A recent round of coronavirus testing in Boston's homeless population is raising concern about asymptomatic spread of the coronavirus. And it's leading both advocates and public officials to call for comprehensive testing in the homeless community.
The testing happened a week and a half ago at Pine Street Inn.
Up until that point, Boston Health Care for the Homeless Program (BHCHP), which gives medical care at the city's shelters, only had enough kits to test people who were showing symptoms of the virus.
They discovered a small cluster of positive test results among people staying at Pine Street Inn. So they pushed to test everyone entering that shelter. The state Department of Public Health gave them the kits.
Of 397 people tested, 146 — or 36% — came up positive, BHCHP President Dr. Jim O'Connell says. But another finding jumped out at clinicians.
"Every one of these folks were asymptomatic. None of them had a fever, and none of them reported symptoms," O'Connell explains. "So the usual screening tool we had been using in order to see who should be tested turned out to be essentially useless for us. So this was stunning to us. We were not expecting that."
When the results came back, BHCHP helped Pine Street Inn immediately move people who had tested positive out of the shelter.
Some of it happened in the dark of night — shelter workers and doctors ferried people to a temporary isolation facility at an old Brighton hospital and a COVID-19 isolation wing at Barbara McInnis House, the homeless health care program's respite facility in the South End.
Once that initial frenzy quieted down, O'Connell and his colleagues zeroed in on what the test results indicated to them: that everyone in every homeless shelter should be tested.
"My big concern is that we don't know right now the extent of the virus in any of these large shelters anywhere in the country," O'Connell says. "We realize that there's apt to be a whole lot of asymptomatic spread in these shelters ... We should be protecting those people."
"You have to go through the painful process of doing this broad-scale testing so that it doesn't get worse," says Pine Street Inn President and Executive Director Lyndia Downie.
Downie explains that shelters need to be able to move everyone who tests positive into isolation, spread out and monitor the population that tests negative, and start moving people back into shelters once their two-week isolation is over.
"If there [were] enough tests, we wouldn't be having this conversation," Downie reflects. "We're trying hard to do what we can to raise the issue and to try and get some movement on it. But it's a challenge. There's no question about it."
O'Connell brought his concerns to the Centers for Disease Control and Prevention. He says the federal agency is now "actively looking into" what was discovered in Boston. And he and other advocates have urged action from the state Department of Public Health.
The City of Boston's Chief of Health and Human Services Marty Martinez points out the DPH has to balance resources across Massachusetts, but he says the state is listening regarding the need for more coronavirus testing in the homeless community.
Starting tomorrow, Martinez says, 200 people will be tested at the men's shelter on Southampton Street run by Boston Public Health Commission.
"We partnered with the state to be able to lift up the fact that we also wanted to do universal testing in some manner within our shelters," Martinez says. "Similarly, the way we found out what we needed to find out at Pine Street, we want to find that out also for our city shelters. The state's just as committed as we are at understanding what's happening with our vulnerable populations."
WBUR asked DPH about coronavirus testing in the homeless community. So far, the agency hasn't commented.
Since the focused testing at Pine Street Inn, another few hundred people who are homeless in Boston have been tested, for a total of 946. Overall, 26% have been positive, according to the city and O'Connell. One person who is homeless is known to have died from COVID-19, and a handful have been hospitalized with serious complications. About 50 test results are pending.
Out of the people from Pine Street Inn who were isolated after positive test results, O'Connell says, one ended up in the hospital and some developed mild cold symptoms.
By next week, officials expect more than half of the city's adult shelter population will be tested. That shelter population ranges from about 1,500 to 1,800 people on any given night, according to the public health commission.
O'Connell says he hates to see any more time lost in the effort to test everyone.
"We feel it's incredibly urgent — emergent to do that — because each day that we don't know of someone who's asymptomatic, they are spreading that virus to two or three other people and it becomes an exponential growth," he explains. "And the sooner we stop that, the more likely we are to be able to get control."
The city and state have worked together to set up more than 900 isolation beds for people who are homeless. So far, the majority of those are not in use. Without universal testing, many people who need to be isolated in those beds may not be.
This segment aired on April 15, 2020.