OPINION: Mayor Durkan, if You Care about Public Health, Stop the Sweeps
by Julianna Alson, Omid Bagheri Garakani, Miranda Vargas
Dear Mayor Durkan,
We are Seattle-based public health practitioners and homeless service providers imploring you to stop the removals of homeless encampments. We also endorse Councilmember Morales' Council Bill 119796 to limit encampment removals during the state of emergency. Seattle is under the national spotlight of pandemic response. You have the choice to set an example for the country with evidence-based public health strategies that truly protect public health and safety.
People living homeless are disproportionately affected by the pandemic. Nationally, they are "twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times as likely to die as the general population," according to the National Alliance to End Homelessness. In Seattle, the first confirmed case of COVID-19 among homeless residents occurred March 30. A mere month later (as of April 20) 112 cases were confirmed, likely an underestimate. Crowded shelters, a lack of isolation and quarantine (I&Q) units, and continued encampment removals, compound existing comorbidities among Seattle's homeless population and propel this crisis.
Tent removals only exacerbate the already devastating health inequities faced by communities of color. The King County (KC) homeless population disproportionately includes people of color, particularly Black, Hispanic/Latinx, American Indian/Alaskan Native people; people who are lesbian, gay, bisexual, transgender, and/or queer; people with mental illnesses; people with disabilities; and young people. The policies and practices that shape homelessness rates cause greater harm to historically and structurally marginalized communities. Current COVID-19 patterns are no different: as of May 1, among confirmed cases, 24% of Latinx and 10% of Black folks tested positive, while only making up 10% and 6% of KC's population, respectively. Conversely, white folks makeup 59% of KC's population but comprise half of positive cases. Taking an equity-centered public health approach will ensure we are also 'flattening the curve' for marginalized communities. With the already disproportionate harm of COVID-19 on communities of color, further harm to people living outside explicitly goes against Seattle's efforts to promote health equity.
Police-led Navigation Teams undermine the very actions taken by you and other officials at Public Health – Seattle & King County (PHSKC) to protect all Seattle residents. We were pleased to see your alignment with Centers for Disease Control and Prevention (CDC) guidance in your March 2020 announcement that encampment removals were suspended, replaced by an increase in health-promotion outreach. Unfortunately, these efforts have fallen short, as encampment removals continue in North Seattle, Ballard, and most recently in Little Saigon at the Navigation Center and at South King Street and Eighth Avenue South.
Reliance on law enforcement to address public health issues essentially criminalizes homelessness and erects barriers to both health and housing resources. The American Public Health Association (APHA) recognizes that people who are homeless, especially those of color, experience disproportionate police contact, likely causing greater physical and psychological harms. APHA calls on "federal, state, and local agencies to identify and adopt alternative solutions to criminalizing homelessness." In the context of this pandemic, we are extremely concerned to see the deployment of police officers to remove encampments, often not uniformly using protective face masks. Deploying Navigation Teams solely utilizing policing strategies is costly and ineffective, maintains homelessness and public health harms, and violates basic human rights.
Encampment removals are actively increasing the spread of COVID-19 and, simultaneously, potentially worsening a hepatitis A outbreak. Per the CDC, "clearing encampments can cause people to disperse throughout the community," increasing the potential for infectious disease spread, putting both homeless and housed at greater risk. Evidence from other outbreaks in the U.S. and globally show the dispersal of urban encampments has, indeed, increased the spread of disease among both groups and has long-term adverse health impacts. All components of CDC's guidance prescribe against encampment removals and instead advise providing safe alternatives for I&Q. However, according to PHSKC's own reports, the number of I&Q units for houseless people is far fewer than was projected; as of March 25, only 305 isolation units were available of the 1,044 projected, suggesting a misallocation of funds.
There is an assumption that encampments, and those who stay there, are threats to public safety. In actuality, the real threats are to social determinants of health, like safe housing and sufficient outreach and mental health services. Since REACH's team of case workers declined to be associated with the police-oriented nature of the Navigation Team (as of July 2019), encampment communities no longer have a civilian-led outreach program to bridge to such resources. Law enforcement's choice to increase the number of immediate removals, without the normal 72 hours' notice, further hobbles outreach efforts. Targeting the true determinants of public safety risk by taking actions, such as placing people into individual housing units, is an effective way to curb the spread of infectious disease. If these options cannot be met, the CDC recommends allowing "people who are living unsheltered or in encampments to remain where they are."
Allowing encampments to remain in place, as well as other harm-reduction approaches, minimizes the effects of COVID-19 and hep A for unsheltered residents and the surrounding neighborhood. Public health evidence suggests the most effective interventions to address homelessness are guided by evidence-based harm-reduction and 'housing-first' strategies. Securing individual shelter units, such as hotels and motels, can properly isolate homeless folks from other community members. Access to sanitation resources (e.g., library restrooms and hygiene centers), health information (e.g., hand washing guides), and the means to distance in temporary shelters can greatly slow the spread of infectious disease. Though there are long-term opportunities here, immediate harm can be reduced by directing resources toward alternative options to tent removals.
To protect the public's health and safety, a different response from our City is needed. The removal of encampments during a pandemic without a place for people to go will only further spread COVID-19 throughout the city. The 'Stay Home' directive is simply not possible for people experiencing homelessness and living in encampments. Without first ensuring all unsheltered people have a pathway to stable housing or are receiving needed homeless services, housing instability and subsequent health harms will increase. We strongly urge you to fully end current removal practices and offer private housing units during this state of emergency, and support Councillor Morales' Council Bill 119796 to limit the practice of encampment removals.
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Featured image by Kevin Schofield.
