Shelters provide vital spaces for unhoused members of the community to rest, sleep and get a meal. People without permanent shelter may have medical conditions, substance use or mental health challenges exacerbated by homelessness, and may not have adequate access to hygiene facilities. These conditions make our unhoused residents particularly vulnerable to communicable diseases.
The follow guidance aligns with recommendations for homeless shelters from the Centers for Disease Control and Prevention.
How COVID-19 spreads
The virus spreads mainly between people who are in close contact with one another (within about 6 feet). This happens when droplets from an infected person who coughs/sneezes/talks get into another person’s mouth, nose or lungs.
There is also a risk if someone touches a surface or object that has the virus on it and then touches their own mouth, nose, or possibly their eyes. Objects or surfaces can become contaminated with virus from droplets landing on them or from the sick person coughing or sneezing into their own hand and then touching an object.
Prevent the introduction and spread of illness
- Place signage in visible locations with these messages:
- Know the symptoms of COVID-19
- Proper hand washing
- Inform visitors that they will not be allowed to enter the facility if they are ill.
- When possible, facilities should use their virtual communication channels to inform prospective visitors of these rules before they travel to the facility.
Staff and volunteers
- Assure staff and volunteers do not come to work sick. “Sick” is purposefully defined at a very low threshold: anyone who feels unwell. This could include fever/sweats/chills, cough, shortness of breath, sore throat, body/muscle ache, fatigue, gastrointestinal symptoms, congestion/sneezing not caused by allergies. Any staff or volunteer who becomes sick at work should be sent home immediately.
- Staff and volunteers with symptoms such as a cough, shortness of breath or difficulty breathing, muscle aches, headache, chills, or fever should stay home. See CDC’s list of COVID-19 symptoms.
- Staff should wash or sanitize hands frequently, and try not to touch their faces.
- Staff should wear face coverings, unless an accommodation for people with disabilities or another exemption applies.
- Staff should wear gloves when touching personal belongings of guests.
- Staff and volunteers at high risk of severe COVID-19 (those who are older or have underlying health conditions) should not be designated as caregivers for sick clients.
- The CDC recommends that employees and volunteers who have been out sick (regardless of whether they were tested for COVID-19 or not) should only return to work when:
- 24-hours have passed with no fever—without the use of medicine to reduce fever, and
- Other symptoms have improved, and
- At least 10 days have passed since symptoms first appeared.
- The local health department will investigate who may have been exposed to the sick person and make sure they receive the right information to watch carefully for symptoms and self-isolate if symptoms develop.
Hand sanitizer and hand washing
Keep hand sanitizer (minimum 60% alcohol) available near points of entry. Washing with warm water and soap is as effective. Promote both.
Make sure that you have adequate supplies for good hand hygiene, including:
- Hand sanitizer (minimum 60% alcohol) available near points of entry.
- Clean and functional hand washing stations
- Paper towels
- Trash receptacles
Routine symptom screening of shelter guests
Please use the Decision Tree for Respiratory Illness, dated 4-26-2020, to identify if someone is a good candidate for entering a shelter program or for remaining in the shelter.
All new prospective shelter guests should be screened prior to entry, and all current shelter guests should have a symptoms check at minimum once a day.
Anyone observed with a new cough or worsening chronic cough should be moved to a medical motel. They do not need a temperature check.
Provide a face covering or mask for the sick person and request them to isolate at least 6 feet from others while you call the medical motel social worker at 503-318-9262.
People who are not observed with a new cough or worsening chronic cough should be asked if they feel feverish. If a guest affirms feeling feverish, check their temperature.
If there are concerns about a guest’s ability to perceive feeling feverish or their ability to communicate whether they feel feverish, check their temperature.
No-touch thermometers are available from the Joint Office of Homeless Services as needed. Disposable thermometers are also permissible. Facilities may also use their own discretion and allow guests to take their own temperatures, so long as staff is careful to disinfect any items touched by more than one person.
Since taking a temperature involves standing closer than 6 feet, it is preferable to ask the guest to wear a face covering or mask for this process.
Anyone with a temperature of 100 degrees F or greater should be moved.
