How Bethesda Project’s Church Shelter Program is responding to COVID-19

In Bethesda Project’s Church Shelter Program (CSP) for chronically homeless men, guests and staff are responding to COVID-19 as a community, using what the World Health Organization (WHO) has called community-based public health surveillance.

In the field of public health, community-based surveillance (“CBS”) is a process of giving people the tools and information they need to monitor health in their community, quickly identify suspicious health-related events, and respond to them.

CBS was used extensively in Sierra Leone during the West African Ebola outbreak during 2014-15 to help identify new cases of the disease. The spread of COVID-19 in Philadelphia is an equally urgent, all-hands-on-deck moment — and every member of our shelter community has an important role to play.

When the risk of COVID-19 spreading in emergency shelters became apparent, Bethesda Project’s senior leadership immediately consulted resources provided by the US Centers for Disease Control and Prevention (CDC). After reviewing the CDC’s guidelines for infection control, pandemic influenza, and COVID-19 in shelters, senior leadership adapted them to create our own COVID-19 prevention, assessment, and management plan.

After CSP staff reviewed the plan, we held community meetings at each of our three shelters to review it with our guests. Here’s what we talked about in those meetings.

Minimizing the risk of COVID-19 in shelter

First, we discussed our plan to minimize the risk of COVID-19 in shelter. We told guests we would be temporarily halting all new admissions into shelter in order to prevent crowding and in order to abide by CDC guidelines for having six feet of space in between beds.

We directed our guests to position their sleeping mats head-to-toe, or in whichever way would help them avoid coughing or sneezing on each other during the night (and potentially spreading COVID-19). We also directed them to sleep in the same spot each night so that staff could create a map of where each person sleeps.

We explained that in the event that a guest developed a presumptive case of COVID-19, this map would enable us—and the Department of Health — to determine which other guests were at greatest risk of contagion.

We reassured guests that we would ramp up our provisions of cleaning and sanitation supplies — including bleach, latex gloves, hand soap, hand sanitizer, paper towels, and a variety of products for cleaning floors, toilets, and sleeping mats.

We also spoke with all guests, but especially those who step up most often to complete household chores, about regularly cleaning every hard surface and every common space.

Clinical aspects of community-based public health surveillance

Second, we discussed our plan for the more clinical aspects of community-based public health surveillance. Guests and staff reviewed the CDC guidelines about what signs and symptoms of COVID-19 all people should be aware of.

We asked our guests to be attentive to their own health, but also to look out for the other members of the shelter community. We asked guests to immediately inform staff if they began feeling unwell or if they noticed someone demonstrating symptoms of COVID-19.

We informed guests that if someone began showing symptoms of COVID-19 overnight, he would be asked to immediately put on a facemask and move to a separate room in the shelter. We acknowledged that this kind of action might seem excessive or disruptive, but was being done out of an abundance of caution and in order to minimize risk of exposure to the virus.

We told our guests clearly and plainly: This virus is serious, and we need everyone to be attentive.

We also clarified that when shelter admissions resumed, all new referrals would be screened for symptoms of COVID-19 and have their temperature taken in order to avoid sending a symptomatic individual into shelter.

We are a community

Third, and most importantly, we reminded our shelter guests that we are a community.

We told them “You are not alone in this.” We validated their fears, their concerns, and their doubts. We acknowledged our own fears, concerns, and doubts. But we also made sure to reaffirm that while this situation is new, scary, and changing daily — even hourly — we are all in it together.

For people experiencing homelessness, emergency shelter becomes their home and the other people residing there, or working there, become their family. At Bethesda Project, our mission is to be family with those who have none — and this is true even during a pandemic.

The risk of COVID-19 spreading in shelter is very real and very serious. Our staff know this. Our guests especially know this.

But what we also know is that at times like these, distinctions like “staff” and “guest” don’t quite hold up against the weight of this moment.

We are in this together, as one family, and we will get through this together.