As the snow began to pile up Monday night, Jim Greene set out to bring a sleeping bag to a Boston man spending the night on the street.
“I wish we could convince him to come in, but he just refuses,” said Greene, director of the Boston Public Health Commission. “It’s a really complex set of issues, struggles and traumatic events in a person’s life that makes them fearful of going into a crowded place.”
Though homeless service providers scramble every winter to move people off of the streets and into shelter, the arrival of this year’s first big storm coincides with another danger: the spread of coronavirus in the state’s shelter system.
Last April, the Boston Health Care for the Homeless Program tested people experiencing homelessness for COVID-19 and linked a group back to the shelter provider Pine Street Inn, where 146 of the 408 people tested were positive but asymptomatic.
“This virus goes right through a shelter,” BHCHP president Jim O’Connell said. “It’s highly transmissible. A major part of the problem is that it’s being spread by people with symptoms but also people that have no symptoms. That has been a shelter nightmare for us.”
Through strict COVID-19 precautions, Pine Street Inn has successfully reduced the rate of positive cases from 36% in April to around 2%. President Lyndia Downie says there are still those who resist shelter for a variety of reasons.
“Some people say, I’m fine, I don’t want to come in, I don’t want to have to worry about any rules in shelter, and I feel safer outside,” Downie said. “And then there’s a group of people who are severely mentally ill who are probably not making the safest judgment, frankly, and just want to be left alone.”
That’s the group, Downie says, who are the most challenging for providers to help.
“They’re in a place where they think they’re safe and where they are comfortable, and you want to respect that,” Downie said. “But you want to make sure you’re walking the fine line between respecting people’s rights and at the same time making sure they’re safe.”
In extreme emergency situations, Downie says people can be involuntarily “sectioned” or placed in shelter if they have presented a danger to themselves or seem at high risk of hypothermia in a storm.
“It’s not preferred,” Downie said. “Obviously the preferred route is that someone who is doing street outreach has built up enough of a relationship that they’ll come in. But that clearly isn’t going to work for everybody. We rely on the police a lot, and the EMTs as well. Sometimes if we can’t persuade people, the police can.”
Though outreach expands around the state during weather events, advocates say anyone 911 calls are still essential to ensure safety and wellness checks.
“When the snow piles up, it means fewer people out on the roads and fewer people out to be eyes and ears,” Greene said. “We really need the 911 calls.”
Worcester’s biggest shelters — Hotel Grace at Ascension Church, the Queen Street Shelter and an overflow shelter at the Martin Luther King Jr. Center — have all made accomodations for COVID-19 safety, according to Worcester city spokesman Walter Bird.
As Monday’s storm began to pick up, a veteran experiencing homelessness was discharged from a local hospital’s COVID-19 unit, according to Bird.
“Here he was, discharged on the day we had a storm,” Bird said. “He found himself unsheltered and in need of treatment and housing.”
Bird says the individual was transferred to a recovery program and will be connected to permanent supportive housing after his two-week stay.
When the weather becomes dangerous, hospitals are encouraged to make space for patients experiencing homelessness even if emergency room capacity is low, O’Connell said.
“If somebody is in the emergency room on a cold night, not discharging them right into the street is really critical,” O’Connell said. “With COVID-19, they’re so overcrowded that keeping people any longer than necessary is really a tough thing for them to do, but they’ve been great about doing it so far.”
Loneliness, particularly for those who are experiencing sickness, has been an additional hardship for the homeless community during the pandemic, O’Connell said.
“Most people [experiencing homelessness] have no family left, or their ties to family have long been severed,” O’Connell said. “So when they’re in the hospital and very sick, many times if they die, they die alone. We’ve been used to watching these folks die alone with no one around, and it has shined a light on how terrible it is to die alone. We now see many of our COVID-19 patients doing that, so I hope collectively we’ll learn a lot about how to take care of one another in a way that will, in the long run, be really beneficial to all of us in health care.”