VA and community efforts to address #homelessness in tandem with COVID19, not usually as “lead” but as “support”. I have some reflections on clinical, organizational & political aspects of response https://www.wbur.org/commonhealth/2020/04/06/massachusetts-homeless-covid-19-coronavirus
2/ #COVID19 transmission is more likely to occur in people who have no home or seek help in crowded places. However, in most places there are NO mechanisms to widely assure testing persons who are homeless or uninsured (payment for costs is possible, maybe) https://time.com/5806724/coronavirus-testing-costs/
3/We can expect that homeless & poor communities will continue to have incident infections that are off radar until someone's hospitalized. At that point we’ll say “wow, that means a whole BUILDING full of exposed, but we don’t have funds or staff to test or evaluate” Yes
4/Given high prevalence of #COVID19 among #homeless & newly dislocated persons, they need a physical space for monitoring & recovery. For any space to succeed, it will need services + safe transportation + sanitation & response to health needs, including addiction.
5/But there is an organizational note required: with this disaster-in-the-making, concerned professionals should NOT go off half-cocked. We must try our best to work within “incident command structure” or “emergency management” authorities.
6/Just to emphasize, each time I have “a good idea” in these issues of homelessness + #COVID19, I learn the idea itself won’t be useful until it's aligned in a structure of logistic and legal issues that other people know about. Hence the need for an incident command structure
7/Organizational insight #3: This should be front & center: emergency management doesn’t work with “all leaders, no followers”. There is someone who should lead and there are others who must assist
8/So for responding to homelessness: to move a person with a possible #COVID19 to a safe environment we need trained staff to ask screening questions, others who facilitate a biologic test, transport, & others who will do the intake on where the dislocated persons are to stay
9/A person who is to be accommodated will need: food, sanitation, meds. They have to be asked up front if they could go into withdrawal. Linkages are required to health providers, including (possibly) methadone programs. If alcohol withdrawal is a concern, you need to know
10/For alcohol, consider a withdrawal protocol, an Rx benzodiazepine or other med. Shelter-administered beverages are reported in Ottawa. Saying this in Alabama, I know it’s not an easy option to advertise. But we need to be "eyes wide open" whatever we do https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1319345/
11/Finally, it's crucial to consider consulting with people who know the law and who know the funding streams. There really are no viable community plans set up entirely by health professionals in this arena.
