According to the Centers for Disease Control and Prevention, people experiencing unsheltered homelessness are at risk for infection when there is community spread of COVID-19. This is because homeless services are often provided in congregate settings, where social distancing is difficult to maintain and access to medical resources is limited.
Based on the 2022 Point-in-Time (PIT) Count, an estimated 4,410 people were experiencing homelessness in D.C. at the end of January. Among unhoused adults, 35% are over the age of 55 and 16% have a chronic physical health condition. These conditions make them even more susceptible to COVID infection.
Health data show how these vulnerabilities play out. By March 2022, 1,248 positive COVID cases were reported in D.C. among people who were staying in a shelter. That accounts for about a third of that population (about 3,720 people, as estimated by the PIT Count). Twenty-six people died in the Homeless Service System, 2% of its total reported cases. Compare this to the total D.C. population, about a fifth of whom tested positive as of March, according to calculations based on city data, with a mortality rate of a little under 1 percent.
To make matters worse, many social services were forced to shut down or operate remotely due to staffing and funding shortages. The D.C. government has attempted to respond to the disproportionate effects of the pandemic on the unhoused community, but these efforts have been largely inadequate, and much more can be done.
Pandemic housing
On March 17, 2020, the D.C. Department of Human Services (DHS) launched the Pandemic Emergency Program for Medically Vulnerable Individuals (PEP-V). The program places unhoused residents at higher risk of being severely affected by COVID into hotel rooms leased out by DHS. Eligible residents include those who have certain medical conditions or are over 55 years old, as well as those who need to quarantine after COVID exposure. Residents may stay in the hotel until their case manager matches them with government housing programs, with the goal of helping them transition to permanent housing.
At its height, PEP-V offered housing for up to 800 residents. In July 2022, almost 600 hotel beds are occupied at PEP-V sites. The city reports that 722 people have moved from hotels to permanent housing, and another 312 have been matched to “permanent housing resources.”
However, the demand for PEP-V is high, and so are its costs. When PEP-V first began in 2020, residents were placed into private rooms at two sites, but within the first month, some residents who received a referral for a hotel room were placed onto the waiting list. By the end of 2021, more PEP-V sites had been created, yet the waiting list was nearly as large as the program’s capacity, and most residents had to share rooms with others. Street Sense reports that it costs the city $6.9 million per month to run PEP-V, and the continuation of the program depends on the availability of federal funding. This is why PEP-V was almost discontinued and subsequently extended several times, and its future is not yet clear.
Encampment removal
In August 2021, Mayor Muriel Bowser launched the Coordinated Assistance and Resources for Encampments (CARE) pilot program to clear out the city’s three largest encampments and move residents to permanent housing. Under the program, individuals residing in the pilot encampments were identified by DHS-contracted outreach teams and offered intensive case management, behavioral health or substance use support, and expedited affordable housing options.
Although participation is technically voluntary, if a resident refuses engagement and services, DHS mandates that they move somewhere else where there are “decreased health and safety risk factors present.” The program has drawn criticism from council members and advocates, who oppose the permanent shutdown of encampments and question whether transitional hotel rooms and apartments can sufficiently meet the needs of those displaced by the program.
Based on the DMHHS/DHS Encampment CARES Dashboard, 41 of 45 residents in the NoMa encampments, 23 of 34 residents in the 20/21st and E Street encampments, and 26 of 32 residents in the New Jersey and O Street encampments have either been leased up or are working with street outreach workers on accessing housing services as of May 2022. This leaves 21 people who have left the encampment sites, cannot, or do not wish to engage with CARE services.
In a statement, The Way Home Campaign expressed concerns about the creation of “no camping zones” that criminalize homelessness in the encampments and demanded a stop to encampment clearings, as the CDC has advised cities not to conduct full encampment cleanups during the pandemic. The statement also argues that prioritizing select encampment residents for housing is unfair to other unsheltered residents waiting for housing placements.
Additionally, an incident during the NoMa encampment clearing in October 2021 — during which an unhoused person was hit by a skid-steer loader driven by a city worker — raised doubts about the treatment of those living in the encampments.
Vaccination efforts
In the District of Columbia COVID-19 Vaccination Plan released in November 2020, “Homeless, Transitional Housing Residents” rank high in the priority list for vaccine allocation. The D.C. government distributed COVID vaccines to those living in low-barrier shelters and PEP-V sites when they were available.
Through the COVID-19 Peer Educator Program, the D.C. government hired and trained 55 shelter residents to help dispel misinformation and promote COVID vaccines across five men’s and women’s low-barrier emergency shelters while also conducting street outreach and running programs like COVID-19 bingo. For those who are unsheltered, the city partnered with Unity Health Care to host pop-up mobile vaccine clinics at multiple locations, including Marvin Gaye Park, Miriam’s Kitchen, So Others Might Eat, and near the NoMa encampments.
Overall, vaccination rates in the D.C. unhoused community plateaued in the second half of 2021, mirroring national trends. Approximately 47% of D.C.’s unsheltered population were fully vaccinated as of July 2021, lagging behind the vaccination rate of the total D.C. population. According to the city’s data, as of July 2022, 28% of people living in shelters have been vaccinated, 4% have been partially vaccinated and 68% remain unvaccinated. These discrepancies could be explained by mistrust in the vaccine and government services as well as racial disparities in vaccine distribution.
COVID vaccine distribution is just one example of the historically inequitable distribution of health care in the U.S., but when it comes to public health and immunity to the virus, everyone should be equal.
More funding and outreach needed
Although COVID-19 restrictions and mask mandates have eased in D.C., the risks from new variants cannot be ignored. Much more needs to be done to protect the unhoused population from the adverse impacts of the pandemic.
For one, more funding is necessary to expand the capacity of PEP-V and ensure its survival throughout, if not beyond, the pandemic. Ward 1 Councilmember Brianne K. Nadeau has called for the D.C. government to invest in the purchase of hotels for short-term use for PEP-V and long-term use for project-based Permanent Supportive Housing.
At the same time, because encampment cleanups displace residents and expose them to even higher risks of infection, they ought to be put on pause until after the end of the pandemic. When they continue, the city must employ a people-centered approach and make sure all the displaced residents are accounted for on their own terms, rather than forcibly removing them from the encampments.
Further, to raise vaccination rates and ensure equitable vaccine distribution, greater street outreach and more accessible vaccination opportunities are needed for unhoused residents who remain unvaccinated, especially for people who are Black, Latinx, and members of other racial and ethnic minority groups. Besides providing more support to nonprofits and social services to spread information about the merits of the vaccine, the government should continue holding free clinics at accessible locations.
It is only when policies take the voices and vulnerabilities of marginalized groups into consideration that good intentions do not inflict more harm.
Jessica Shao is a rising junior at Georgetown University’s Walsh School of Foreign Service majoring in International Political Economy with a Certificate in Diplomatic Studies. She is a member of the HOME Program Research and Advocacy Team at Georgetown’s Center for Social Justice Research, Teaching & Service.
