COVID-19 vaccine logistics are tough as it is, but inoculating transient people living in homeless shelters or on the street adds more layers of complication.
State officials and shelter workers in New Jersey are grappling with tough questions: How do you make sure people get a second dose of the vaccine if they don’t regularly return to one shelter? How do you build trust and persuade people to take a vaccine, especially if there are complicating factors, such as a fear of needles? Where would vaccines be administered if shelters don’t have health care workers on site to help? What if people don’t have access to a computer to make an appointment for a vaccine?
“Some of our clients were concerned about how quickly they saw the vaccine being rolled out — can they trust it?” said Kathy White, the chief operating officer for VOA Delaware Valley, a nonprofit that operates six emergency shelters across the state. “For some suffering from substance abuse, they fear needles could be a trigger and cause them to relapse. So how are we educating people in specific situations, or those with mental health issues, to make sure this is done right?”
The state Department of Health did not directly answer questions about what vaccine priority group the homeless population falls into. “Congregate, long-term settings” and group homes such as developmental disabilities group homes, adult foster homes and correctional institutions are all part of phase 1A — the first phase of the vaccine rollout — but homeless shelters are not included on the state’s public list. The state is still working to determine what people fall into the next phases, 1B and 1C, spokesperson Donna Leusner said.
State officials said they would help community groups build trust about the vaccine among the homeless throughout the state.
“To improve vaccine confidence, trusted community-based organizations and community health workers — who know this population — will be trained as vaccine educators to explain the importance of getting vaccinated and staying healthy,” Leusner said.
Shawn Sheekey, executive director of Joseph’s House, an emergency overnight shelter in Camden, said their experience testing residents for COVID could inform a vaccine rollout.
“We would call up someone and say, ‘Sean, you tested positive, we’re sending you down the street to the COVID quarantine site,’” Sheekey said. “Most of our guests are reachable by phone. If not, a handful disappear but then show up at the shelter in a couple of days, or someone else knows where they hang out.”
Joseph’s House partnered with the international health care organization Project HOPE to regularly test staff and residents onsite, and the plan is for the nonprofit to begin administering vaccines, Sheekey said.
But while the average person stays at the VOA Delaware Valley shelters for three to six months, about half of the people who use Rescue Mission of Trenton’s 75 beds stay for less than a week.
“This is not going to be the easiest of lifts,” said CEO Barrett Young. “We do have a group of case managers who are wonderful, but keeping track of all this information is going to be tough.”
Johnson & Johnson has a one-dose COVID-19 vaccine going through early-stage trials, and data published Wednesday in the New England Journal of Medicine showed antibodies appeared in 90% of study participants after a month. It’s possible the state could wait until a vaccine such as Johnson & Johnson’s is approved under an emergency authorization and reserve doses for the homeless.
Health Commissioner Judy Persichilli also said during a coronavirus briefing that New Jersey plans to send vans equipped with vaccine educational material and actual doses to hard-to-reach populations, such as those without stable housing or immigrant communities.
How testing played out
Shelter leaders hope the state will assist as it did with COVID testing: The Department of Health led a pilot program starting in July, partnering with federally qualified health centers and localities to test as many people experiencing homelessness as possible.
Out of the 5,000 tests administered, the state found less than 50 positive cases in the homeless population, according to the Department of Health.
More than 9,600 New Jerseyans experienced homelessness in January 2020, the latest comprehensive point-in-time survey by NJ Counts and Monarch Housing Associates.
When COVID hit, shelters scrambled to keep their staff and residents safe as they lost volunteers and housing space.
Shelters slashed the number of beds — and people they could house — and installed plexiglass to provide some protection to the dozens of people sleeping in one room. According to a survey of about 20 shelters, New Jersey lost 30% of its beds.
On top of that, public spaces like municipal buildings or libraries where many people sleep or take cover during the days began to close. Social service agencies and nonprofits moved to remote work, and fewer people in need were referred to resources and shelters.
Volunteers — many of them older individuals at a higher risk for COVID-19 — stayed home, so shelters pushed on with leaner staff.
But at the same time, Gov. Phil Murphy banned all evictions and foreclosures during the public health emergency, keeping thousands in their homes when they otherwise would be kicked out for not making rent or mortgage payments. The state said shelters saw less demand than usual. The moratorium worked, or residents stayed with family or friends, said Rebecca Rhoads, the director of the Office of Homelessness Prevention at the Department of Community Affairs.
In Paterson, St. Paul’s Community Development Corporation was able to keep COVID out of the 25-bed shelter for men by banning those who stayed there from leaving the premises for six months. When the shelter began letting people return to work, 12 staff members and guests tested positive in the last month, said executive director Richard C. Williams.
St. Paul’s was able to benefit from a federal Centers for Disease Control grant that provided weekly onsite medical personnel who performed health screenings, fever checks and regular testing, Williams said.
Salvation Army partnered with Newark to open up a shelter in a downtown hotel for the chronically homeless. Each person got their own room, and staff delivered meals to their doors — and the Salvation Army found no positive cases the first time residents were tested, said Nemin Jaya, the Salvation Army’s director of administration in Newark.
Case managers were also able to move about 70 of the nearly 270 residents to permanent housing with the help of Section 8 vouchers and other funding assistance.
Joseph’s House expanded its open hours “to keep people close to home, under our wing, not walking the streets of Camden sharing cigarettes and in close contact,” said Sheekey.
Sheekey was one of six people at the shelter who contracted COVID-19 and spent nine days in the hospital on oxygen.
“We were all scared, we had no idea where it came from,” Sheekey said. “I’m okay now, and the pandemic has evolved from a scary thing, to turning us into hardened soldiers. We’re walking through it, but we’re doing okay. We feel more confident we can beat this.”
Ashley Balcerzak is a reporter in the New Jersey Statehouse. For unlimited access to her work covering New Jersey’s Legislature and political power structure, please subscribe or activate your digital account today.