COVID-19 OUTBREAKS IN MISSION DISTRICT SROs

Rapid Response & Mass Testing Needed to Prevent Additional Outbreaks

This week, on April 20th, Dolores Street Community Services learned that 22 residents and 2 staff at Casa Quezada, a Mission District, permanent supportive housing SRO, had tested positive for COVID-19.  

Casa Quezada is managed by Dolores Street Community Services (DSCS). The organization believes a slow response time and a delay in mass testing at a facility with a confirmed case of COVID-19 contributed to a preventable scenario. Coordination efforts with HSH and DPH to address the evolving outbreak fell on the responsibility of DSCS. 

Casa Quezada’s 52-unit site serves individuals who have been previously homeless. Many residents are monolingual Spanish-speaking immigrants with limited access to other forms of subsidized housing in San Francisco. The majority of the residents at CQ have underlying health conditions such as diabetes, hypertension, obesity, or heart and pulmonary conditions which make them particularly vulnerable to severe illness or death from COVID-19.  Studies have shown that people with underlying health conditions have a 20% increase rate of dying from COVID-19 complications. These high risk factors highlight the impact of COVID-19 on Latino communities across the country, and locally in the Mission District,

DSCS is fortunate to have designated staff who tirelessly advocated for residents to get immediate medical attention. However, this is not the reality at other SRO hotels. If we are to get ahead of the high risk of communal transmission at congregate settings we need mass testing for early identification of COVID-19 positive individuals. We need to be able to quickly move into isolation rooms vulnerable individuals who have come into contact with confirmed cases of COVID-19.

To prevent, reduce, and respond to the spread of COVID-19 within congregate facilities, DSCS is demanding that the City of San Francisco, Department of Public Health & the Department of Homelessness & Supportive Housing:

• Increase contact tracing and mapping of vulnerable populations, in particular those living in congregate settings and of those that are unsheltered. 
• Conduct mass testing of all people who are unsheltered, living in shelters, SROs residents, those known to have underlying health conditions and those who have been previously homeless.  
• Conduct mass testing of all essential service workers in the city.
• Immediately house unsheltered people, who are 60 years or older, and anyone who has underlying health conditions. 
• Ensure language access and culturally competent information is made available throughout the coordinated response process.
• Ensure supportive services are available to Permanent Supportive Sites and ensure residents in private SROs who are positive for COVID-19 are connected to DPH for case management services immediately after receiving their test results and transported to Isolation and Quarantine. Individuals who are COVID-19 positive can not properly isolate in SRO with shared bathrooms or kitchens. 
• Coordinate with CBOs working with high risk populations to resolve and equitably address challenges and standardize contact tracing in congregate settings, prevention and quarantine control measures, triage and testing, criteria of priority groups for testing and clinical case management – for individuals presenting symptoms and awaiting test results, confirmed COVID-19 cases, for those over 60 years of age, and anyone with preexisting health and income disparities. 
• Allow HSH providers to disclose the number of COVID-19 positive residents at shelters, SROs, transitional and permanent supportive housing, and public housing. 
• Increase public health education to address health inequities and encourage members of the Latinx community and those underlying health conditions to get tested 
• Increase neighborhood testing sites like the one in Bayview-Hunters Point, in neighborhoods with a high number of confirmed COVID-19 cases and neighborhoods with health and income disparities: the Mission, Excelsior, SOMA, Potrero Hill, Western Addition and Tenderloin. 

“Every step of the way, (see Timeline of Events) knowing the risk factors influencing COVID-19 transmission, our staff have had to arduously advocate for testing, contact screening and access to isolation and quarantine rooms for our residents. We regret that the testing did not happen sooner. In order to flatten the curve, we need to make sure DPH is properly resourced to prevent and respond to outbreaks in SRO’s” says Laura Valdez, Executive Director of Dolores Street Community Services.

After being notified that there might not be enough rooms to move all residents who were exposed, DSCS advocated for all Casa Quezada residents to be placed in hotel rooms where they can properly isolate. Although 17 residents were negative, some most certainly will develop COVID-19 symptoms over the next two weeks given the high rate of contagion. As of April 23rd, all residents were safely transported to hotel rooms in the city’s Isolation & Quarantine Department. 

“As an organization fighting for racial equity and justice we are not surprised that the historical and generational structural inequities impacting the Latinx community would place their health, safety and economic well-being at great risk. It would be shameful to let this moment pass without any structural reform that brings about long-term solutions for our community’s most pressing issues.” says Laura Valdez, Executive Director, Dolores Street Community Services. 

At least two other districts are reporting outbreaks in SRO hotels. The Mission SRO Collaborative, a program of DSCS, has confirmed four COVID-19 positive cases at the Grand Southern and 1 at 16 Virginia. DSCS continues to advocate for testing to be made available to asymptomatic residents who’ve come into contact with positive individuals. The Grand Southern is a 60+ unit hotel with mostly families, seniors and immunocompromised folks. 

