Med Journal Jan 2021 Final - Page 8

Case Study by Appathurai Balamurugan , MD , DrPH

Operation Compassion : COVID-19 Pandemic & Homelessness in Arkansas

Abstract

Three thousand Arkansas residents face homelessness on any given day . As the COVID-19 pandemic began to unravel , a third of Arkansas homeless shelters closed , placing this vulnerable population in a dire situation . In this article , we describe Arkansas Department of Health ’ s concerted efforts in COVID-19 testing , case investigation , contact tracing , and mitigation strategies that were put in place to the address the needs of homeless populations in Arkansas through the Operation Compassion program . Additionally , we describe how the quarantine and isolation needs of this population were met and how alliances were formed with community partners to address the non-COVID needs of homeless shelters in Arkansas .

Introduction
Even during the best of the times , the needs of marginalized populations tend to be overlooked . The COVID-19 ( SARS-CoV-2 ) pandemic disproportionately impacts vulnerable populations such as those experiencing homelessness or incarceration and those struggling with substance-use disorders . In the U . S ., 1.5 million people experience homelessness in a year . They are not only at a higher risk of contracting communicable diseases , but also typically suffer more severe symptoms from their current chronic medical conditions . 1-3 Indeed , living in crowded shelters or on the streets for extended periods of time increases the chance of being exposed to communicable diseases , namely SARS-CoV-2 . 3 The lack of stable storage of medications , routine health care , and chronic stress can worsen ongoing conditions as well . 1
Since the beginning of the pandemic , several clusters were reported in homeless shelters across the nation . 4 , 5 Multiple factors contributed to these clusters including the mobile nature
Operation Compassion team members Jarrod Ritchie and Amanda White waiting at a homeless shelter before COVID-19 testing .
of the population , uses of multiple homeless shelters , and crowding and use of congregate sleeping arrangements . These factors , combined with enforcing public health efforts of physical distancing and face coverings , presented unique challenges . 6 In this article , we describe ADH ’ s efforts in addressing the needs of homeless populations in the state as it relates to the COVID-19 pandemic .
Context
Arkansas , home to 3.02 million Americans , based on 2019 U . S . Census estimates , has 3,000 individuals who face homelessness on any given day . As the ADH saw cases rising in our nursing homes , correctional facilities , and other congregate settings , we developed an approach called Operation Compassion to address the needs of the homeless population in Arkansas – especially COVID-19 testing , case investigation , and contact tracing . We also wanted to serve this population that otherwise often gets overlooked during a crisis .
The ADH disseminated guidance to homeless shelters and services as the pandemic began to unravel in the state back in March of 2020 , essentially to implement the Centers for Disease Control and Prevention ( CDC ) recommended infection control practices . These included applying social distancing measures , ensuring residents ’ heads are at least six feet apart while sleeping , and promoting use of cloth face coverings among all residents . An ADH team visited several of the homeless shelters to provide on-site guidance and measures to prevent an outbreak .
ADH developed the Operation Compassion team comprising of a medical director , emergency medical services providers , and support staff to plan and implement a COVID-19 polymerase chain reaction ( PCR ) testing , case
152 • The Journal of the Arkansas Medical Society www . ArkMed . org