In early April, Shane McNamara Gazzo, an emergency medical technician who lives in Providence, answered Gov. Gina Raimondo’s call for medical workers to join the state’s COVID fight.
He volunteered first at a hotel in Warwick that was set aside for COVID-positive homeless people, then became the assistant program director when they moved to a state-owned building called Putnam Place in Smithfield.
By October, he quit in protest. In disgust, really, about the way the state government looked after homeless people at Putnam Place:
-Raw sewage and a cockroach infestation made some areas of the building unfit for human habitation.
-The fire alarm system repeatedly malfunctioned, going off at random times and forcing people sick with COVID to evacuate.
-When parts of the Putnam had to shut down because of those issues, the program — under pressure from the state to take as many people as possible into the quarantine and isolation site — moved people who had COVID into the same areas as others who didn’t have their results yet. In at least one case the results came back negative, but the person had to be retested after their exposure, McNamara Gazzo said.
This was an important program, deeply necessary, but it couldn’t run this way. McNamara Gazzo had tried to address those issues, to get the state and the nonprofit providing services for the people there, Fellowship Health Resources, to fix them. Instead he was ignored, left out of meetings and chastised for putting his concerns in writing, he said.
As Rhode Island experiences another coronavirus surge, the Putnam is now closed, and the quarantine and isolation site for homeless people is back at the hotel in Warwick. But not before McNamara Gazzo left his job at Fellowship Health Resources, disillusioned by the state government and disturbed by what he saw.
It seemed as if the state thought of homeless people not as individuals, but as vectors for a virus who might spread it to someone else, McNamara Gazzo said later.
“The fact that they gave their blessing, a clear directive for us to do this, is just so devoid of all humanity,” McNamara Gazzo said. “Because our clients didn’t have a voice. Because they’re homeless individuals.”
In response to questions for this story, the Department of Health — one of the state entities involved in the Putnam and the hotel in Warwick — disputed the notion that the government did not prioritize homeless people.
Spokesman Joseph Wendelken said in an email that “health equity, and the health and safety of every Rhode Islander has been a priority for us throughout this response.”
“We have had a special focus on our more vulnerable populations throughout,” Wendelken said. “People experiencing homelessness are at increased risk for infection when there is community spread of COVID-19. We recognized this early on and worked hard to set up spaces where people could safely isolate, and have access to food, sleeping accommodations, bathrooms and showers, and other basic needs.”
Still, the department did acknowledge that because of a leak, people waiting for their test results were housed with people who were positive. That happened in one emergency instance over a weekend, Wendelken said; McNamara Gazzo said it happened multiple times, and put it in writing in an email on Oct. 14 to various state officials. Two of his former colleagues separately supported his account.
Wendelken said the contract with FHR required people with positive COVID tests and people without positive COVID tests to be separate, but the state was only aware of it happening once. People were monitored for illness after, Wendelken said.
In another instance, the state acknowledged that someone came into the Putnam from a homeless shelter who was unaware they had scabies. The issue was addressed, the state said. The building did have maintenance issues, like a pest control problem, but they were typical of a building its age, Wendelken said.
Fellowship Health Resources, a behavioral services provider that runs programs up and down the East Coast, said in an emailed statement that the Putnam was closed and moved back to the hotel because of increases in cases and “feedback that the temporary program space had facility concerns.”
FHR, as the nonprofit is sometimes known, did not directly address the issue of mixing COVID-positive residents with people waiting for test results. But it did say that “without this program, many Rhode Islanders affected by COVID-19 would not be able to receive the housing and behavioral health care they need. … Driven by our mission to improve the quality of life of those in our care, we will continue to monitor and assess the best way to meet the needs of those who depend on our support.”
Two of McNamara Gazzo’s colleagues, meanwhile, echoed his more grim account. Like McNamara Gazzo, both felt like the state had let down homeless people in their time of need.
“I think they’ve been more focused on just getting people in, and just cycling through people, than actually getting these people in, getting them help, making sure they don’t end up right back in their programs,” said Jordi Garcia Santos, a mental health counselor for Fellowship Health Resources who worked both at the Putnam and the Warwick hotel. “It’s about the numbers, not making an impact.”
