A Hard Year for Those Without Shelter: Death Rates Rose and Pressures Increased for the Homeless During the Pandemic

by Ashley Archibald

In a video posted to YouTube, a woman in a blue surgical mask stands in the corner of a walled-off yard, a puffy, slate gray jacket zipped against the cold. To her right is a table draped with a white cloth holding 19 votive candle holders. Slowly, deliberately, the woman reads a list of names.

"Azhane Mitchell."

"Charles Lingenfelter."

"Christopher Mann."

In the silence following each name, a man lights a candle.

Over the course of the 51-minute recording uploaded by The Church of Steadfast Love and Friends on Jan. 8, individuals read the names of homeless people who died in 2020 in King County, people whose passing might otherwise receive little formal recognition. Sons and daughters. Mothers and fathers. A child in the womb who would never take its first breath.

In a year marked by death and suffering, people experiencing homelessness found no respite. Women in Black, a group organized by homeless women to honor those who lost their lives outside or by violence throughout the year, stood vigil for a record 140 people in the first 11 months of 2020. December deaths, which had not yet been released, will push that number even higher. Even if 140 were the final tally, it is still a 25% increase over the 112 people that Women in Black stood for by the end of 2019.

None of those people died of known COVID-related complications, although the available data makes the determination difficult. A countywide online dashboard reports 18 coronavirus-related deaths, which Public Health — Seattle and King County references. It uses a wider definition of homelessness than data reported through the Health Care for the Homeless Network (HCHN) each month. That report is pulled from data held by the Medical Examiner's Office, which does not see the majority of deaths, regardless of housing status.

Women in Black, HCHN, and a countywide dashboard use different criteria or underlying data to compile their respective lists, which is likely why the dashboard counts 18 deaths attributable to the coronavirus among people experiencing homelessness while the other two figures do not.

The impact of the coronavirus on the homeless population is more than its death toll — it's the ancillary impacts of the pandemic that advocates say create higher rates of stress, anxiety, mental health concerns, and even deadly violence.

"There is great stress all around, great stress to society," said Anitra Freeman, who stands with Women in Black. "Violence is rising all over. You have more 'deaths of despair,' which means murders, suicides, and overdoses."

The pandemic has been hard on housed people. The disease cut down millions across the globe directly and more indirectly as overburdened health care systems failed to forestall preventable deaths. Shutdowns meant to slow the spread of the virus created deep economic pain, forcing millions in the United States out of work. Local news outlets showed images of lines at food banks stretching into the distance. Alcohol sales spiked as more people reported mental health concerns, anxiety, and isolation. Homicides in Seattle jumped 61% to 50 murders in 2020, according to the Seattle Police Department. In the waning days of 2020 and first week of 2021, the Medical Examiner's Office identified 42 suspected or confirmed overdose deaths, the highest ever documented in a two-week period in the county.

But for people already at the margins of society, sleeping rough or in congregate shelter, the fallout from the coronavirus ripped away even small vestiges of comfort and normality.

While housed people hoarded toilet paper in the early days, homeless people lost the ability to use restrooms altogether. When employees began working from home, those who relied on foot traffic in the downtown core for panhandling or shoe shining lost a source of income. Where those privileged with a roof chafed under edicts to shelter in place, those without were caught in an impossible bind — risk congregate shelter and disease or the dangers of the streets.

Even efforts to make shelter safer with additional precautions such as masks and extra space between guests created barriers that kept some of the most vulnerable out in the cold, Freeman said.

"The people who are hardest to serve, who are people who are the most vulnerable and most likely to die, are left on their own," Freeman said.

People experiencing homelessness already live hard and die young.

Studies have found that people experiencing homelessness die at 50, on average, decades less than their housed counterparts. It is physically taxing to exist outside, living off of less healthy foods, lacking regular access to medical care, constantly battling the elements or other people. The accumulated effects wear on the body in a process called "weathering," in which a relatively young person exhibits the medical maladies of a person two decades or more their senior.

