Like many homeless people in the United States, Carmen Morris was already in the throes of a crisis before the deadly COVID-19 epidemic began.

In December, she moved into The Sophia Way, an all-women’s homeless shelter in Bellevue, Washington, near Seattle and roughly 6 miles from the suburban nursing home that was the site of the first known COVID-19 outbreak in the country.

Living spaces in the shelter were already tight, but they have become even tighter as managers have sought to implement social distancing and head off infection among the 80 women who are served by the shelter’s programs and the 35 people who work there.

“We’re kind of cooped up, honestly,” Morris, 49, said. “We’re already a population that already has a lot on our plate, with regards to who are we, what are we doing.”

And as New York, Los Angeles and other cities try to prevent the spread of COVID-19 among homeless people, officials are likely to discover what the Seattle area already has — that social distancing is much harder to implement among people who often have little choice but to eat and sleep in close, communal settings, like shelters and tent encampments.

“In order to survive on the street, what a lot of homeless people do is they live communally, they share food, they share drugs, they share cigarettes,” said John Olson, a physician who works with homeless people receiving opioid treatment in the Seattle area. “There’s a lot of behaviors that put them at unique risk that aren’t going to change overnight.”

The result is this will be a very hard population to keep from becoming seriously ill. And while many cities and counties, including Seattle and King County, are ramping up temporary isolation, quarantine and recovery facilities, they still might not be enough.

Social distancing is “damn near impossible” in the shelter, said Alisa Chatinsky, the executive director of The Sophia Way. “We don’t have the space.”

“A Cauldron of Homelessness Risk”

Long before the Seattle area became a hot spot for the United States’ COVID-19 epidemic, the region was in the eye of the West Coast’s homelessness crisis. King County, which includes Seattle and Bellevue, has the third-largest homeless population in the country, behind New York and Los Angeles.

Homelessness in cities along the West Coast has been steadily rising for years, the culmination of more than three decades of shrinking safety net programs, coupled with rising costs of living, rents and home prices.

Places like Seattle, which have spent the last several years working to move people out of homelessness into permanent housing, must now rapidly pivot and focus on simply keeping homeless people alive.

That’s difficult under any circumstance. The homeless population nationally is aging and especially vulnerable to disease. In Seattle, as in cities across the country, the places where homeless people used to spend their days — libraries, coffee shops and even some shelters — have abruptly closed or dramatically contracted their hours in response to the outbreak.

“Trying to prepare for handling something like this on top of a massive homelessness crisis, that has a huge unsheltered component to it, makes it beyond daunting,” said Daniel Malone, executive director of the nonprofit organization that oversees one of Seattle’s largest shelters for homeless single adults, the Downtown Emergency Service Center. “It may prove to be the thing that undoes us, I guess, that we can’t deal with the massive [COVID-19] health crisis because it’s coming on top of another health crisis.”

And homeless numbers are likely to grow as unemployment surges.

“It’s like a cauldron of homelessness risk that is brewing as a result of the economic effects of the virus,” said Dennis Culhane, a leading researcher in homelessness and a professor at the University of Pennsylvania.

Culhane co-authored a paper published last week, in which he and other researchers estimate another 400,000 shelter beds will be needed to address the needs of the U.S. homeless population during the COVID-19 pandemic. One-quarter of those would simply be to increase social distancing in existing shelters.

Seattle and King County are adding roughly 630 new beds for isolation and quarantine or assessment and recovery, and the state of Washington has made $30 million available for counties to help their homeless populations. Last week, California Gov. Gavin Newsom announced $100 million for communities to increase homeless shelter capacity and emergency housing, with the state predicting 60,000 homeless people could be affected by the virus and another 12,000 hospital beds needed for them.

Culhane estimates the need at much more: Seattle and King County would need more than 9,000 new beds; New York City would need almost 21,000; and Los Angeles County would need nearly 63,000 new beds, based on Culhane’s projections.

Creating those beds would cost $11.5 billion in federal funds, Culhane and his co-authors estimate, on top of what is already annually spent in this country on homelessness — money that mostly comes from state and local governments and private donors.

Nowhere to Go

In the annual single-night count last year, nearly 570,000 people were estimated to be homeless nationwide, a 3% increase from 2018. One-third of them were unsheltered, meaning they lived in camps, on the streets, in vehicles or in abandoned buildings.

Homeless encampments are communal spaces by necessity. Often more than one person shares a tent.