“It’s crazy,” said another employee, who echoed accounts of mixing COVID-positive people with people who didn’t have their results yet, but asked not to have their name published for fear of losing their job. “You don’t understand how many times that happened, and how many times we were like, that’s not OK. They were so desperate to have bodies in the building.”
Homeless people are particularly vulnerable to COVID-19. They might stay in densely populated shelters where physical distancing is a challenge. They might not have great options for washing their hands. They probably have limited access to healthcare. And they often have the sorts of underlying health conditions that can predispose someone to serious complications if they get COVID. The average life expectancy for a homeless person, even before COVID, was 49 years old, according to some experts.
In the spring, as the pandemic swept across the globe, Rhode Island’s initial response for homeless people with COVID was to open up a quarantine and isolation site at a hotel on Post Road by the airport in Warwick. Once operating under the Wyndham brand, the remaining signage there — paper taped to a window — calls it to the Cru hotel. Homeless people who had COVID-19, but who didn’t need to be hospitalized, could stay there, rather than in cramped shelters or on the streets.
Because it was in a hotel building, everyone had their own room, but that’s about where the similarities to a typical hotel stay ended.
The hotel was at first run by the state police and the National Guard, and they did what they do, McNamara Gazzo said: They asserted control. Many people working for the Guard and the police had good intentions and were trying their best. But, McNamara Gazzo said, they weren’t best suited to lead in a medical catastrophe.
In one instance, a person tried to leave the site, and was tackled by a National Guardsman in the parking lot, McNamara Gazzo said. He also said he overheard National Guard members talking callously about someone who’d tried to take their own life at the hotel.
(Maj. Dennis Pineault, a spokesman for the Rhode Island National Guard, said in an email that service members tried to speak to someone leaving the site who was subject to an isolation compliance order, and “brought the individual to the ground when he closed distance in an aggressive manner with our service members who perceived this as a threat to their safety.” That person was charged with violating the isolation order and disorderly conduct, Pineault said. Pineault said he was unfamiliar with the attempted suicide incident, but added: “We take the COVID response mission very seriously and hold our service members to a high standard. Anything short of that is unacceptable and is addressed by National Guard leadership.”)
The state took pains, for liability reasons, to distinguish the building from a medical facility, McNamara Gazzo said. It wasn’t a hospital. It was a shelter. Anyone driving by the hotel in the spring might have noticed the military Humvees in the parking lot, not quite post-apocalyptic but still deeply unsettling.
For weeks at the hotel, there were more guns than doctors or nurses.
McNamara Gazzo was among the volunteers on site. He’d responded to an appeal put out by the Rhode Island Disaster Medical Assistance Team, seeking a corps of workers willing to help. McNamara Gazzo needed 2,000 hours of hands-on work just to get into physician assistant school, and in addition to just being the right thing to do, this would help him rack up the time he needed to take another step in his career.
As an EMT, one of two volunteers on site at any given time, McNamara Gazzo would check in on patients, give them oxygen, see whether they needed to go to the hospital. One patient at the hotel had to be hospitalized with a life-threatening gastrointestinal bleed, and two others that McNamara Gazzo is aware of ended up in the hospital with COVID symptoms.
But people at the hotel often suffered from medical emergencies that were beyond McNamara Gazzo’s ability or licensure, he said. Though a National Guard doctor visited, it wasn’t the sort of presence that could possibly meet the many needs of people there, from methadone to suboxone to diabetes treatments to ointments for gum disease.
That remained true until mid-April, when Dr. Rahul Vanjani, a soft-spoken physician and associate professor of medicine at Brown University, read a story in The New York Times about a similar COVID isolation site at a hotel in New York City where multiple people died. At around that same time, a patient of Vanjani’s wife, Dr. Catherine Trimbur, called up and described what was happening at the hotel, and what sorts of medical care was available there. It wasn’t very much.
“I sort of freaked out a little bit and approached them,” Vanjani said of his early outreach to the state after he read the Times story. “They were very welcoming. They never included a medical presence because maybe they didn’t know where to start.”
Vanjani and Trimbur, on the other hand, knew exactly where. They mobilized a team of medical students, resident physicians and attending physicians, who volunteered there in shifts. There was always a resident physician or two on site, an attending physician or two on call. Vanjani folded it into his work for House of Hope, a nonprofit that provides services for homeless people.
