A COVID-19 outbreak at a homeless shelter

Sunday, November 22, 2020

For most in health care this would be a major stress – an outbreak of COVID-19 at a homeless shelter. This is the story of just such an event in Durham, NC, an outbreak that called for a major multidisciplinary response.

Julia Gamble was prepared. Julia is a nurse practitioner with the Duke Outpatient Clinic (DOC) where she participates with a multidisciplinary team serving patients who are frequent visitors to the ED. Apart from DOC clinic Gamble is a director of Durham Homeless Care Transitions which is a transitional care management service for homeless persons with ongoing medical issues post hospital admission. Her skill set was instrumental in this positive outcome of a community homeless shelter impacted by the coronavirus pandemic.

The COVID outbreak as told by Julia Gamble, NP

Managing COVID-19 is tough for anyone but crowded conditions in homeless shelters and a population that is poor and in ill health creates a situation ripe for an outbreak. In March 2020, preparing for such an outbreak, a team of community leaders from Lincoln, DOC, mental health (Alliance Health), the county and the city came together to develop a plan. 

17 positive COVID results in 2 days

In October the community's hard work came in handy. A COVID outbreak was discovered at Urban Ministries of Durham. The staff learned on Monday, October 26, of a positive COVID test. This followed an October 16 positive test of a resident who happened to have a job working at a nursing home. By Wednesday, October 28, testing results were identified positive for 17 residents.

[Photo of Drs. Feigal and Turner]

Altogether 45 residents were tested that night at a site on the campus of Urban Ministries, testing led by Dr. Jacob Feigal and his team from the Healthcare for the Homeless Clinic of Lincoln Community Health Center. These testing events are continuing every Wednesday with the support of resident and faculty volunteers from the internal medicine, medicine-psychiatry, and family medicine programs.

Dr. Feigal’s expertise has been invaluable to the Durham Homeless COVID Response team. Feigal completed residency at Duke in the combined internal medicine and psychiatry program, and primary care training at the DOC clinic. He is now a faculty member in the Department of Psychiatry and Department of Medicine. 

Testing and hand-off to isolation

Next, Dr. Nick Turner, with his expertise as a specialist in Infectious Diseases, stepped in to advise the group on COVID testing in the homeless population. He contributed his experience with high risk populations as a faculty member from the Duke Division of Infectious Diseases. In a previous response to a positive case at Durham Rescue Mission, Dr. Turner led surveillance testing events, and later, in coordination with Dr. Jacob Feigal, held testing events at Urban Ministries.

Managing isolation

Julia, through her work with Durham Homeless Care Transitions, a service supported by the city and county, supervised the isolation process for the residents. Daily check-ins included management of medical and mental health needs, including coordination with outpatient psychiatry and substance abuse treatment programs and the Department of Public Health. The rapid isolation of shelter residents resulted in control of the outbreak, as follow-up testing revealed only 1 case in the following 2 weeks.

"Homeless people are socially complex because of homelessness but also can be ill medically, psychiatrically, and cognitively and really require engagement from all those areas.”

  Julia Gamble, NP

At this date we know that all the patients recovered. It’s these challenges that our health care professionals rise to serve and for which we are extremely grateful.