That happens under normal circumstances. But 2020 was anything but normal.

Libraries and day centers shut down, leaving people few places to go during the day. Businesses closed and with them access to restrooms and the ability to wash one's hands. Trash accumulated and with it attendant health impacts. At one point, an encampment in Ballard Commons Park found itself with two potential outbreaks — the coronavirus and hepatitis A. One of the few truly accessible public restrooms in the city, the park's self-contained Portland Loo, was out of commission for roughly a week for a deep cleaning because of hepatitis A concerns, and health workers visited the park to offer vaccinations.

As outreach workers struggled to support their clients to get through harsher circumstances, service providers tried to adapt their offerings to meet people's needs while keeping clients and staff safe.

At times that was a frustrating balance to strike, said Colleen Echohawk, executive director of Chief Seattle Club, an organization that supports urban Native people.

For example, early information about coronavirus prevention stressed frequent handwashing and sanitization on top of social distancing and masks. With day centers, libraries, and restaurants all shut, however, there were few sinks to access at all, much less for two full renditions of the "Happy Birthday" song.

"That is just a really terrible thing to have to do to someone," Echohawk said. "And it's traumatizing for those of us who are providers too, to constantly message that and then say, 'OK, good luck.'"

Chief Seattle Club set up a handwashing station outside of its building in Pioneer Square to alleviate some of the need. It also brought on new staff to help people in domestic violence situations and ease reentry from incarceration. Certain inmates were released to reduce crowding and the threat of the virus in jails and prisons but reentered into a society without many employment opportunities and less ability to lean on family and friends.

The Club adapted, but the inability to gather hurt services centered around community, culture, and tradition, Echohawk said, even as the coronavirus is attacking all three.

Native people are more likely to get sick and die of COVID than their white counterparts. The disease ran rampant on reservations, killing many Native elders who spoke tribal languages and were keepers of traditions. At one Chief Seattle Club staff meeting, 3 of 5 people had lost close family to the disease, Echohawk said. They cried together.

Living through a pandemic inflicts trauma, stress, and fear. There are already signs that the coronavirus is taking its toll, even on people who have not contracted it.

According to a survey conducted by the Washington State Department of Health, 1 in 4 adults in King County reported that they had experienced poor mental health on at least 14 days in the past month. A study by the Centers for Disease Control and Prevention (CDC) found striking results for adults across the country — symptoms of anxiety disorders were three times the level reported in the same period in 2019, and reported depressive disorders quadrupled as best as researchers could tell given certain methodological differences between the two samples.

Early on in the pandemic, guests at the ROOTS Young Adult Shelter reported spikes in mental health challenges and suicidal ideation early on in the pandemic, said Jerred Clouse, executive director at ROOTS.

"We continue to see that," Clouse said. "There's definitely fatigue."

There's also fatigue stemming from safety precautions put in place to prevent the spread of the virus.

So far, ROOTS is one of the only shelters serving homeless youth aged 18 to 25 that hasn't been forced to temporarily shut down due to the coronavirus. That and the belief that young people are at relatively low risk for the virus has engendered frustration with mask and social distancing policies.

"Early on particularly, guests were willing to humor staff, out of respect. Not particularly because they thought it was a critical tool in shelter," Clouse said. "As it's gone on and on and on, we're definitely seeing people being less receptive to what we're trying to do to keep people distanced."

The number of guests in shelter rose as the weather worsened but then went down again. Clouse thinks guests are finding other places with fewer rules that are more inviting than the shelter, where they can enjoy the respite that a housed person has when they cross their threshold and take off their mask.

"Masks are a deterrent," Clouse said. "People would rather sleep outside than wear these masks. We have had a lot of debate internally in the agency on how do we manage masks in a safe, but compassionate, way. Unfortunately, given the risk of being in congregate shelter, you just have to wear a mask."

A crisis on the scale of the coronavirus pandemic can rip away artifice, revealing weaknesses in policies and procedures hidden in better times. It can also force radical, positive change.

