Over the course of a month, COVID-19 cases have exploded in L.A. County, increasing 20 fold from June 21 (124 new cases) to July 21 (2,551 new cases). The upward trend has alarmed health officials, led to the reinstatement of the indoor mask mandate, and even caused some restaurants to temporarily close out an abundance of caution. While some “breakthrough” cases have been reported among the fully vaxxed, the resurgent pandemic is largely spreading among the unvaccinated and partially vaccinated. That’s cause for concern in the unhoused community, where the vaccination rate lags behind the rest of L.A. County by more than 20 percent.
As of July 11, almost one month after the reopening, 31.6 percent of people experiencing homelessness in the county were fully vaccinated, and 41.5 percent had gotten at least one dose, according to the county health department’s Housing for Health division. That’s well below countywide numbers for the general population: according to the latest data, 70 percent of Angelenos 16 and older have gotten at least one shot, and 62 percent are fully vaxxed. Dr. Emily Thomas, deputy medical director for Housing for Health, says that the vaccination rate has started to slow across the board, but also among the unhoused.
“The goal right now is to provide education and access to the vaccine,” Thomas says.
Part of the recent spike in cases has been attributed to the spread of the more transmissible Delta variant. There’s concern that if vaccinations remain low, it could spread out of control among the more than 66,000 unhoused people in L.A. County.
Since the pandemic began, fear of a mass outbreak among unhoused people has been a constant, due to a lack of access to hygiene facilities, cramped shelters, and dense encampments in areas such as Skid Row. The state’s Project Roomkey program, which moved elderly and unhoused people into hotel and motel units, was created in part to try and get people out of congregate spaces. But in Los Angeles, that program never reached its stated benchmarks and many contracts with hotels have ended. Meanwhile, hygiene centers set up by the city have been poorly maintained and contracts for them are ending a month early, according to reporting from L.A. Taco. That shift—along with the spread of the Delta variant, the easing of restrictions, and summer weather—increases the chance of outbreaks among the unhoused.
The COVID death rate for unhoused is on par with the general population, according to Randall Kuhn, associate professor at UCLA’s Department of Community Health Services. Data from the last year shows that unhoused people have had a lower infection rate than the general population, in part because COVID-19 is often spread at social functions unhoused people don’t attend, Kuhn said. However, unhoused people who are infected die at a higher rate, according to research from UCLA.
So far, the effort to vaccinate unhoused people has been carried out by a mix of county healthcare providers and community partners, like nonprofits and other groups that have built up trust among the homeless. The unhoused could also use city and county vaccination sites along with the general public. Thomas says that Housing for Health teams are trying to reach unhoused individuals where they are, in encampments, riverbeds, and near churches.
“We’re also doing up to 50 vaccine clinics a week, hitting all eight [service areas],” Thomas says.
Part of the problem at this point is that many people who haven’t been vaccinated at this point are specifically avoiding getting a shot, Thomas says. Approximately 20 to 30 percent of unvaccinated people say they’re waiting to learn more before getting jabbed. “It’s a long-haul strategy with engagement, and not everyone is ready,” Thomas adds.
In light of the past month’s surge in COVID cases, Housing for Health is implementing some new strategies to protect and vaccinate unhoused people. It opened another site for isolating and quarantining people with COVID-19, and is urging universal masking inside shelters. Thomas says Housing for Health is also providing expedited vaccine clinics at shelters with COVID-19 outbreaks.
Kuhn says that news of the spread of the Delta variant could spur more people to get vaccinated, if they view it as serious enough. However, Kuhn says, unless hesitancy is seriously addressed, a large portion of unhoused Angelenos might still avoid getting vaccinated. The other factor that could change some rates, he explains, is that people are still becoming homeless, some of whom could already be vaccinated.
If a COVID outbreak did hit unhoused Angelenos, it could take longer to detect than a spike of infections in the general population, Kuhn says. Past spikes in Los Angeles County, such as during the winter surge, took approximately two weeks to become evident. Due to the slower reporting with unhoused cases, it could take closer to three weeks before any major spread of COVID in the county’s encampments became clear.
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