BRIAN KLAUSNER: Local silver lining amid COVID's 2020

I have had the opportunity to work with homeless patient populations throughout my career in medicine. For years, I have witnessed expensive societal shoulder shrugs and reflections of blame on to homeless patients for the severe pathologies they suffer from.

I cared for too many good people who were ultimately unsuccessful in their desperate attempts to overcome overwhelming barriers to good health … or simple survival. They did not get the help they needed. Many suffered and died, expensively, as a consequence of falling through a collection of poorly coordinated and fragmented safety nets.

As COVID stormed into our communities last spring, there were strong concerns for how it would impact homeless communities. The homeless are particularly vulnerable to COVID, predisposed to rapid transmission due to struggles with social distancing in crowded shelters and encampment sites and at risk for worse outcomes in the context of baseline chronic disease, malnutrition and lack of access to hygiene facilities.

It is a population that, if not well managed in a pandemic, could suffer greatly and have a high utilization of valuable, and even potentially limited, medical services.

As communities across the nation scrambled to develop and implement COVID-19 public health strategies, many did not have the bandwidth to address the complex needs of homeless populations. In many cities, homeless residents were left stranded without access to suddenly restricted shelters and without resources to keep safe as the pandemic quickly spread.

In Wake County however, county leadership quickly moved to leverage uniquely strong historic collaborations with community, faith-based and healthcare organizations in coordinated efforts to protect our most vulnerable homeless residents.

Quarantine hotels were quickly established to care for stable homeless residents who were infected or were awaiting test results. Local homeless programs and shelters coordinated strategies around screening, triaging, telemedicine and decreasing transmission risks.

Community health clinics quickly stood up testing sites for homeless residents. Homeless street outreach teams worked together to identify residents in need. Oak City Cares innovated on how to maintain the provision of basic services such as showers, laundry and access to bathrooms.

Shelters were re-structured to allow for adherence to social distancing guidelines. With homeless program and shelter capacities restricted, the county quickly moved to identify our highest risk elderly and sick homeless residents and place them in hotel rooms along with social support and case management.  The Department of Housing worked to leverage federal funding for COVID into permanent housing solutions for many of these vulnerable chronically homeless residents.

This past month, county and non-profit partnerships worked to develop an emergency shelter that would open in dangerous cold weather conditions for people who remained on the streets.

Local leaders are now pivoting, thankfully, to how we end the pandemic, engaging homeless agencies and residents that are being prioritized for COVID vaccinations.

It has not been perfect, but there has been a determined and tireless effort by local leaders throughout to help minimize the risk to our local homeless. Their work prevented suffering, saved money and saved lives.

There will be people playing with their kids, celebrating moving into housing or going to work in 2021 that would not have been here if not for their efforts. In the midst of the worst global pandemic in the past 100 years, the collaborative work of many has made us a more humane and efficient community, providing a reassuring contrast to the exhausting narratives of conflict and chaos being pushed at a national level. The coordinated efforts to serve our homeless is just one example of the broader community effort around managing COVID that has been proactive, innovative and collaborative.

As we hopefully and thankfully move to put COVID-19 behind us in 2021, we can find comfort in, and be proud of, these local collaborations that can be built upon for future community healthy efforts. It is an important, and therapeutic, silver lining at a time when one is desperately needed.