Andre Jarrett shifted nervously in his seat at a homeless shelter in northeast Minneapolis.
The 45-year-old had a hacking cough. His nose was running. It was past 8 p.m. and his body sagged from a day wandering the streets. Like others at the shelter, tucked in the basement of Elim Church on NE. 13th Avenue, Jarrett just wanted a hot meal and a place to sleep. But first he had to answer a series of questions from two concerned-looking women in masks who could tell he was sick.
Across Minnesota, shelters have been on high alert since state health officials last week reported the first cases of the novel coronavirus within the homeless population. As of Friday, four Minnesotans who are homeless and had been staying at shelters have tested positive for COVID-19, the deadly respiratory disease caused by the virus; none have died.
Dr. Julia Joseph-DiCaprio, chief medical officer at UCare, was volunteering at the Elim Church shelter to screen residents for the virus. She asked Jarrett how long he had been coughing. Was it getting worse? Had he seen a doctor or visited a clinic recently? Had anyone tested him for the coronavirus?
“Andre, I just heard you cough again. I’m thinking you need to be seen,” Joseph-DiCaprio said.
County and state officials have been trying to prevent the sort of devastating outbreaks that have infected scores of shelter residents in other cities. More than 90 people and 10 staff members have been infected by the coronavirus at a large shelter in San Francisco, and nearly 400 shelter residents in New York City have tested positive. Many cities have stopped clearing outside encampments and are moving homeless to vacant hotel rooms, to ease pressure on crowded shelters.
But some staff and volunteers at smaller shelters like the one at Elim Church said they have struggled with a lack of clear guidance on how to respond to residents who are showing signs of the illness. They struggle to isolate people in buildings where dozens of people sleep just feet apart in the same room. And there are few protocols for seeking emergency medical care, particularly for those suffering from mild symptoms.
Early this week, the shelter at Elim Church received official notice that someone who stayed multiple nights at the facility had tested positive for the coronavirus, potentially exposing dozens of unwitting residents, staff and volunteers. Suddenly, the small and densely packed shelter shifted into full crisis mode.
Within 24 hours, the shelter’s few staff had to recruit volunteer health care professionals to screen all residents; secure dozens of donated masks, thermometers and other gear; and figure out how to communicate the risks of the outbreak without creating panic.
“You think you will get all this support” when an outbreak occurs, said Monica Nilsson, director of the Elim Church shelter. “The reality is, we are pretty much on our own.”
At 7:30 on Wednesday night, Nilsson delivered the news to the crowd gathered in the shelter’s basement dining hall: Someone who had “prolonged exposure” to the facility, she said, had tested positive for the coronavirus.
Hands immediately shot up in the air around the room. Many wanted to know how easily the virus could spread, what the symptoms are, and how long it would take for the symptoms to appear after a person is infected.
Someone noted the proximity of the shelter’s sleeping mats — close enough for people to hold hands. Could anything be done to isolate people in such a crowded environment? Would the masks need to be worn all night?
There were more questions than answers as the conversation carried on into the night.
“Don’t worry, 90% of us will never get this and be healthy as horses,” announced Robert Kleen, 62, who is homeless and had spent several nights at the shelter.
“You don’t know that!” a woman retorted, angrily.
“If I die, I die,” another resident said.
Nilsson, a longtime homeless advocate, had to calm the crowd of 80 men and women to make sure they could hear her central message: that anyone with symptoms of the virus — including a cough, shortness of breath or fever — seek help from shelter staff. Hennepin County had already leased three hotels to isolate people at high risk of getting sick from COVID-19.
“I know some people in their 20s who were healthy and now they have this [virus] and they’re in an intensive care unit,” Joseph-DiCaprio said to the crowd, trying to convey the urgency. “This is serious.”
And yet, with nowhere else to go, the crowd of homeless people decided the risk of getting infected was worth avoiding a night sleeping on the streets. Nearly everyone bowed their heads in silence as Elim Church’s pastor, Paul Stephen Olson, read from the Book of Proverbs. “When you lie down,” he said, “you will not be afraid.”
When the prayer ended, Jarrett was pulled aside because of his persistent cough. Yet shelter staff were unsure of how to respond, given that he lacked a fever or other symptoms associated with the virus. Jarrett said he thought it was probably “just a cold” from sleeping outside in a tent. Still worried, Nilsson put her smartphone on speaker so that Jarrett could talk with a medical professional at Hennepin Healthcare.
After a brief conversation, the clinician concluded that Jarrett’s symptoms were not serious enough to warrant him being quarantined. She suggested, however, that he visit Hennepin Healthcare’s viral screening clinic in downtown Minneapolis when it opened in the morning.
“What we’re telling people with mild symptoms is just to stay put,” she said on the phone. “If you get worse during the night, that’s a different story.”
As darkness fell, Jarrett gingerly spread his blanket over one of the dozens of blue mats on the shelter floor.
His spot in the far corner under a window was more isolated than most, but he was still just several feet from the nearest person. He tried to avoid coughing as he drifted off to sleep with a thin mask covering his face.