The temperature is dropping on an already cold January morning. Still, Marcus, a client of The Night Ministry's Health Outreach Program, has removed his coat and sweatshirt and pulled his arm out of his shirt sleeve so Stephan Koruba, The Night Ministry's Senior Nurse Practitioner, can give him a COVID vaccination booster.
Marcus had lost his vaccination card a few months prior when the tent he lives in on the edge of downtown Chicago was ransacked. Koruba scrolls on a phone to locate Marcus's electronic vaccination record and then issues him a new card with the date, brand, and vial number of his first vaccination, and now his booster.
Just like any Chicagoan dining in a restaurant this winter, Marcus and other individuals experiencing homelessness have had to show a vaccination card to sit down for a meal and find respite from the cold weather. But, as Katie League, COVID-19 Program Manager at the National Health Care for the Homeless Council points out, the vaccination proof requirement can create barriers for unhoused individuals.
"We know that holding onto a plastic ID is something the population struggles with. A paper card makes it just that more complicated," League said.
Experts say public health measures undertaken to combat COVID-19, while necessary, sometimes have unintended consequences for homeless populations or do not consider their unique circumstances and the challenges they face.
"The federal program to ship at-home tests to residences, which is wonderful and very needed, speaks to the inequities faced by the population," said League. "There is an underlying way in which the homeless community has been left out of solutions that have been created during the pandemic."
In Chicago, the emergency shelter system has been under strain since the pandemic began. Many adult shelters have been operating with reduced bed capacity to ensure appropriate physical distance between shelter guests, a process known as decompression. Temporary shelters were opened early in the pandemic in other facilities, including unused Chicago Public School buildings and the Chicago Park District's Broadway Armory, to provide additional beds. But many of them have since closed.
"Shelter decompression is a necessary measure to ensure people experiencing homelessness are protected from COVID outbreaks," said Sam Carlson, Manager of Research and Outreach at the Chicago Coalition for the Homeless. "Chicago is seeing a huge demand in shelter beds, but the solution isn't simple."
"More shelter beds solve the immediate need of keeping people warm, but they don't solve the long-term need of housing," he added. "Increased investment in housing solutions may be the solution to this shelter demand issue."
Meanwhile, by some estimates, vaccination rates among unsheltered Chicago residents have lagged behind the general population. The Night Ministry has relied on the strong relationships it has with its clients to provide them with vaccination education and access over the past year. Still, unhoused individuals continue to face significant barriers to getting vaccinated.
"With all of the uncertainty they face, it's really hard to think about getting any type of health care, especially a vaccine that was known to cause some discomfort and the need to convalesce, and there aren't places to do it," said League.
Individuals experiencing homelessness may also be at higher risk of severe illness and death from COVID-19 due to underlying health conditions, lack of access to health care, and other factors. Carlson said there are some resources available in Chicago for those who do become infected with the coronavirus and to protect the most vulnerable.
"The City of Chicago has supported a medical respite center for people testing positive for COVID. For people at high-risk of COVID, the City also helps maintain hotel-based isolation spaces," Carlson said. But, he added, "capacity is very limited at each space."
The Night Ministry has experienced the impact of these limitations at its Youth Housing Programs. During the Omicron surge, the medical respite center stopped taking in people who tested positive for COVID but who were vaccinated and did not have significant risk factors. That meant The Night Ministry had to develop isolation protocols for each of its shelter programs to continue providing housing to vaccinated residents who contracted the virus while keeping other residents and staff as safe as possible. The agency has had to implement those protocols within at least one of its shelter facilities so far.
"Fortunately, we already had quarantine plans in place that we have employed all throughout the pandemic when there had been exposure, so we were able to provide isolation space when needed for those residents," said Betsy Carlson, Director of The Night Ministry's Youth Programs.
League said these kinds of challenges underscore the need to provide adequate and appropriate housing to everyone.
"Why do we have people living in shelters at all?" she said. "If we didn't have to have congregate settings, this wouldn't be something we would have to navigate around."