Sister Modesta Littleman vaccinated patient Peter Sulewski in late January on the first day of vaccination at a clinic run by Health Care for the Homeless in Baltimore. Yuki Noguchi / NPR hide caption
Yuki Noguchi / NPR
Yuki Noguchi / NPR
Peter Sulewski spent nearly four years roaming Baltimore’s homeless shelters and saw the health consequences – even without the added threat of COVID-19.
“I saw people freeze to death out there,” says Sulewski, whose house burned down six years ago. At the same time, he says, “I would hate to be in a shelter during a pandemic. You walk through the doors at the same time with people sharing the same bathroom as nine or ten other people.”
People affected by homelessness are particularly susceptible to disease and often live in confined spaces. Reaching them for COVID-19 vaccination is critical, health officials say, but it also poses some unique challenges. Addresses and phone numbers are constantly changing. Few of those affected have reliable internet access.
The pandemic also stopped many mobile clinics and others Public relations for homeless camps; In the meantime, patients dispersed or avoided the clinic for fear of infection.
“If they are homeless, all bets are void,” says Kevin Lindamood, CEO of Health Care for the Homeless in Baltimore, a community health clinic that treats 10,000 patients annually and has recently begun patient vaccinations. “It’s incredibly difficult to reach people, even in times without COVID.”
The Centers for Disease Control and Prevention this month the vaccination was urgent in soup kitchens and shelters.
But the pandemic has restricted many visits to homeless camps and other activities of his organization, according to Lindamood. The mobile clinic operated by Health Care for the Homeless in Baltimore – part of a national network of 200 similar clinics – will be back on stream in the coming weeks. However, the staff is currently trying to contact eligible patients in their database.
When the clinic’s first vaccination day began in late January, the available seats were occupied by eager patients who, like Sulewski, waited in a lobby with chairs lined up in a checkerboard pattern. Just taking the bus to get vaccinated meant risking infection, he told NPR. “People are packed like sardines and three-quarters of the bus without masks – that was a scary experience.”
At 66, he now lives in an apartment but still feels that his health is fragile. He limps from arthritis and has urinary problems.
Vaccines are in short supply in many places in the US. However, some states, including Maryland, have given priority to homeless populations because someone without adequate housing will suffer other conditions that make them particularly susceptible to disease.
The nationwide rollout of the vaccine is already complicated. According to Lindamood, homelessness exacerbates those headaches, such as coordinating with customers to get a second booster shot four weeks after the first dose.
“In four weeks – it can seem like forever if you don’t know where you will be tomorrow, if you temporarily live from place to place,” says Lindamood.
Meanwhile, COVID-19 isn’t even the biggest health threat to most of its customers. Among the 157 patients at the clinic who died last year, COVID-19 was not the leading killer.
“People have already died of high blood pressure and diabetes, addiction and mental illness,” says Lindamood.
A poster commemorates recently deceased customers of Health Care for the Homeless in Baltimore. Among the clinic’s 157 patients who died last year, COVID-19 wasn’t the leading killer, according to CEO Kevin Lindamood. “People have already died of high blood pressure and diabetes, addiction and mental illness.” Yuki Noguchi / NPR hide caption
Yuki Noguchi / NPR
Yuki Noguchi / NPR
Race and immigration status can create other barriers as people in marginalized communities tend to distrust medical care and may be reluctant to receive the vaccine. About 85% of the clients at the Baltimore Clinic are black or members of another disenfranchised minority. Women, children, and undocumented immigrants make up a growing percentage of the patient base. “COVID-19 is spread across all of these pre-existing emergencies,” he says.
Joseph Taylor, 72 years old, says that the suffering or death of friends and family brings fear of COVID-19 into him. “I’m not scared easily, but I couldn’t wait for the vaccine,” he says.
Taylor is diabetic, hypertensive, and has a history of heart and lung problems – conditions that put him at the top of the vaccine line at Health Care for the Homeless. Some time ago he got medical care there after he was in prison.
Eager patients like Taylor easily fill the 10 spaces on the first day of vaccination. Initially, the clinic will only give you one vial of the Moderna vaccine, which contains 10 doses.
Finding patients, managing traffic flow, and adjusting patients to doses get more difficult as vaccination goes up, he says Catherine Fowler, a registered nurse who leads the clinic’s nursing team.
One big reason is the vaccine itself, which expires six hours after a vial is pierced, she says. Therefore, the patients must be treated in groups of 10. In the event of cancellations or no-shows, replacement doses must be quickly forwarded to other patients.
“You have to have a nimble system to find more people and get those 10 cans in your arms,” says Fowler. However, this again increases the communication and transport barriers for those without a stable home.
So Fowler is monitoring other patients in the building or nearby. While she explains this process, her phone rings with a text message from a colleague: “I know a patient who can be here in five minutes if necessary.”
Back in the lobby, Peter Sulewski sits socially distant from other patients who are monitored for 15 minutes after receiving their shot to ensure they can be treated easily if they develop an allergic reaction, which is rare.
“I’m relieved,” says Sulewski and points to his left shoulder. His attention is already shifting to the other people he wants to follow. He’s worried they won’t.
He says his girlfriend told him, for example, that she would not get the vaccine because she was afraid of needles. “Therefore,” says Sulewski, “COVID-19 could stay here.”