COVID-19 outbreak among Anchorage’s homeless points to gaps in testing strategy

A worker dressed in black leaves thebeige double doors of a grey building. In the foreground, a sign reads "at capacity"
A worker leaves the Sullivan Arena in Sept., 2020 (Lex Treinen/Alaska Public Media)

When the first COVID-19 case was detected at the Brother Francis Shelter, the resident who tested positive was no longer staying at the shelter. Immediately, residents who may have been exposed were tested.

But by then, the virus had already spread to dozens of residents who had stayed at the shelter. As of Sunday, it had infected at least 93 people. 

That raised the question of whether the outbreak might have been caught earlier with regular testing. But national health experts on homeless medical care say there’s a bigger problem. 

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“It’s hard to say that they should have done better, like that they should have known. Especially because there is no national testing strategy. At all,” said Bobby Watt, CEO of National Health Care for the Homeless Council, a Nashville-based organization. 

Watt said that outbreaks like the one at Brother Francis illustrate the real-world consequences of a lack of a national testing strategy since it forces local health departments and shelters to make decisions about where to prioritize a limited amount of testing without access to all the data they need. He said that in the case of testing the homeless population, the Centers for Disease Control doesn’t have any real guidance. National organizations such as NHCHC do provide advice, but it doesn’t always make it into local strategies. 

“Unfortunately it is city by city, county by county, everyone is in their own Department of Health in their own resources, coming up with very different plans,” said Watt. 

In Anchorage, the situation was more complicated than strategy oversight.

Anchorage’s testing strategy does prioritize weekly testing of people at homeless shelters, but that wasn’t happening at Brother Francis. Lisa Aquino, executive director of Catholic Social Services, which operates the shelter, said it was working with the city’s Emergency Operations Center and was in the process of standing up testing when the first case was detected. 

“We had been working with them to figure out the logistics of that to make sure that there was enough non-congregate shelter available if there were positive cases,” said Aquino. 

Anchorage City Manager Bill Falsey, who is directing the city’s response to the virus, said that in retrospect, it is easy to see the need for more testing, but part of the problem was the lack of supplies early on. 

“For many months in COVID, it was just impossible to even find swabs vials and transport media you needed. So it wasn’t a person power issue. It was really a materials issue,” he said at a Friday news conference. 

He also pointed out that so much of the transmission was asymptomatic.

“The percentage of the total number of people who have stayed at the Brother Francis who ultimately ended up being positive is very high, but a very large number of them ended up with very mild or even asymptomatic cases,” he said. 

Still, the shelter outbreak led to at least six hospitalizations and at least one death. Since the beginning of the pandemic, Brother Francis has been serving the physically handicapped and elderly experiencing homelessness, and older people are particularly vulnerable to the worst effects of COVID-19. 

Other shelters around the country have seen even fewer symptomatic cases at homeless shelters. In April, officials in a Boston shelter identified an outbreak that infected nearly 150 people. All of them were asymptomatic. 

And unlike the shelter at the Sullivan Arena, which is operated under a city contract and has been providing weekly testing for guests for months, Brother Francis is a private facility providing a public service to the city, Falsey said. This has slowed the process of getting testing going not just at homeless shelters, but also at nursing homes and other congregant facilities around the city. 

“We don’t have orders that say I’m showing up, opening the door and I need to test every person in here. These are all voluntary arrangements,” he said. “So we have a going facility to facility to work out how those voluntary tests are going to be conducted.”

Falsey said logistical delays with Brother Francis slowed down the process of getting testing up and running at the shelter, though managers of the shelter and city officials both say they were working productively together. 

But not only do shelter managers have to agree to take tests, they also need buy-in from residents. At the Sullivan, about half of the residents have been getting tested during the last few weeks, according to numbers provided by Bean’s Cafe, which is operating the shelter. 

But some residents at the shelter say that the recent cases at Brother Francis make them even more inclined to get tested. Moses Aguilar, a guest of the shelter said that he doesn’t see getting testing as a burden, but as a sign that the shelter is taking COVID-19 seriously. 

Moses Aguilar and Paulette
Moses Aguilar and Paulette Dunbar, guests and volunteers at the Sullivan shelter, say that they’re more than happy to get tested weekly for COVID-19. During the last few rounds of testing, about half of the residents staying at the shelter got tested. Sept. 3, 2020 (Lex Treinen/Alaska Public Media)

“Anybody who’s offering candy bars, popcorn and some chips to take a COVID virus test seems that you actually care about the homeless,” he said, taking a break from volunteering in the kitchen. 

Bean’s Executive Director Lisa Sauder said she thinks the regular testing has so far made a difference. 

“We’ve been doing a lot of testing. So we were able to identify those initial one and two people that were positive and remove them from the shelter and get them off-site. And I think that made a big difference,” she said. 

But even that might not be enough to keep the disease from spreading to more of the homeless population. Twelve residents at Sullivan tested positive during the latest round of testing.

While city officials say a better answer is working to find permanent housing for people experiencing homelessness, but until then, it said regular testing will continue at Brother Francis and other shelters around town.