On Saturday morning, in the medical mecca some call Boston, Dr. Jessie Gaeta learned a valuable skill: the boola-boola knot. She used it to suspend a gray plastic basket holding a blood pressure cuff, a stethoscope and a thermometer from a rope inside a medical tent. Each of the 16 suspected COVID-19 patients in the tent, in bays separated by heavy white plastic walls, now has their own rigged vital signs kit.
“This is a new kind of medicine in Boston,” said Gaeta. “Tent medicine.”
It’s innovation born of necessity. About three weeks ago, as the coronavirus erupted in eastern Massachusetts, Gaeta grew increasingly anxious. How would her patients at the Boston Healthcare for the Homeless Program isolate themselves if they became infected? Where does someone quarantine if they don’t have a stable home?
Gaeta, nurse Maggie Beiser, program CEO Barry Bock and others called colleagues and scoured the web for answers. They heard useful tips but couldn’t find a model to copy.
So, “we made it up,” said Gaeta, with a giddy, sleep-deprived laugh. “We made it up.”
“It,” is a MASH style compound in a parking lot, flanked by a jail and a homeless shelter. There are two tents, trailers holding individual showers, a line of porta-potties and generators to power the 24/7 operation. One tent is for quarantined patients. It can hold 20 people who do not have symptoms but who’ve been in contact with someone who has COVID-19.
“If you had a co-worker who screened positive, you’d be asked to stay home for 14 days,” Beiser said. “We can’t do that in a shelter so we will be doing that here.”
The quarantine tent is scheduled to open this week.
The second tent can hold 16 patients who have symptoms, have been tested and need to be in isolation — or as close as they can get. Patients in this tent are assigned their own bathroom and supplies.
Both tents have a negative pressure ventilation system to reduce the spread of infection. They have heat, electricity in each patient bay, oxygen and basic life-saving equipment as well as naloxone in case of an opioid overdose. The tents have hand washing stations and lots of wipes. They do not have running water.
The transition from idea to plan took about two weeks. On Sunday, March 15, Gaeta got input from MASS Design Group, which has experience building hospitals in the developing world. Later that same day, Boston Health Care for the Homeless reached out to Boston Mayor Marty Walsh and a member of his team.
As Gaeta recalls, “the Mayor said 'let me call Suffolk,'” as in Suffolk Construction, “and Suffolk just sent a massive team over.”
Beiser says the first crew members arrived at 3:30 that next morning, in pitch dark.
Suffolk says it took about 25 crew members, including some city employees, a little more three days to erect the tents and infrastructure. Suffolk employees continued to help with fencing and finishing touches through Saturday morning.
“These folks are on the front lines. Wherever we can be helpful we want to be helpful,” said a Suffolk spokesman.
It’s not clear how much of the supplies and labor Suffolk will donate. Mayor Walsh says he’ll worry about any costs later.
“Our homeless population are some of our most vulnerable people out there,” Walsh said. “They’re a population of people I’m really concerned about because most people are not in the best of health.”
Dr. Josh Barocas, who specializes in infectious disease at Boston Medical Center, says it may be more important to control the spread of the coronavirus among homeless men and women because what affects one person could have a wide ripple effect.
Barocas, who worked on infection control planning for the tents, say they will relieve pressure on hospitals that are holding homeless patients who don’t need hospital level care, but don’t have a safe place to await test results.
“Every person we can isolate here and make sure that they’re safe and not spreading the disease, is one more emergency room bed, one more hospital bed that is open for someone else,” he said.
Boston Health Care for the Homeless has set up safe transportation to the tents from homeless shelters that are now screening guests for symptoms or exposure. There’s a mission control operation at the main BHCHP's office that is coordinating rides tied to available beds.
The isolation tent opened around 1 p.m. on Saturday and was full by Sunday night. Patients who need nursing care but not a hospital bed may go to BHCHP’s medical respite facility, the Barbara McInnis House, which has created a separate COVID-19 unit.
A few blocks away from the tents, a man named Jose says he hadn't heard about the makeshift facilities but knows they are needed to fight the pandemic.
“If it goes for a long time, I got a feeling it’s going to be real bad out here. It could spread fast,” said Jose, who declined to give his last name out of fear doing so might hurt his job prospects.
There are no confirmed coronavirus cases in Boston’s homeless population yet, but doctors are awaiting test results on 70 patients.
This segment aired on March 23, 2020.