If the new coronavirus has proved anything, it's that uncertainty is the only certainty, that action is better than inaction, and that it's important to have hope in light of a pandemic.
Just ask Tim Mercer.
"I'm hopeful. Yeah. I'm definitely hopeful. This is a marathon, for sure, not a sprint," he says with a nervous laugh. "Well, actually it's both. It's a marathon that we have to sprint in."
Mercer is the director of global health and an assistant professor at UT's Dell Medical School. He's one of a handful of minds trying to figure out a long-term plan with Austin Public Health to prevent the spread of COVID-19.
In particular, he and others are focusing on how to help prevent the spread of the disease among homeless Austinites. As the area settles into shelter-in-place orders, the question is raised: How can unsheltered people safely shelter in place or homeless people stay at home?
The question is plaguing both the homeless population and the people who serve them, because those city orders have crippled the capacity of groups providing crucial help.
Risk factor
The pandemic has laid bare how difficult it is for humans to keep to themselves – and that's especially true for people living in camps or crowded shelters.
Intrinsically, Mercer says, that's one of a handful of factors that put homeless Austinites at particular risk of COVID-19.
"All roads in combatting this virus lead to self-isolation, essentially. And that is a challenge for our neighbors experiencing homelessness, whether they're living in shelters or whether they're living in encampments," he says. "Self-isolation is very challenging. Sometimes that's downright impossible."
Homeless people, in general, have higher risk factors for most conditions. Being homeless can double your risk for heart attack and diabetes alone. And people experiencing homelessness are more likely to have substance-use issues, Hepatitis C, HIV and hypertension, as well as depression.
It takes a toll, Mercer says, and that can leave homeless folks with compromised immune systems and little social distancing. On top of that, people experiencing homelessness are also likely to be older, putting them in the group at higher risk of serious complications from COVID-19.
"There's an aging population ... in this country that's experiencing homelessness," he says. "And we know they're often age-accelerated ... living many years on the streets kind of has an age-acceleration effect, if you will."
There's also the issue of getting medication for underlying health problems made worse by being outdoors.
Andrew, who didn't want to give his last name, sleeps under I-35 in downtown Austin and checks a lot of those boxes. The 48-year-old has PTSD, along with high blood pressure, and he's on multiple medications – medications he says he can't always hold on to, because people have been stealing them while he sleeps.
Like a lot of people, housed or unhoused, he's trying to socially distance. His bedroll is in a parking spot, away from the perimeter of the lot, where roughly 20 camps are staked side-by-side. He's being careful and washing his hands with bottled water when he can find it, but he still fears for the worst.
"Me? Oh, if I get the coronavirus, I'm dead," he says, holding an empty water bottle.
At a distance
All the uncertainty surrounding the pandemic that's killed thousands globally has been magnified within Austin's homeless communities.
Andrew didn't know the virus was in Austin until the city pretty much shut down – when he went to Sixth Street looking for a side-gig and found bars boarded up. What was more telling was when folks from nonprofits and churches stopped bringing food and clothing donations, because they'd run out of volunteers.
James Demond Pettway, 42, says it's been hard to find clean water since a handful of nearby providers limited access to restrooms and showers.
"I think it's been hard to even get food, to get water. It's hard to be able to shower – to go to the places where we can shower," he says. "It's hard to reach out to those places, because there are only limited, small amounts of resources and it's not enough."
Now, Pettway, Andrew and others are stuck searching for the absolute bare necessities in a city that's been shuttered.
"It's like ... 'What did we do to deserve all of this?' Because we can't get no goddamn help," Andrew says. "I went to get some help, and I can't even get no help because they shut everything down because of the scare."
Less with less
Still, some providers are making do with what they have, while complying with social distancing protocols and trying to keep everyone – clients and, in most cases, volunteers – safe. First United Methodist Church, which used to open up its gym on 13th and Lavaca streets to 300 people every Tuesday and Thursday, has scaled back drastically. They're still offering breakfast – but on a to-go basis – and they're having a hard time finding volunteers to keep up with demand. It's worth noting that charitable groups offering food and shelter to people in need are designated essential businesses under the city's and county's shelter-in-place orders.
