Updated March 30, 2020

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 by droplets from an infected person’s coughs or sneezes 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 cough/sneeze droplets landing on them or from the sick person coughing or sneezing into their own hand then touching an object.

Prevent introduction of illness

  • Place signage in visible locations with these messages:

    • Know the symptoms of COVID-19

    • Proper hang and cough hygiene

  • 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 COVID-19

  • Make sure all volunteers and staff stay home if they feel ill.

  • Advise staff to check for symptoms of respiratory illness such as cough or fever before reporting to work each day. 

  • Advise staff to notify someone if they become ill while at work and to leave immediately.

Hand sanitizer and hand washing

The most important measure for preventing the spread of pathogens is effective hand hygiene. 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: 

  • Clean and functional hand washing stations

  • Soap

  • Paper towels 

  • Trash receptacles 

  • Alcohol-based sanitizer

Options for individuals with coughing illnesses

Please use the Decision Tree for Respiratory Illness, dated 3-29-2020, to identify if someone is a good candidate for entering a shelter program or for remaining in the shelter. People with a temperature 100.4 degrees F or with observed new cough or worsening chronic cough should be moved. (See decision tree for thermometer recommendations). 

Mask 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.

Mask guidance

Outside of a healthcare setting, masks are most effectively used by sick individuals to prevent spread of their secretions and cough droplets to others.

Staff and volunteers

  • Assure staff and volunteers do not come to work sick. Any staff or volunteers who become sick at work should be sent home. 

  • Staff should wash or sanitize hands frequently, and try not to touch their face. 

  • Staff should wear gloves when touching personal belongings of guests.

  • Healthy staff should not wear masks, unless spending extended time in an area designated for guests with coughs or providing direct care to sick guests. 

  • Sick staff and volunteers should stay home until they are well.

  • 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 who are staying in the shelter.

Guests

Staff should identify guests who have a new, worse, or different cough. These guests should wear masks to contain secretions/droplets. Staff can review correct mask use in order to assist guests.

Use a mask correctly

  • The mask should fit snugly over the face.

  • The colored side of the mask faces outwards.

  • The strings or elastic bands are positioned properly to keep the mask

  • firmly in place.

  • The mask covers both your nose and mouth.

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

Watch this video about how to wear a mask correctly: https://www.youtube.com/watch?v=9VbojLOQe94

Social 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 social 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.  

Common areas

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.

In common areas, separate individuals with possible respiratory illness symptoms from those without symptoms.

Where space allows, maintain daytime common area space separation for coughing guests and non-coughing guests, like sleeping areas. Guests who are coughing may occupy shared space, such as restrooms, if masked.

Sleeping arrangements

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. 

  • Create barriers between beds using foot lockers or curtains.

Arrangements for an ill person

  • An ill person should be isolated in a private space predesignated by the facility, and cared for by predesignated staff. 

  • If only shared rooms are available, consider housing the person who is ill in a space with the fewest number of other residents.

  • House older adults, people with underlying medical conditions, or people with disabilities as far away as possible from someone who is ill.

Meal service

Since individuals with a cough need to unmask to eat, individuals with known respiratory symptoms should eat with maximum spacing from others, and in a place with maximum ventilation, including outside if necessary or offering meals to go. 

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

  • Add sneeze guards to shared condiment locations.

Exclusion

Strongly consider asking a guest to leave only if both of the following are true:

  • They are coughing, AND

  • They are unwilling to use a mask 

Cleaning

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.

Resources

CDC Hand Hygiene Posters

English: https://www.cdc.gov/handwashing/pdf/Handwashing-Middle-School-8x11-p.pdf

Spanish https://www.cdc.gov/handwashing/pdf/wash-your-hands-poster-spanish-508.pdf

Chinese: https://www.cdc.gov/handwashing/pdf/wash-your-hands-poster-chinese-508.pdf

CDC How to Wash your hands poster

English: https://www.cdc.gov/handwashing/pdf/wash-your-hands-poster-english-508.pdf

Spanish: https://www.cdc.gov/handwashing/pdf/Handwashing-Middle-School-SPANISH-8x11-

p.pdf

CDC Clean Hands for 20 seconds poster

English: https://www.cdc.gov/handwashing/pdf/HH-Posters-Eng-Restroom-508.pdf

Spanish: https://www.cdc.gov/handwashing/pdf/HH-Posters-Spa-Restroom-508.pdf

Cover your cough poster