The homeless are vulnerable to coronavirus; here’s how they’re being screened in Wake
When someone who is homeless or destitute gets sick, they are more likely to seek care at a hospital emergency room.
That’s often not a good use for the emergency department. But it’s an especially bad idea during the coronavirus outbreak, as hospitals try to keep potentially contagious people from simply showing up unexpectedly.
Now the people who work with the homeless in Wake County have alternatives for screening and testing people for coronavirus without sending them to the hospital.
One is a set of computer tablets, shared with a half dozen shelters and drop-in centers, that allow people to consult with a health care provider virtually. WakeMed and the WakeMed Foundation, with help from pharmaceutical company Biogen, have provided the tablets and donated 1,200 telehealth visits through a Durham-based telemedicine company called RelyMD.
Those with COVID-19 symptoms of a cough and fever will be referred to WakeMed’s respiratory testing center on weekends. On weekdays, they’ll be sent to a clinic that Advance Community Health, a nonprofit community health center in Raleigh, opened Monday inside Oak City Cares, an agency that provides services for the homeless and those at risk of homelessness. WakeMed will arrange safe transportation.
The goal is to manage potential coronavirus cases without involving an emergency room or a hospital, which are trying to preserve staff and equipment needed to treat people with respiratory illnesses.
“Most of our clients utilize the emergency rooms at a very high rate, a lot of times for small things,” said Katie Gonzalez, director of social ministries for the Salvation Army of Wake County, which has one of the tablets. “Using these virtual visits during a pandemic, it keeps them safe by staying out of the hospitals, and it will help the hospitals by not jamming up the emergency room.”
For homeless patients awaiting the results of coronavirus tests, or who test positive but aren’t critically ill, Wake County is providing hotel rooms where they can wait or recover without spreading the disease.
“Most of us can just go home and self quarantine,” said Kathy Johnson, executive director of Oak City Cares. “But when you live outside or in a shelter, that’s not possible.”
Homelessness is an underlying health condition
COVID-19 is particularly dangerous for people with underlying health problems, and being homeless is essentially an underlying health condition, said Dr. Brian Klausner, a primary care physician and medical director for WakeMed’s Community Population Health program, which works to improve the health of uninsured and homeless patients.
Chronically homeless people live 20 to 25 years less on average than those who aren’t homeless, Klausner said, because of factors such as poor nutrition, lack of access to health care and crowded living conditions. The death rate from the flu is seven times higher among the homeless than the overall population, he said.
“The homeless community is particularly vulnerable and predisposed to rapid transmission,” he said. “They can’t social distance.”
Klausner spoke to more than 80 homeless people about how to protect themselves from COVID-19 at Oak City Cares in early March, as the illness was just emerging in North Carolina. Johnson said people who seek help from her agency aren’t able to keep up with the news and often don’t know what’s going on with the coronavirus outbreak.
The use of telemedicine to screen and diagnose homeless patients builds on a test program last year at Healing Transitions, a shelter and substance abuse center in Raleigh. The goal, Klausner said, was to deal with minor health problems such as colds, sinus infections or skin infections that people were showing up with at the emergency room.
“That’s inefficient,” he said, “but in a pandemic it can also be dangerous.”
But the clinic at Oak City Cares is something new, says Ryan Jury, Advance Community Health’s chief operating officer. It’s designed to minimize interaction between patients and health care providers and reduce the number of “touch points” that could transmit the virus.
Patients wait outside, properly spaced, rather than in a waiting room, Jury said. Those with coronavirus symptoms are given a mask and escorted to one of two canopy tents set up inside the building, where they’ll find an iPad on a table. Instead of a pen and clipboard, the patient signs in on the iPad, where they will interact with a health care provider in another room using Zoom.
“This is challenging because it’s making a lot of us rethink how we can deliver quality primary health care in this almost virtual world,” Jury said. “It’s a change from what we’re used to and the habits we’ve been taught.”
If a coronavirus test is warranted, it will be administered by an employee with gown, mask and gloves. When the patient leaves, the iPad and table are disinfected and readied for the next one.
This story was originally published April 7, 2020 at 2:37 PM with the headline "The homeless are vulnerable to coronavirus; here’s how they’re being screened in Wake."
