COVID vaccinations lag behind, outbreaks spread to Bay Area shelters

Even as the Bay Area celebrates high COVID vaccination rates, the region is running out of efforts to vaccinate thousands of people living on the streets, in vehicles and in homeless shelters.

In some counties, homeless people are vaccinated almost half the rate of the general population. Other counties don’t even track vaccination rates in homeless communities, making it nearly impossible to gauge their success and target areas for improvement.

Experts are concerned about low vaccination rates, combined with the continued spread of the highly contagious Delta variant and the end of some hotel programs that used to protect homeless people, put homeless communities at risk. A major outbreak at a homeless shelter in Santa Rosa this month infected dozens of people, while Alameda County and San Francisco reported smaller outbreaks in their homeless communities.

“Our vaccination rates in shelters are certainly not where we would like them to be,” said Lucy Kasdin, director of the Alameda County Homeless Health Care Program. “I think there is definitely a concern about this.”

His agency estimates that between 25% and 40% of people living in county homeless shelters are vaccinated, which is far from the county’s 60% target. About 70% of the general population aged 12 and over is vaccinated. The agency does not follow the rates in the camps.

Meanwhile, case rates are increasing in some places. During the week of July 5, Alameda County reported 20 new COVID infections among its homeless residents – the most the county has seen in a week since early February.

Bay Area health agencies have set up pop-up vaccination clinics and sent mobile teams with coolers full of vaccines to shelters and homeless settlements, but reaching everything can be difficult. the world. The shelters have transient populations and camps often form in remote areas, where it is easy for health workers to miss people.

“This is a concern to us, so much so that we do not post any of the PPE (Personal Protective Equipment) restrictions on any of our assembly shelter sites,” said Andrea Urton, CEO of HomeFirst Services, which manages the largest in Santa Clara County. shelter. “We keep everything in place. Because we just don’t know what’s going to happen right now. “

San Francisco estimates that it has fully immunized 38% of its homeless residents, compared to 76% of its general population aged 12 and older. In Contra Costa County, an estimated 33% of homeless residents are fully immunized, compared to 74% of the general public aged 12 and over.

The data is spotty and some counties, including San Mateo and Sonoma, were unable to provide estimates. The California Immunization Registry does not track the housing status of a vaccine recipient, so county officials are collating information from multiple databases. To complicate matters, officials do not have a current baseline count of the Bay Area’s homeless population. The counts that were due to take place this year have been canceled due to COVID precautions.

The Santa Clara County Valley Homeless Health Care Program surveyed 1,800 of its homeless patients and found that 70% were vaccinated, according to spokesperson Joy Alexiou. But in the camps, only 30 to 40% of people who were offered a vaccine accepted.

“You have to be able to trust the science, you have to be able to trust the health system, you have to be able to trust the people around you,” said Dr Margot Kushel, professor of medicine and director of the UCSF Center for Populations. vulnerable. “And I think homeless people have often had a lot of trauma and a lot of reason not to trust these systems.”

Santa Rosa reported a major outbreak earlier this month at Samuel Jones Hall, where about half of the shelter’s 156 residents either had COVID or were suspected of catching the virus. Many infected residents had been vaccinated – including six who were hospitalized despite their injection.

Experts say that in a shelter where dozens of people eat and sleep nearby and many people are unvaccinated, the virus is likely to spread more easily, even among those vaccinated.

Like much of the Bay Area, Sonoma County has relied heavily on the Johnson & Johnson vaccine to protect its homeless communities. The one-size-fits-all approach means outreach workers don’t have to worry about finding people for a second dose. But Johnson & Johnson’s shot struggled to be accepted because it is somewhat less effective at preventing COVID than the Pfizer and Moderna vaccines and comes with warnings that recipients suffered from Guillain-Barré syndrome and blood clots in very rare cases.

While vaccination rates may be low in the rest of the Bay Area, Leland Wells, director of the St. Vincent de Paul refuge in Oakland, is proud of his numbers. When county health workers began showing up with vaccines, Wells made it a mission to convince everyone to get vaccinated. Now just about all of the shelter’s 45 or so regular guests have been vaccinated, he said.

“I think a lot of it is about trust and relationships,” Wells said. “I’m here and they know I’m here. And I know they believe I’m not going to make them do something that’s not for their good.

Carlos Dubose is his most recent success story. The 51-year-old came to Saint-Vincent-de-Paul for a free lunch on Tuesday and ended up leaving with a sandwich and a Johnson & Johnson shot.