Defying expectations, COVID-19 has hardly spread among Knoxville’s homeless population. But as community advocates plan ahead for winter, they say the pandemic may pose new risks to those seeking shelter from cold streets.
Some programs focused on helping homeless families depend on volunteers, and have been suspended. Meal programs and emergency shelters can be crowded, making the virus easier to spread. And when you have no place of your own, it’s tough to keep a mask clean -- or to self-quarantine.
“COVID scares the living you-know-what out of me,” says T. Hancock. She and her dog sleep at a small emergency shelter run by the Volunteer Ministry Center. She says she feels comfortable there, but scared when she has to head out on the street each morning. Hancock has an enlarged heart and has suffered from aneurysms. COVID makes her nervous about accepting food from strangers, even when she’s hungry.
The virus can also increase the stigma of homelessness. “People that have homes and cars and everything else, they kind of shun us, thinking we’re going to give it to them,” Hancock said.
Testing and quarantine
In fact, there have been very few COVID cases among the city’s homeless, says Charity Menefee, director of communicable and environmental disease and emergency preparedness for the Knox County Health Department. Menefee expressed confidence that homeless residents are getting tests when they need them.
“On the plus side, we have a lot with close relationships with the homeless providers, and they’re keeping us posted,” she said. “If there’s any concern at all -- if there’s been a contact or any symptoms, they get tested.” Hancock said she was tested for COVID as a condition for treatment of an unrelated health problem.
Still, the exact number of cases among the homeless is unknown.
Doctors aren’t always aware of the living conditions of transient patients, Menefee said. Those patients often lack the health insurance or stability needed to manage chronic illnesses. COVID can push them out of shelter, making them even more vulnerable.
“We’ve run into situations where they weren’t homeless before, but they find themselves homeless. And that’s a hard thing to track,” Menefee said. “They might be staying with a friend or a relative and end up with COVID, and the friend or relative doesn’t want them to stay there any more and they don’t have anywhere else to go.”
Circumstances like this can also make it hard to deliver their COVID test results, Menefee acknowledged. But the health department has years of experience with finding people experiencing homelessness during disease outbreaks -- most recently, Hepatitis A.
Once identified, people without their own place need somewhere to quarantine after testing. So the city partnered in spring with the Volunteer Ministry Center, Metro Drug Coalition and others to open a quarantine shelter called “The Guest House.” It consisted of 18 offices temporarily converted into bedrooms.
Previously, the health department had been using hotel rooms for this, but Menefee said it was harder to provide food and monitor compliance there.
The Guest House served about 60 people over two months, but only two actually tested positive for COVID, said Bruce Spangler,CEO of the Volunteer Ministry Center. The shelter closed because it didn’t seem to be needed. With winter on the way and infections climbing in Knox County, a smaller version of The Guest House reopened in early September.
Shelters and camps
The homeless may be somewhat insulated from the virus partly because so many sleep outside. Over the summer, the city left homeless camps alone unless they were wedged dangerously under bridges. The CDC recommends that “if individual housing options are not available,” people without permanent shelter be allowed to stay in camps, which offer more social distance than some shelters.
“That’s the reason you’ll see on Blackstock (Avenue), there’s a growing number of folks who are there camping out,” Spangler said. “To disrupt those camps could cause some spread.”
The city even provided some portable toilets for people camping in that area. But Michael Dunthorn, coordinator of homeless programs for Knoxville, said the situation created an uncomfortable paradox: “Dealing with street outreach, dealing with folks that are out of shelter is complicated by the pandemic -- because you want to keep folks safe, but you also don’t want to just throw your hands up and say it’s OK to be unsheltered in our community,” he said. “Being in a camp is not the healthiest situation.”
Although the Blackstock Avenue camp seems large, Spangler said it doesn’t reflect an increase in homeless people living outside: They just aren’t hiding as much as usual.
In August, the CDC recommended communities add shelter space -- even in hotels if necessary -- to provide shelter to people without homes while allowing them to have more social distance. It also recommended providing separate shelter space for the more medically vulnerable.
