Perlia Bell, an outreach worker with JOIN, talks to a woman about services after handing her gear.

Interim guidance updated May 20, 2020

Federal, state and local health officials are working with communities across the region to protect their residents from the spread of the novel coronavirus COVID-19. 

Local officials have also been working to protect people who are experiencing homelessness in particular, whether in congregate shelters, where close quarters can increase the risk of passing illnesses, or whether they're surviving without shelter.

At the same time, so many of our neighbors who've been experiencing homelessness have already been stepping up, checking on one another, and taking steps to protect and watch out for each other.

Even though many people will have only mild symptoms from COVID-19 and recover without medical intervention, it's also clear that some people — those who are older or have underlying medical conditions, including many people experiencing homelessness — face a higher risk of serious symptoms and need support from everyone in the community.

Following these steps can help protect vulnerable community members and lessen the chance of introducing or spreading diseases like COVID-19.

 COVID-19 information card for street outreach (English) (163.01 KB)

 COVID-19 information card for street outreach (Spanish) (488.35 KB)

Basics about how COVID-19 is spread

COVID-19 or novel coronavirus has symptoms similar to the flu. People with symptoms can have a cough, shortness of breath or difficulty breathing, muscle aches, headache, chills, or fever.

The virus spreads mainly from person-to-person, between people who are in close contact with one another (within about 6 feet). This happens by droplets from an infected person’s coughs or sneezes getting into another person’s mouth, nose, or lungs. 

If a well person touches a surface, object, or a sick person’s hand that has the virus on it from the sick person’s cough/sneeze droplets, the virus can infect the well person when they touch their own mouth or nose. 

Most people recover without medical intervention and have mild symptoms.

But certain people do face a higher risk of having more severe symptoms, including pneumonia. Those folks tend to be older, have weakened immune systems or have underlying medical conditions (things like heart or lung diseases).

COVID-19 is new, but the work to address it isn’t. It builds on the work and planning already in place to address flu and measles and shigella.

Steps to limit the spread of infections

  • Hand-washing is important, but we recognize that access to hand-washing facilities is limited for folks living without shelter. Sanitizer is also effective.

    • If someone is sick, it will help them not spread germs from their lungs or nose to other things they touch. If they are well, it will help them not pick up germs from things they touch and spread them to their mouth, nose or eyes.
  • Folks should do what they can to avoid touching their noses, eyes, and mouths. 

  • Cover coughs: Any cough, even if someone otherwise feels well, should be covered — not with someone’s hands but by coughing into an elbow, a mask or a bandana.

  • As much as possible, encourage those you’re working with to limit sharing personal items, particularly cigarettes, food, phones, utensils and other items.

  • Outreach workers and volunteers should not work when they are feeling sick and should not spend time with potentially vulnerable people. 

Hygiene and cleaning

Use disinfectant wipes that say “kills human coronavirus” on the back. Follow the instructions on the label.

Most important is to not dry off whatever is wiped with sanitizer or a wipe. Whatever is wiped will need to stay wet for the amount of time listed on the label. This step is important because that contact time is what is required to kill the germs. 

Wipes can be used to clean high-touch items like phones and other surfaces.

Medical Masks and Cloth Face Coverings 

Recent studies suggest some people with COVID-19 never show symptoms and others may transmit the virus before they show symptoms. A face covering can block droplets from someone coughing, sneezing, or even talking before they know they are ill.

The State of Oregon provides detailed Mask and Face Covering Guidance for Business, Transit, and the Public. It is recommended that people wear face coverings when they must be within 6 feet of each other, to the extent possible. The guidance acknowledges that some people can't wear a face covering due to health conditions, age, or differential ability. Children under 2 years old should not wear face coverings

If service providers have paper medical masks in supply from an earlier purchase, preference would be to use those to mask anyone who becomes sick with symptoms associated with COVID-19. 

People who are sick and coughing should have access to, and wear, medical masks or cloth face coverings. These will help contain droplets that can spread the novel coronavirus. Outreach workers should identify those who have a new, worse or different cough. 

Medical masks

Medical masks are only effective when they are used properly. The following rules must be followed for correct mask use:

  • The colored side of the medical mask faces outwards.

  • Any strings or elastic bands should be positioned properly to keep the medical mask firmly in place.

  • The medical mask should fit snugly over the face and cover both your nose and mouth.

  • The metallic strip should be molded to the bridge of your nose.

When taking off a medical mask, fold it in half, inside in, and throw it away so the germs don’t spread. 

Watch this video (https://www.youtube.com/watch?v=9VbojLOQe94) about correct medical mask use.