"I struggle with the question of what do we do."
Caritas of Austin has closed its kitchen, opting to provide sack lunches. And the Angel House at Austin Baptist Chapel is handing out breakfast and lunch, but it's not allowing anyone indoors.
Another key provider, the Trinity Center, shut its doors entirely on Tuesday.
The center serves as a mailing address and helps people get IDs and bus passes. It typically serves breakfast most mornings. Irit Umani, who heads the center, hopes the plan Mercer and other officials are working on addresses the needs for both sheltered and the unsheltered Austinites.
"As we think about the elderly, of which I'm one, and as we think about people with lung diseases and compromised [immune systems] and as we think about children spreading it without knowing it, I want to know what's the emergency plan for people with no options?" she says. "They're out in the street – of course they congregate."
Umani says she wants to see handwashing stations and port-a-potties – which are hard to find near camps downtown. (And the ones there are seldom cleaned.) The city recently installed them outside Little Walnut and Terrazas libraries. Newly released CDC guidelines suggest halting clearing up camps of 10 or more – which both the city and state have previously done – and providing toilets and handwashing stations.
The city and county orders suggest keeping 6 feet between encampments, and Mayor Steve Adler told The Texas Tribune's Evan Smith on Wednesday that the city has set aside some space for isolating homeless patients who test positive for COVID-19.
As for shelters, the response has been day-by-day. Both Salvation Army and Front Steps, which operates the Austin Resource Center for the Homeless, have been scrounging for supplies like hand sanitizer and wipes, as well as protective gear to keep their dwindling staff safe.
Both the ARCH and Salvation Army's downtown shelter can serve roughly 370 people on a given night.
Greg McCormack, executive director of Front Steps, says staff has discontinued service for most people unless they're staying at the shelter – which only serves men –and they've discontinued most appointments.
To combat a possible spread of the coronavirus, they're spacing people out in the shelter's crowded bunk beds, as well as putting 6 feet between sleeping mats.
But staff is not requiring people have their temperature taken as they enter – because there's no real protocol for dealing with the disease yet.
"I struggle with the question of what do we do," McCormack says. "So, if someone comes in with a 100.4, are we going to say you can't come in?"
Mercer says the solution, at least on the city and county level, is to provide much-needed resources to service providers like Front Steps and Salvation Army, along with policies that can manage the eventual spread of COVID-19.
"It's critical because they're so vulnerable, and helping to address the pandemic in that population will help to stem the tide of the transmission for the broader community," he says. "So, it's important for all of us."
Better than nothing
But the problem facing all service providers – shelters like the ARCH and places like the Trinity Center – is the lack of volunteers and staff as a result of social distancing.
Over the last few weeks, volunteers have been urged to stay at home; administrative staff members are working remotely; clinics have closed; counseling or case-management services have shifted online or over the phone.
There are a lot of unknowns for everyone involved here, but Umani says one way to clear up at least one unknown is to expand testing for COVID-19 – so people can get a real sense of the spread in Austin.
"If testing is going to become wildly available, then I'm hopeful that we'll know what we're dealing with and then we'll deal – because we're strong people," she says. "And my question is, 'Are we compassionate people?'"
Under I-35, Andrew and his neighbor, Clayton Trew, found an answer to Umani's question.
"This dude that just passed by ... gave us something. And guess what? Now I have a little something – a little – because nobody comes down here, man," Andrew says, opening up a bag full of snacks.
It's not a fresh meal. It's certainly not a feast. But it's something.
"That'll help you make it through the night. It'll at least give you a little energy. You think this is going to last me?" Andrew says. "But it helps."
Andrew says, despite all this, he's trying to stay positive – that this is a storm he thinks Austin and Austinites can weather.
Trew takes his bag of snacks and heads back to his tent across the lot, while Andrew heads back to his bedroll in the shade – to the shelters they've made their homes – with something, which is better than nothing.