Some homelessness experts worry the Trump administration could use the virus’s spread as a justification for removing homeless encampments, based on comments the president has made about cracking down on camps in California. However, the Centers for Disease Control and Prevention on Sunday explicitly advised against removing encampments during the COVID-19 outbreak, because such action can “cause people to disperse throughout the community and break connections with service providers” and increase “potential for infectious disease spread.”

Homeless shelters pose their own sets of challenges, with people sleeping on mats on the floors or in bunk beds. Even some of Seattle’s so-called enhanced shelters, where there are fewer people to a room, are still tight spaces.

Then there are the demographics of the homeless population. Last year, 40% of the 1 million people the National Health Care for the Homeless Council served were over 50. Chronic homelessness itself accelerates the aging process. Many in the homeless services community consider a 50-year-old homeless person to be elderly, said Bobby Watts, CEO of the National Health Care for the Homeless Council. Homeless people often suffer from chronic sleep deprivation and stress, and they aren’t in control of their nutrition. Respiratory illnesses are common.

That means homeless shelters are facing a two-pronged fight in their effort to hold off COVID-19: finding ways to isolate those showing symptoms, but also isolating those who would be most likely to become severely ill.

That’s been difficult, even in places like King County, where officials are racing to set up additional facilities in the coming days and weeks.

A significant number of homeless people are also dealing with mental illness that may make understanding the outbreak challenging. Others have just been through too much already. They’ve experienced extreme trauma, hunger, loss and diseases that could easily kill them. Some are simply confused why their day shelters are closing, as homeless service providers reduce hours and close drop-in centers.

“There is nowhere for them to go right now,” said Dietra Clayton, director for client services and shelter programs at the Sophia Way.

That’s a major concern long-term, as the virus requires continued social distancing and sheltering at home.

Olson, the doctor who works with homeless patients, said people used to mill about the day shelter where he sometimes worked.

“Now there’s just a lot of people walking down the street and poking their head in,” he said, but they have to be turned away. “That loss of the human connection in the community is something I worry a lot about.”

“These Are Your Mothers, These Are Your Grandmothers”

For one 55-year-old woman who moved into the Sophia Way just two weeks ago, the closures related to the coronavirus have only compounded an already stressful life. The woman, who asked not to be identified because she was fleeing an abusive ex-husband, used to go to public libraries during the day to avoid the harassing remarks of men she encountered on the street. COVID-19 has stolen almost every option she had, except maybe a park. “It makes it a lot harder for homeless women,” the woman said.

The Sophia Way has shifted to a 24/7 model to try to meet the needs of all of its clients. Now, all three programs the shelter runs — a day center program, an overnight emergency shelter and an extended stay residence for 21 women — are operating under the same roof.

Precautions that public health officials might recommend, like taking clients’ temperatures, are challenging.

“If we took their temperature and I would say to you, ‘Looks like you have a fever and we’re going to isolate you,’” Chatinsky said, “many of them will just leave and they’ll go sleep in the woods.”

And Chatinsky can’t imagine telling her clients to leave if they are sick. About 40% of the women have some kind of physical or emotional disability. Reflecting the larger homeless population, roughly one-third are over the age of 55, the vast majority of them experiencing homelessness for the first time, Chatinsky said: “We have women coming in and shuffling with walkers. These are your mothers, these are your grandmothers.”

Morris, the Sophia Way resident who arrived in December, is coping as best she can. She rushed to the library and the Goodwill before both had to close to pick up a handful of new books to read. Prize-winners, she called them, books that make you think. No Danielle Steele.

She and her fellow shelter residents have made hand washing parts of their daily routine. After so many years of hardship, she’s found comfort here and friends who will give her a warm embrace.

But COVID-19 has stopped even those simple gestures. It’s elbow bumps now.

“I miss the hugs,” Morris said. “I miss good hugs.”

For Chatinsky, the situation is deteriorating. The shelter is out of gloves, masks and disinfectant. It is running an additional $20,000 a week in expenses, to meet the demands of the virus. On Tuesday morning, one of her case managers abruptly announced she was leaving and headed back to New York to be with her family.

Chatinsky wonders if it’s only a matter of time before the virus not only affects how her clients and staff live but threatens their actual lives.

“I’ve been staying strong up until now and now I just feel like I’m melting,” Chatinsky said, as she cried. “We haven’t lost anybody yet. And I say yet. Because, it’s going to happen.”

---