Vanjani stressed that he felt like the state was doing everything it could to help a marginalized population, and although McNamara Gazzo described him as a “knight in shining armor,” Vanjani credited the team of 50 to 60 volunteers for the work that went on there.
They worked without pay. And unlike the experience in New York, nobody died at either quarantine site — “and we didn’t even have close calls,” Vanjani said.
According to McNamara Gazzo, after Vanjani and the others arrived, medical emergencies dipped. This was how the program should have been running all along, McNamara Gazzo said.
It’s expensive, though, to rent out an entire hotel. The spring contract to rent out the hotel in Warwick set the cost at $89 per room per night, at a minimum of 52 rooms. That didn’t include costs for supportive services, meals or cleaning.
And as the summer months wore on, cases dipped not just among the community in general but homeless people in particular. The Raimondo administration was getting national plaudits for the state’s handling of the pandemic. From a high of about 50 in the spring, the number of people needing to quarantine or isolate at the hotel was in the single digits, and the cost at the hotel became harder to justify.
The state found a cheaper option: an unused building on Putnam Pike in Smithfield, last used in 2018 as a home for people with developmental disabilities. Because it was owned by the state, the state didn’t have to pay a private party to rent it out, just for things like meals, cleaning and supportive services, including a nurse on site. The total cost between July and October at the Putnam was $282,343, the state said.
McNamara Gazzo was in his back yard when he got the phone call. The nonprofit Fellowship Health Resources, which got the contract to provide supportive services for the people staying there, wanted him to become the assistant program director, a paid position.
Despite his concerns about how the program had gone so far at the hotel, McNamara Gazzo said he was reassured that things would get better. There would be a registered nurse there. A tour of the building in late June revealed it to be austere, and a little dirty, but he was told it would be cleaned.
That wouldn’t fix the broken windows, but McNamara Gazzo put his misgivings aside and went to work.
The building at 551 Putnam Pike is shaped like a cross, with a pod at each point. Each pod had a communal area, and three bedrooms, with room in each bedroom for twin beds a few feet apart.
With one of the pods in use by staff, they could fit around 18 people in the building, McNamara Gazzo said. As the program transitioned from the hotel to the Putnam in late June and early July, just one person made the move.
Things started slowly. Originally, the contract between the state and Fellowship Health Resources said they’d take in only people who were confirmed positive with COVID.
But in the weeks and months that followed, Rhode Island’s COVID success story began to deteriorate. Cases picked up, and the plan changed in September: The program would start taking in people who were positive, and people who were waiting for test results.
McNamara Gazzo said that was a bad idea, but the state pressed ahead. Sure enough, within days of that decision in September, two women came in – one who hadn’t been tested, and another who was waiting for results, McNamara Gazzo said. A sewage emergency forced them into the same living area as someone who was positive.
McNamara Gazzo was livid. He brought the issue up with his FHR supervisor, who brought it to state officials. The answer: This was better than being in a congregate shelter. They needed to run at full capacity.
“Imagine that patient is your mother,” McNamara Gazzo responded to his supervisor. “If you’d be OK with a family member being put in a location with confirmed COVID individuals.”
McNamara Gazzo puts the blame at the feet of the state, which he said pressured the program to “get creative.” His supervisors at FHR was unwilling or unable to stand up to the state, he said. Though he isn’t aware of anyone picking up the contagious disease because of mixing people with different COVID statutes, it was luck, not careful attention by the state, that prevented it, he said.
Dr. Kelly Doran, an emergency physician and a researcher on homelessness at the NYU School of Medicine who isn’t involved in Rhode Island’s response, said that mixing people with different COVID statuses would seem to violate U.S. Centers for Disease Control and Prevention guidance on running homeless shelters during the pandemic. According to the CDC, people with confirmed COVID should be prioritized for individual rooms or be placed in a separate area with others who have tested positive for COVID, with set aside bathrooms, apart from people who have not tested positive for COVID.
It can be hard, Doran noted, to determine who does or does not have COVID based on symptoms alone. Chronic coughs aren’t uncommon among people experiencing homelessness, and might not necessarily indicate the person has COVID.
