Distributing COVID Vaccines to Unhoused Angelenos Poses Unique Challenges
In the wake of an unprecedented spike of COVID-19 among L.A.'s unhoused residents, Los Angeles County health officials have started tackling the complicated task of distributing vaccines to the tens of thousands of people who live in shelters, encampments, and vehicles.
Collaborating with a patchwork assortment of local service providers and healthcare partners, county officials have been scrambling to set up pop-up clinics and mobile vaccination sites throughout L.A. since early February, and have provided vaccines to more than 5,000 people experiencing homelessness so far, according to the Department of Health Services.
Though the effects of the pandemic took longer to reach some Angelenos experiencing homelessness, new research from UCLA epidemiologists shows that unhoused L.A. county residents who contract COVID-19 are 50% more likely to die than members of the general population.
Public health officials are focusing first on congregate sites like shelters and encampments, where people are more likely to be exposed.
One area that's being prioritized is Skid Row, where several shelters struggled to contain an outbreak of cases in January.
On a recent Wednesday, a line of Skid Row residents stretched down the block in front of the Midnight Mission for a pop-up vaccine clinic organized by the Department of Health Services and Los Angeles Christian Health Centers.
Inside the courtyard, healthcare workers worked to distribute the 88 Moderna doses they had available before they expired, hustling between socially-distanced patients seated in folding chairs, taking down registration information, and explaining potential side effects of the vaccine.
Of the doses, 30 were restricted to individuals over 65, while another 58—left over from another distribution—were made available to all Skid Row residents. In the beginning of the rollout, health officials were prioritizing seniors, but earlier this month the county's entire unhoused population became eligible to receive vaccines.
"WANTED TO PROTECT MYSELF"
One of the restricted vaccines went to 76-year-old Ray Carrington, who biked to the Mission from the Skid Row apartment where he lives. After he received the shot, a volunteer handed him a card with a return date to receive his second dose, and asked him to wait for 15 minutes to make sure he didn't have an adverse reaction.
Carrington, a jazz musician, said he came to get the vaccine because he was sick of staying inside. He looked forward to being able to go out and play music again.
"I wanted to live another 75 years," said Carrington. "I wanted to protect myself."
55-year-old Christopher McCray, who lives in a tent at the corner of 6th Street and Wall Street, said he felt "blessed" to have received one of the unrestricted doses. He has been wary about leaving his tent amid the recent outbreak, becoming something of a "stranger to the streets."
"Now that I've gotten a vaccine, I still have to wear my mask and keep my social distance, as I've been doing," said McCray. "But I do feel that I am a little safer now, because I have something other than myself to fight the pandemic, which is something that I don't know a lot about."
MEETING PEOPLE WHERE THEY ARE
While walk-up clinics like the Midnight Mission's work well for concentrated areas like Skid Row, health officials will have to use more innovative ways to offer vaccines to people who live in encampments in other parts of the city, or in isolated areas.
John Connolly, Chief Strategist for the Los Angeles Department of Public Health, said that some COVID-19 response teams from the Department of Health Services who previously focused on doing wellness checks and testing will now focus on setting up vaccine testing sites in the field.
The county has also partnered with a number of Federally Qualified Health Centers, some of which could distribute vaccines through mobile or van-based clinics. This will allow them to meet people where they are.
"They can set up, through a van or a vehicle, a temporary kind of clinic or distribution site that's close to where people experiencing homelessness spend their time," said Connolly.
Some providers are concerned that unhoused individuals may also have a distrust of government officials, or come from communities who have been subjected to medical racism, making them wary of receiving the vaccine.
"There is resistance to the vaccine, whether you're housed or unhoused, among the general population. Especially in communities of color, for very good reasons," said Stephanie Jaeger, Executive Director of the NoHo home alliance. It was one of the first organizations to launch a pilot vaccination program for the unhoused in early February.
Jaeger said it's critical that the county continues to partner with community organizations like hers, who have long-standing relationships with unhoused clients, so that they can work to overcome any lingering vaccine resistance.
"Our volunteers are able to talk to our unhoused guests one on one about why the vaccine is important and how it helps them to avoid really serious illness," she said.
Jeanette Rowe, Director of Programs at the Midnight Mission, said the Department of Public Health has been doing preliminary outreach in Skid Row to educate the community about the vaccine, and Mission case workers have been working with clients to address peoples' concerns.
Rowe said they met with one 87-year-old client for five days in a row to ease her into the idea of getting the vaccine before she finally agreed to it.
"This client had some real fears about getting the vaccine, but I think by just talking to her everyday and making it a little more normal, she was able to really just go ahead and take care of that for herself," said Rowe. "It's not perfect, but it's working."
Once unhoused people get the vaccine, it's critical to ensure they come back to receive their second dose — or that they don't get too many doses. This is a particular concern for those with mental health issues which might interfere with their ability to remember if, and when, they got a shot.
The single-dose Johnson and Johnson vaccine, which recently started its rollout, might help resolve this issue once more doses become available. For now, providers are relying on county data systems to keep track of patient activity.
"If they want a vaccine, first or second, they go through the system so health services can make sure they're identifying the person, and that they haven't been vaccinated already," said Rowe.
The Department of Health Services is also using text messages, email reminders, phone calls, and alerts in homeless service information systems to send follow-up reminders. Clients who do not have phones are provided one so that the teams can reach them to provide the second dose.
To date, the second dose follow-up rate is 80 percent for all vaccination clinics, according to the Department of Health Services.
After clients receive their second dose, Rowe said her concern shifts to making sure they have a place to rest comfortably while they recover from the sometimes intense side effects that can ensue, such as fever, chills, exhaustion, and headaches.
"If I have side effects from the vaccine, I just come home and go to bed," she said. "But that's harder to do on the street."
She says the Mission is currently offering vaccine recipients the option to stay in their courtyard overnight.
Despite the numerous and complicated challenges that lie ahead, Rowe said there has already been one unexpected positive outcome from the vaccine clinics the Mission has hosted. A number of people, after receiving their shots, have asked to come stay in the shelter.
The first clinic alone brought in 13 new clients, said Rowe.
"I keep looking at the number on my screen, and I just leave it up," she said. "They now have the option to get employment services, education, everything we have."
Rowe said the experience has made her feel a little more hopeful overall.
"I'll honestly say that for Midnight Mission and myself, it has been a long road to the point of vaccinations," she said.
"But now, there's a light at the end of the tunnel—if someone does get COVID, at least they have a chance of surviving it."
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