The Women's Housing, Equality, and Enhancement League (WHEEL) uses space at Trinity Episcopal Church for its emergency shelter. In normal times, the organization could squeeze in every woman who came to them at night, peaking at a capacity of around 60 in a 40-person shelter.

Coronavirus safety precautions required the shelter to lower its capacity to 29, and while they've been able to find places for people who come to the door, staff working the phones have had to tell desperate people that there was no space.

However, the shelter may now stay open all day for the first time. It's been "an astonishingly positive change," said Julie L. Thompson, who stays at the WHEEL shelter. The freedom to remain during the day rather than pack up her belongings and search for services has allowed her the stability to begin tackling issues like social security applications and better integrate into her community.

"A typical day now in my new shelter area is beautiful," Thompson said. "I wake up, there's java time, there's wake-up time."

Overdoses spiked, but access to medications to fight addiction has widened. Medical providers can start patients on buprenorphine over telemedicine, removing a barrier that can prevent people from overcoming or managing their disease.

For hundreds in the community, shelter options also improved, giving people luxuries that many take for granted — privacy, stability, and comfort.

The statewide pandemic restrictions and public health recommendations froze tourism and the hospitality industry in its tracks. They also created a series of distressed properties such as hotels that King County Executive Dow Constantine hopes to purchase to create safer spaces for people experiencing homelessness.

County officials can point to at least one test case in the Red Lion Hotel in Renton, where more than 200 people currently reside. The Downtown Emergency Services Center (DESC) has operated the facility since spring 2020, and the impacts on clients have been dramatic, said Daniel Malone, executive director of DESC.

Even in the early days of operation, medical services providers from Harborview found clients more willing to talk about substance use and find ways to address it, for example.

"The way I put it to folks sometimes is that the more housing-like the environment is, the more the kind of differences or outcomes resemble what you see when people go from homelessness to housed," Malone said.

That doesn't mean that the switch has gone off without a hitch.

The Red Lion site saw an uptick in coronavirus cases and one death of a person who was coronavirus positive at the beginning of January 2020. South King County, where the facility is located, has also been hard hit by the virus overall. In December, the Renton City Council passed an ordinance that permits the current use of the Red Lion until June 2021. DESC has been looking for alternative locations so that it can continue to offer people safe, healthy accommodations as the pandemic continues.

Echohawk has seen the benefits of hotel stays firsthand.

A grandmother with whom she was familiar mentioned that she and her 6-year-old granddaughter had moved out of congregate shelter and into a tent — the matriarch has chronic obstructive pulmonary disease, better known as COPD, and felt the shelter was too risky.

"That broke my heart," Echohawk said. "This wonderful elder who has spent her most recent years taking care of her granddaughter? How dare we ask her to sleep in a tent in the cold and the wet. So, we got her a hotel room."

Reports from relatives ensconced in hotel rooms have been overwhelmingly positive. People have seen their depression and mental health improve; they have access to better food and could take showers. Many reduced their substance use. Some asked for treatment options.

"The importance of safety and security when you're experiencing homelessness cannot be overstated," Echohawk said.

People wished 2020 good riddance as Dec. 31 turned into Jan. 1, 2021, but there was little to cheer when the countdown struck zero. Nothing had materially changed. The virus is still with us. The hope manifested by the historically fast development of vaccines is ephemeral until accompanied by a jab in the arm.

The material and emotional misery of 2020 hit nearly everyone, one way or another, but where some were inconvenienced, the less privileged were trampled. Many lost their lives.

On Jan. 20 at noon, Women in Black will once again gather to stand for them. Another 14 names were added to their list for December, Freeman said.

Ashley Archibald is a Seattle-based freelance journalist, formerly with the Real Change newspaper. On behalf of all Californian expats, she apologizes for the traffic.

Featured Image: A memorial honors homeless people who have died in King County in recent years. (Photo: Alex Garland)