In some cases through the pandemic, people have had to “accept the good because the perfect wasn’t possible,” Doran said. It might be better to have five people with symptoms highly suggestive of COVID in a pod together, instead of having someone with symptoms in a congregate dorm setting among 20 others, Doran said. But those sorts of choices were more understandable early on, in the spring, when testing and especially rapid testing weren’t as available.
“This whole thing has illustrated that when you’re functioning in these austere systems that don’t have a lot of resources, you end up having people feel like they have to make really hard choices,” Doran said. “It would be better if they didn’t have to make them.”
Other types of resources were scarce at the Putnam, too, McNamara Gazzo said. The nurse who was supposed to be there was stretched thin with multiple responsibilities, he said. Yet again, the program was without a doctor or nurses regularly on site, McNamara Gazzo said.
And the mixing of people who had COVID along with those who didn’t know if they had it or not continued. They shared couches, eating spaces and bathrooms, McNamara Gazzo said. In some cases toward the end, they shared bedrooms, two of McNamara Gazzo’s colleagues said.
Fire alarms kept going off, forcing people to evacuate, McNamara Gazzo said. Sewage overflow and a cockroach infestation forced the closure of some areas. Even as the number of people who needed help climbed, the amount of usable space in the building diminished.
McNamara Gazzo also said he was instructed, by FHR and through the state, to have a woman who didn’t have the virus but was potentially exposed to it sign a liability waiver — two days after she was exposed. The language of the waiver said people who had COVID were being held in different pods from people who were waiting for their results, according to a copy he provided (without any names). That simply wasn’t what was happening: People were, in fact, mixing in the same pods.
McNamara Gazzo, in an act of insubordination carried out in good faith, refused to have her sign it. But others did sign.
His frustration reached a breaking point. On Oct. 14, he wrote an email about the plumbing issues — sewage was overflowing into living spaces, again — to his contacts at the state Department of Health and the state Department of Behavioral Health, Developmental Disabilities and Hospitals, and the Department of Administration.
One pod was out of service because of overflowing sewage. Another had six men, max capacity, a mix of people who had COVID and others who were waiting for test results, and the active scabies case. Three women were staying in the only other pod that was serviceable. One had COVID, one was waiting for her test results, and one had tested negative, but would need to be re-tested because of her potential exposure.
His frustration was evident in his email. Especially frustrating was that he was getting orders from state officials who weren’t even on site.
“I would encourage anyone with questions or concerns regarding this issue to come visit the facility,” he wrote. “I hope a resolution can be found on behalf of the patients. Thank you all for your consideration.”
Later, he’d have a strange conversation with one of the officials in the state Department of Health after raising some of the issues, he said. She said, in effect: So what’s this I hear about putting COVID-positive people together with people who didn’t have their results yet?
“Are you kidding me?” McNamara Gazzo reflected later. “Did you not read all those emails? You knew this.”
(Asked about this conversation, the Department of Health said the mixing of COVID-positive people with people who were waiting for their results was not an ongoing practice except in one emergency situation, contradicting the three people who worked on the ground there who said it happened multiple times.)
In late October, facing ever-increasing cases and a building that wasn’t up to the task, the state pulled the plug on the Putnam, and headed back to the hotel in Warwick. The Putnam maxed out at 19 people at once.
McNamara Gazzo didn’t go with them. He didn’t feel right, receiving a paycheck for the work he was doing. So he resigned from his job at FHR in October, typing out a letter that laid out all the problems. Two of his colleagues did make it over, and said it seemed like there was little planning in place, although one said things had improved in the weeks since.
Vanjani, the doctor who gathered together the team at the hotel, said there were discussions about his return. Vanjani said they may use an urgent care teleservice.
The Putnam now sits empty. If you were to visit on a recent weekend day and peek into the windows, you’d see chairs flipped up on tables, bottles of disinfectant wipes on counters, sparse rooms with a few overstuffed couches. It’s silent except for every 30 seconds or so, when a fire alarm chirps for no apparent reason.
In about a month, McNamara Gazzo will start physician assistant school, moving on from a bitter experience. But late in November, he said, he received yet another plea for volunteers to help homeless people.
“We’re back to square one,” McNamara Gazzo said. “We’re back at the Wyndham and we’re still pleading for volunteers in this effort. I read that, and I felt shook. We’re still here pleading with volunteers to help the homeless community being afflicted by COVID. It’s shocking to me.”
On Twitter: @bamaral44