Cloth face coverings

If someone doesn’t have a medical mask, a bandana or other cloth face covering can contain their droplets from coughs, sneezes and talking. Here are some tips for creating and wearing face coverings:

Setting up a campsite to limit the spread of infection

As much as possible, people who are camping should work to separate individuals with respiratory illness symptoms (coughing, fever, shortness of breath or difficulty breathing, muscle aches, headache, or chills) from those without. This will stop the sick person’s respiratory droplets from getting into a well person through the air.

This is helpful even if coughing people are wearing masks or face coverings.

Outdoors, people can space themselves out. Ideally, there would be about six feet between a well person and a sick person. Again, as much as possible, people who are sick should avoid sharing a tent with those who do not have symptoms of respiratory illness (like coughing). 

If space is constrained, then the guidance that Public Health has provided shelters and other congregate spaces can be helpful. Create a six-foot buffer to separate those who have symptoms of respiratory illness from those who do not.

Remind people not to share bedding and clothes and other personal items, especially with someone who has those symptoms and has been coughing on their blankets and clothes.

As much as possible, people who are coughing should try to keep their tissues, bedding and worn clothes and trash separate and contained from refuse produced by other campers.

Pets

The U.S. Centers for Disease Control and Prevention says it does not have evidence that companion animals, including pets, can spread COVID-19 to people or that they might be a source of infection in the United States. But there isn’t much information on COVID-19 and pets. 

To be safe, the CDC has recently recommended that we treat pets as we would other humans – do not let pets interact with people or animals outside your family or group. As much as possible, keep pets away from people who are actively sick. 

Caring for someone with respiratory symptoms

Many people with COVID-19 can receive the care they need without medical intervention. People are probably most contagious when they have symptoms like cough and fever.

Someone who’s mildly sick may have the following symptoms: coughing, sneezing, sore throat, a fever and aches.

Offer care as if the person has the flu:

  • Ensure they rest. And offer non-prescription medicines, like acetaminophen (Tylenol) and ibuprofen (Advil) for symptoms like fever and aches.

  • Keep the sick person in a separate, well-ventilated space and apart from other people and pets as much as possible. If that’s not possible, keep a distance of at least six feet from people who are well. People who are sick should avoid sharing a tent with people who are well.

  • Avoid sharing bedding and clothing if someone’s been coughing or sneezing on them. 

  • A sick person who is coughing or sneezing should wear a medical mask or cloth face covering. If that person cannot wear something to cover their mouth and nose, then the person caring for them should wear a mask or face covering or cover their nose and mouth when close to the ill person (within 6 feet).

When to seek additional medical care 

Testing for COVID-19 remains limited and has primarily been reserved for people who are already in hospitals with serious respiratory symptoms.

Generally, someone should seek care for their symptoms only when they’re seriously sick, and through the usual means they would access medical care.

Someone should get medical help right away if they develop some of the following symptoms: difficulty breathing, pain or pressure in the chest or abdomen, or if they’re unable to drink or keep liquids down.

An ambulance will come like usual when someone calls 911. The paramedics will be wearing extra masks and coverings to keep themselves healthy so they can keep working.

If someone knows someone who needs medical care but won’t seek it, they should urge them to do so — ask them to wear a mask or face covering and help them stay at least 6 feet away from others. 

Guidance for caregivers

The risk of catching a virus from a sick person is highest for their direct caretaker. But others who share space with a sick person should also take the same precautions to limit risk.

First, folks should check their own health regularly, as best they can, to watch for the development of similar symptoms.

Caretakers and close contacts should always follow guidance around hand-washing and sanitizer, and touching their faces — particularly after sharing space with the ill person and handling their belongings.

Properly clean all frequently touched surfaces on a regular basis, using everyday cleaning products.

Avoid sharing personal items, utensils, towels or bedding with an ill person.

If laundry access is available or is being provided, items from a sick person and someone who’s not showing symptoms can be shared. But to avoid germs, folks should avoid shaking dirty laundry or “hugging” dirty laundry to their chests to carry it.

Additional questions

What if someone asks why they should take these precautions if they feel well right now?

It’s true that many people who contract COVID-19 may never develop serious symptoms or may never even know they had it in the first place.

It’s also true that the fundamental reality of trying to survive outside, day in and day out, all year, in flu season and out of flu season, in cold weather and out of it, is life-threatening and deeply traumatic and challenging all on its own. 

It’s important to acknowledge that.

But because some people do face a higher risk of serious symptoms from COVID-19, including some of the folks you might be camping with or spending time with, we’re asking everyone across the community, no matter where they live and who they are, to do their part and do whatever they can to limit the spread of infection.

We don’t want folks to panic, but we do want everyone to be clear about the risks for people who are vulnerable.

We also know that so many people have already been stepping up, checking on their neighbors and campmates, taking steps to protect and watch out for one another.

They have been taking those steps all on their own, caring for another with a deep sense of community, without waiting for official guidance. That agency and initiative is powerful and it will continue to be important in the days to come.

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