Keeping the Homeless Safe During COVID-19

Chris Heiser compares himself to because he brings people together and makes things click.

The deputy chief of San Diego Fire-Rescue Department is the incident commander for Operation Shelter to Home, one of the largest shelters for the homeless under one roof in the country right now, located in the city’s convention center, which serves as a temporary residence for 1,300 homeless individuals. As incident commander, he coordinates all aspects of the shelter’s emergency response.

“This population has unique challenges. Trying to gain their trust is not easy,” Heiser says. “We asked them to come to the convention center and trust us to take care of them. We do our best to help them connect with behavioral health, get their clothes clean and have showers.”

Moving in 1,300 people, many with a complex medical history and health care needs, has been possible only with the help of 15 different agencies that Heiser coordinates with on a daily basis. Their efforts have been paying off: Since April 1, when the convention center opened its doors to them, only 14 of the new residents have tested positive for COVID-19, and there have been no deaths.

[Read: How the Pandemic Is Changing the Way Hospitals Care for Patients.]

In the broader San Diego County, there have been about 180 positive cases among more than 7,600 homeless individuals, both those in shelters and on the streets. In comparison, shelters in other cities report significantly higher numbers of positive cases, as cramped quarters can be a tinderbox for viral spread.

This is a sea change from the situation on the ground in 2017, when a Hepatitis A outbreak spread like wildfire through the region’s homeless population, killing 20 people and sickening almost 600, while officials scrambled to contain the outbreak.

Still smarting from that experience, the city, county, various agencies and nonprofits that provide services to the homeless came together in the early days of the pandemic and proactively decided to offer individuals the option of moving into one central location where all services would be provided and social distancing was possible. Heiser led the charge to figure out the complex logistics necessary.

The details spanned the gamut, from simple to complex: ensuring enough shower trailers and washing machines were brought in; arranging for food to be cooked on site and delivered to residents; coordinating with service providers to address mental and medical health needs; and putting in place staff to ensure social distancing and good hygiene were being practiced on the floor daily.

The residents are housed in three large halls on one floor, with beds arranged in neat rows 6 feet apart, with their belongings stacked close by. One end of each hall serves as the dining area, while the other end is designated for pop-up clinics and daily temperature checks. Testing for COVID-19 is offered every few weeks.

“The biggest challenge is that I’m working with agencies that have not had this kind of oversight before, over the long term,” Heiser explains. “We are at 127 days right now, which is a long time to have an incident management team in place. So you can become susceptible to the mundane, to complacency, and it’s hard to be on your game if you’re doing it every day for 100 days.”

[Read: Our Family’s Tragedy: Dr. Lorna Breen Is the Canary in the Coal Mine.]

Heiser is no stranger to tough situations. He served in the U.S Army and was a reservist for 30 years while he worked his way up from being a paramedic in the fire department. But he finds COVID-19 particularly challenging, since the emergency continues with no end in sight.

When incident-management teams are formed to tackle catastrophes like earthquakes and wildfires, both increasingly common events in California, the expectation is that crises will be tamed in a few days or weeks. COVID-19 is prolonged.

“The ongoing challenge now is coming in daily and recognizing it’s not groundhog day. It’s what everyone at the front lines is facing and we have to ensure we are as efficient and responsive today as we were when this first started,” Heiser says. “It’s been the most challenging incident in a 40-year career.”

In April and May, he and the team worked 12-hour days, seven days a week. Now, that’s settled into eight-hour days, six days a week. Heiser starts his day at 7 a.m, doing a walk-through to get a feel for what’s going on.

Briefings, which he held several times a day at the outset of the pandemic, are now held twice daily. They’re a chance for Heiser to meet with stakeholders from every agency involved and discuss issues that crop up, and use feedback from the floor in real time to adapt.

Community paramedics, volunteers from city departments such as libraries and pools, and others walk the floor daily, interacting with residents and reporting back on areas that need to be addressed. A total of 800 support staff, part time and full time, play roles at the center, and the program has cost roughly $9 million so far.

Interacting the residents taking refuge at the center has given Heiser and his colleagues a better appreciation for who they are and has helped clear away misconceptions.

“These are people just like us, in a different time and place,” Heiser says. “They just need some help, some support. Being given an opportunity to do that is truly a privilege, and when you see the impact you’re having, it’s truly inspiring.”

[Read: EMT in COVID-19 Hot Zone: ‘I Know I’m Needed.’]

Many individuals shared with his team what it’s actually like to live on the streets — such as the threats faced by some women on a daily basis — and how they feel safe in the convention center and can count on a good meal, take a shower and get medical care. Some decided they never want to go back on the streets, and agencies are working with them to figure out permanent housing when the pandemic ends.

“The things I take for granted, they don’t,” he explains. “To see the positive outcome is amazing. And to see the passion of the staff with the health care providers, they’re the true heroes who work with these people daily.”

More from U.S. News

Fear, Courage, Grit: Meet More Than 50 ‘Hospital Heroes’ in Pictures

Dr. Sanjay Gupta: Holding America’s Hand Through the Pandemic

A Look at Hospitals, Health Care Workers Fighting the Coronavirus Pandemic

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