However, Knoxville is now clearing out the camps, according to a press release issued Oct. 2. It stated, “The City and outreach partners will facilitate a transition to connect those currently living in encampments with shelter services and notify occupants that camping is no longer permitted.” The press release stated that shelters have “modified their facilities to allow safer sheltering during the pandemic.”
City spokesman Eric Vreeland stated in an email that campers are being notified “well in advance,” although he declined to name a specific date. “On the scheduled clean-out date, outreach workers accompany KPD and public service workers to once again offer assistance with shelter placement and other services,” he said.
Knox Area Rescue Ministries (KARM) runs downtown’s largest shelter, which can house up to about 400 people a night. It actually saw a slight decline in visitation because people perceived that sleeping there wasn’t very safe, said Burt Rosen, KARM president and CEO. (He disagrees, pointing to extensive cleaning, rearrangement of the facility and new special air filters.)
Some homeless services that rely on volunteers were interrupted in spring, including church-based family shelter programs and classes at KARM. But most adapted. For example, KARM started serving meals outside. The VMC shelter bought several thousand masks and began providing them to the neighbors who stay there, Spangler said.
Shelters didn’t close. Neither did the daytime “safe space” managed by the city beneath Interstate 40. A public restroom was opened at a nearby VMC shelter to make hand-washing easier for these day visitors.
Rosen says many people who sleep in the Blackstock Avenue tent camp gather under the I-40 bridge next door to KARM during the day.
“I have concerns about that space and some of the things that are occurring underneath that space,” he said. “At any given time, it is very, very crowded there, and those folks are without masks. But, on the flip side, we’re not seeing an increase in the number of cases because of that.”
Both the VMC and the KARM shelters have been checking all visitors for fever before entry. If someone has COVID symptoms, they are taken to a hospital or referred to Cherokee Health Systems for testing and care. Those who decline won’t be forced to seek medical help, Spangler and Rosen said.
However, Menefee said the health department does have the ability to force someone to quarantine or isolate, at either The Guest House or a provided hotel room. As of late September, no person experiencing homelessness had refused to quarantine, although one person tried to leave before the isolation period ended. The health department began the legal process to prevent that, but it ended up being unnecessary, Menefee said.
Gaps and grants
The City of Knoxville recently received a $2.2 million to provide emergency services to the homeless during the pandemic. The money, which was allocated through the Coronavirus Aid, Relief, and Economic Security (CARES) Act, will help local nonprofits fill gaps by providing rent assistance, mobile medical care, and other services.
Some of the money will be directed toward developing more options for getting people “under roof and ultimately into a permanent housing situation,” Dunthorn said. For instance, there are very few emergency shelters for homeless families that want to stay together, and that demand is growing. There has been an uptick of families sleeping in cars, Dunthorn said.
Shelters could use some of the money to house more people while spreading them out more. KARM plans to apply for money to build a covered area for fever and safety screenings outside its building, Rosen said. KARM also hopes to use the funding to create additional medical space that could flex between being used for quarantine and more routine medical care, like wound treatment.
Spangler said he’d like to see some of the funds used to open more small emergency shelters across the community, and to educate the homeless on the street about how to avoid COVID infection.
Another good investment would be a program to take 15-minute COVID tests directly to tent camps, Spangler said: “The ability to do fast testing I think would really, really help, especially with knowing what we’re up against.”
Ultimately, the pandemic may affect the homeless community the most by adding to its ranks.
The effects of layoffs and furloughs are already cascading. “We’re seeing an increase in domestic violence, in people abusing substances,” Rosen said. “And as we’re watching the moratorium on evictions expire, as people’s unemployment benefits are expiring, we are very much expecting to see what we saw back in 2008 when the economy tanked.”
Dunthorn said those in Knoxville without shelter, or at the cusp of homelessness, can call 211 to be connected to help and resources. Community members who want to support the homeless should contact United Way, Volunteer East Tennessee, or other agencies and inquire about what gaps most need filling, he suggested.
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This story was updated Monday, October 5, to include new information about the city of Knoxville's plans to clear out homeless camps for the winter.