Homelessness poses special challenges for H1N1 preparations

From the Sept. 18 edition of Street Roots.

Flu season, and perhaps a particularly nasty one, is on the horizon for everyone. On the streets, it looms like a pall.

The network of homeless providers face challenges unlike those for the housed populations, and with the H1N1 (formerly called the Swine Flu) vaccine still weeks away from being delivered to the public, and still then prioritized for distribution, questions remain as to how an outbreak would be managed at the street level. How would a serious outbreak play out in the shelter system, with its dormitories of mats and cots, or the clinics that are working under heavy loads with a vulnerable population, or simply the realities of another rainy season outdoors?

For the answers to those questions, all eyes seem to look to the county.

“There are couple of realities we’re going to face, particularly for those who utilize shelters,” says Gary Oxman, health officer for Multnomah, Clackamas and Washington counties. “There’s a danger there of transmission of disease in those settings. Obviously, vaccination is a part of that strategy.”

Oxman said they anticipate receiving the H1N1 vaccine in the coming weeks, and it will be administered to those priority groups identified by the CDC and adopted by the state.

Those priorities are for pregnant women, children and their caregivers, health care workers and emergency personnel. It would also notably include people with high-risk health conditions.

“Homeless people as such are not identified as a priority group,” Oxman says. “But there are significant numbers of homeless people who would fall into that priority group: youths, as would larger number with chronic illnesses, asthma, chronic lung disease, liver, Hepatitis C. We’re hopeful to move as rapidly as we can to the homeless. It’s a question of how much vaccine we get and how fast we get it.”

The availability of the vaccination is still a few weeks away, coinciding with what some projections put at the peak of a possible H1N1 outbreak. But Oxman says that he doesn’t think it’s possible to predict the peak of the outbreak, if it happens.

“Basically, it’s a race between the vaccine and the flu virus,” he says.

In the meantime, he says, shelters and providers will need to resolve the basic questions: “How do you deal with situations where people become ill in the shelters? How do you identify ill people? How do you separate them from the rest of the population and make sure they have access to health care and medications?

“Those are the issues we need to work out,” Oxman says. Meetings among a workgroup of health providers and the homeless continuum are planned for the coming weeks.

Portland Rescue Mission is one of Portland’s primary shelters for people who are homeless. There, the planning is in motion to decide how to contain an outbreak in a shelter environment.

‘It’s something we’re taking very seriously,” says Brian Merrell, the community relations specialists with Portland Rescue Mission. “It’s at the forefront, which is why we’re putting together policies and practices.”

That could include policies of declining services to people exhibiting symptoms and referring people for medical treatment to other agencies to avoid a spread of the virus throughout the shelter, Merrell says.

“It’s best for everyone to get the medical treatment,” Merrell says.

The Old Town Clinic, operated by Central City Concern, is a primary caregiver of health care for the homeless, treating between 2,500 and 3,000 patients each year, according to Rachel Solotaroff, medical director for Central City Concern.

“At Old Town, where we see a primarily homeless population, we are doing an aggressive campaign to make sure everyone gets their regular seasonal vaccination,” Solotaroff says. “For those who are high risk, and who meet the criteria the county gives us, than they get the H1N1 vaccine.”

Solotaroff says that a lot of the folks they see would fall under the high-risk category.

“The trick is to get people in for the immunization,” she says.

However, Solotaroff says the clinic is not in a position to accommodate a surge in demand, nor have they received additional resources to deal with a surge should a major outbreak hit, she says.

“That’s something that Multnomah County is attentive to and is working on, and then they would communicate that out to the providers,” she says.

Precaution remains the universally understood objective.

“It’s the same thing that it’s always been, the same sorts of standard precautions, but to have extra vigilance,” Solotaroff says. “I think this can apply to people on the streets as well as those who are housed: Keep hands clean, cover your cough, find a place to throw way your tissues; get your vaccination. Those are the very standard kinds of prevention that actually make a huge difference.”

Beth Kaye, the public affairs manager for the Portland Housing Bureau, says that in the case of an outbreak, there are sufficient resources within the current contracts to respond to a surge situation. It could mean redeploying resources toward provisions to prevent the spread of the virus, but also options on putting people with the virus in a sheltered environment. That could mean creating a segregated facility as an infirmary for recovery, or issuing motel vouchers to put people in rooms while they recover. But in terms of what is the best course of action, those decisions will be made as the situation develops. Kaye says.

“We are waiting on the health department to advise us what to do,” Kaye says, adding that the role of the housing bureau will be to get the information out.

“In an emergency, we are prepared to be flexible, to think creative, and to respond with all of our energy just as we did in the snow emergency last winter. …Any discussion about discharging people to the streets, that’s not in the picture,” Kaye says.

Oxman says that given that the H1N1 virus is new, more people are likely to get sick, up to a third of the population in a serious scenario. For the Portland metropolitan area, that could mean a 200,000 to 300,000 people becoming seriously ill. One of the distinguishing traits of the H1N1 virus is its attack on young and middle-age adults, rather than the very young or elderly, which is characteristic of other influenza viruses.

In the event of an outbreak, the practice of putting people under quarantine is highly unlikely, according to Oxman, and there’s no talk of shutting down the shelters, he says.

“We’re not anticipating using quarantines to any extent,” Oxman says. “It’s intrusive on people’s rights, and it’s not a particularly effective tool with influenza. Quarantine just means restricting the activities of people exposed to the illness but not yet sick.

“What we’re going to need to do is keep up with creative solutions to keep sick people and well people isolated,” Oxman says. “We see any kind of congregate living situation as a potentially dangerous situation. Dorms, nursing homes — we’ll be watching for outbreaks in those settings, but prevention is a much better deal, and that’s where we’re trying to put most of our energy.”

By Joanne Zuhl, Staff writer

One response to “Homelessness poses special challenges for H1N1 preparations

  1. This is just another example of how the homeless are discreminated against…quite frankly, I dont want to be vaccinated anyways, but some people could probably benefit from it. Here in Seattle there have been over 100 homeless people die in the past 2 years due to homelessness, it is very disheartening, does anyone out there know how many people die every year due to homelessness?

Comments are closed as of Dec 17 2012 to prepare for migration of content to our new News site.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s