*Casa Quezada is named in honor of Eric Quezada, Dolores Street’s former Executive Director who passed away from cancer in 2011.

Timeline of Events Leading to Casa Quezada Outbreak

• 4/9 – Resident who resides on the 4th floor notifies staff that he has been presenting with COVID-19 symptoms for the past two weeks. Staff and resident call DPH’s Triage Line. Staff disclose that the resident has a fever of 102 and persistent cough.  Triage counselors do not recommend that they be tested and suggest the resident is told to self-isolate in their room. Concerned with the high risk of communal transmission the program and supportive team contact Mission Neighborhood Health Centers (MNHC) and they agree to test the individual. They were transported to Isolation & Quarantine that afternoon.
• 4/10 – We receive an email from HSH stating: 
• “If someone tests positive who is living in an SRO, disease control (DC) and prevention staff will reach out to the individual and assess their ability to shelter in place and not expose others. If DC staff determines that the individual cannot safely shelter in place, they will offer them a unit at an isolation hotel.”

• 4/13 – Resident who resides on the 4th floor notifies us that they have tested positive for COVID-19.
• 4/13 – A second resident who resides on the 2nd floor starts presenting with COVID-19 symptoms and is tested at SF General Hospital. 
• 4/13 – Concerned of an outbreak at Casa Quezada given a confirmed case of COVID-19 and a second resident presenting COVID-19 symptoms, we request that DPH conduct on-site testing. DPH doctors inform our team on a call that they will not proceed to test all the residents of Casa Quezada. We then requested to have a DPH nurse come out to Casa Quezada and conduct temperature checks and health screenings for our residents. Given that at our single adult shelter it took a DPH nurse and our Program Manager about 1 ½ hours to conduct this process with about 100+ residents, we requested one DPH nurse and about one hour of their time. We were told it was not possible to send out a DPH nurse to CQ.
• 4/13 – HSH responds to our request for support in conducting health screenings and temperature checks by providing the following guidance:
• “In terms of the screening tool and temperature checks, all residents and staff who may have had contact should monitor themselves for symptoms. I do not know if DPH will go out to the site to conduct any screening, that is done through the case investigation team and it sounds like you have already spoken to someone there. If the DPH shelter team is supporting you to implement the screening at the shelter I would suggest asking them about it. Unfortunately, HSH does not have thermometers to distribute to PHS (permanent supportive sites) sites, but you certainly could use that thermometer at your other program as well if needed.” 

• 4/13 – We reach out to MNHC Deputy Director Fernando Gomez-Benitez who shares our concern for communal spread in an SRO congregate setting. He agrees to begin testing Casa Quezada residents. That afternoon 5 residents are tested and 10 more residents are scheduled to be tested on 4/14.
• 4/14 – We learn from HSH that a position has been created to support contact tracing investigations for SRO residents confirmed positive for COVID-19. We begin communications with Katie Burk, MPH, SRO Site Liaison. 
• 4/16 – To facilitate the referral process, our Supportive Services team began reaching out directly to our residents to secure signed release of information (ROI) forms to share their names and phone numbers with DPH. We needed to ensure that the majority of our monolingual spanish speaking residents who do not have phones or have interrupted mobile service due to COVID-19 were connected.
• 4/16 – A second resident  who resides on the 2nd floor notifies us that he has tested positive. Resident begins to feel extremely ill and is transported by ambulance to the San Francisco General Hospital Emergency Room. Resident is admitted to the hospital.
• 4/16 – We reach out again to DPH to inform them that a second resident has tested positive and ask if they will reconsider conducting on-site testing at Casa Quezada for the remaining of our residents and our staff. That night we received notification that DPH will proceed with conducting on-site testing. 
• 4/18 – Casa Quezada staff member becomes seriously ill and taken to the ER. Employee is tested for COVID-19 and discharged from the hospital, encouraged to self-isolate at home.
• 4/19 – Casa Quezada staff member confirms that their test result is positive for COVID-19.
• 4/19 – DPH conducts on-site testing for all remaining residents and staff. Once, DPH agreed to test our residents and staff, our Program and Supportive Services Team were able to move quickly and work collaboratively. Dr. Stephanie Cohen, Dr. Elizabeth Imbert, Dr. Jessica, Bloome and their entire team worked tirelessly alongside our team and for that we are extremely grateful. 
• 4/20 – The second resident who resides on the 2nd floor reports to staff feeling extremely ill and is experiencing difficulties breathing. Staff call 911 and the resident is transported to the ER.
• 4/20 – DPH confirms 22 residents and 2 staff have tested positive for COVID-19