When tracking outcomes as guests are screened, use the following categories: “screen negative” (meaning no symptoms) or “screen positive.” Do not note the actual temperature or symptoms. This is personal health information and should not be documented.
Face coverings guidance
Recent studies suggest some people with COVID-19 never show symptoms and others may pass the virus to others before they show symptoms themselves. 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 Statewide Mask, Face Shield, Face Covering Guidance. Face coverings are required in Oregon for everyone 5 and older, in all indoor public spaces and also outdoors when you cannot keep 6 feet from others. The state’s mandate acknowledges that some people can request an accommodation due to health conditions, age, or differential ability.
Masks and face coverings should fit snugly to cover the mouth and nose.
We recognize that even in shelters that are able to provide six feet of distance between people who are sleeping, it may be difficult to ensure routine maintenance of six feet of distance between guests and between staff and guests. There may be shelters where individuals share smaller cooking, eating, and hygiene areas.
In those situations, it is recommended that both staff and guests wear face coverings to the extent possible. The state’s guidance acknowledges that some people may not be able to wear a face covering due to health conditions, age, or differential ability. Children under 2 years old should not wear face coverings.
It is appropriate to wear reusable face coverings. However, it is important to follow CDC guidance on the proper use of reusable face coverings and medical masks.
Individuals wearing reusable face coverings should refrain from touching the outside of the covering, as this may transfer the virus to the wearer’s hands. It is important to remove and replace your face covering if someone coughs, sneezes or otherwise has likely caused droplets to be deposited on it. Reusable face coverings should be machine washed.
Wearing a face covering is NOT a substitute for physical distancing. It remains essential that everyone maintain 6ft of distance from each other whenever possible.
The Joint Office and shelter operators have been providing face coverings for people experiencing homelessness, whether in shelter or not, as part of their shared COVID-19 response. Multnomah County is collecting cloth face coverings for distribution to residential congregate settings and other high-need groups.
Physical distancing in shelter settings
The virus that causes COVID-19 is most likely to be transmitted to someone within six-feet of the infectious person. Staff and guests should practice physical distancing (6 feet of space) from others whenever possible.
Staff and guests should reduce face-to-face interactions with others. Use bulletin boards, posters, brochures, emails, and phones where possible. Slide information under someone’s door.
In common spaces and transit, create distance between individuals in these ways:
- Schedule staggered use of common spaces
- Avoid activities that bring residents or staff close together.
- Stagger bathing schedules
- In transport, limit people per trip and increase space between passengers.
Shelters will likely need to reduce their census to improve spacing in sleeping areas to follow these recommendations:
- Create at least 6 feet of space between beds.
- Space out units or dorms, when possible.
- Arrange beds so individuals lay head-to-toe or toe-to-toe.
Since individuals need to unmask to eat, maximum spacing from others will be important to consider, as well as hygiene.
Be diligent in following hygiene and food safety rules about keeping food covered, not using personal utensils in shared containers, washing hands before eating and handling shared objects, and cleaning kitchen surfaces and dining areas between use.
Also consider these recommendations:
- Stagger mealtimes.
- Stagger scheduled use of shared kitchens.
- Mark off sections on the floor in 6-foot increments for lines to collect food
- Have meals already prepared on separate trays or bags
- Maximize ventilation
- Include eating outside if necessary, or offering meals to go
- Add sneeze guards to shared condiment locations.
A person who is identified feeling feverish or with new or worsening cough should use a paper medical procedure mask or cloth face covering and be separated from other shelter guests until they are able to be relocated to one of the motel shelters for people who are symptomatic. It is appropriate to exclude an individual who refuses to mask and/or to be relocated.
Increase frequency of routine cleaning and disinfection, emphasizing cleaning and disinfecting frequently touched objects and surfaces such as water coolers, desks, countertops, doorknobs, computer keyboards, faucet handles, phones and toys.
Use standard procedures for cleaning and disinfecting, and use an Environmental Protection Agency (EPA) registered disinfectant with a claim for human coronaviruses.
Custodial or EVS staff should follow the disinfectant manufacturer’s instructions for use, including:
Using the proper concentrations of disinfectant.
Allowing required wet contact time.