In Montezuma County, COVID-19 Among Those Who Are Homeless Creates Challenges And Solutions

May 26, 2020

The six weeks between mid-March and early May leading up to the seasonal closure of The Bridge’s emergency shelter in Cortez were unlike any the organization had ever experienced. When Colorado Gov. Jared Polis announced a statewide stay-at-home order would start on March 26, the nonprofit’s executive director, Laurie Knutson, described it as the start of a major shift. 

“I think the whole world flipped on its head for those six weeks, and we were included in that,” she said.

Knutson explained that shortly after the lockdown restrictions went into effect, the shelter had to shift from staying open only at night to requiring guests to stay for 24 hours a day, seven days a week. People had to remain at the shelter, and if they left, would not be allowed back in due to potential exposure to COVID-19. This was different from how the shelter had operated for the past 15 years, which was to provide shelter for people who had nowhere else to sleep during cold winter nights.

Knutson said the stay-at-home period went well for some of the patrons. They stayed inside, had the opportunity to chat amongst themselves or with their families over video chat or telephone, and to watch “way too many movies,” Knutson said with a laugh.

However, she said the experience was an “abject failure” for those with mental health and addiction problems.

“We lost a significant number of guests in the first 24 to 48 hours [of the stay-at-home order],” she said, referring to the people who left the shelter in part because they weren’t allowed to bring alcohol or drugs onto the premises. Some of the people were also not mentally stable enough to stay locked inside for long hours at a time, she explained. By the time the shelter closed for the season on May 1, the shelter was housing only 10 people, down from about 30 several weeks before.

“It made us all sad that we weren’t able to retain everybody at the shelter,” Knutson said. “I wish more people would have decided to stay, but there wasn’t much we could have done to keep them there.”

Challenges such as this illustrate how prevalent substance abuse and mental health issues are among people experiencing homelessness in the community, Knutson said. It also points to larger societal issues.

“When society decides that liquor stores and pot shops [are] an essential service, it says a lot about our culture,” she said.

Now, with the Bridge closed for the season, even with the state’s relaxed “safer-at-home” restrictions, many people experiencing homelessness do not have safer places to go. Many folks who had stayed at the shelter in the winter now rent motel rooms, stay with friends, or camp outside.

But Knutson explained that the presence of the virus also compounds the number of issues that people without stable access to housing face, even if they can receive assistance for mental health and addiction issues. Food insecurity, poverty, limited access to medical care, and limited access to hygiene become even more critical problems when faced with the potential spread of a disease like COVID-19. Furthermore, because many people who do not have permanent housing tend to spend time in groups, they risk spreading the virus between each other.

Over the past several weeks, this challenge has drawn the attention of state and local officials. Meetings between Montezuma County commissioners and members of the Colorado Department of Public Health and Environment have highlighted political tensions between the state and county, in part based on these populations.

Some of the tension stems from CDPHE’s denial of Montezuma County’s request for variance from state social distancing regulations. One of the reasons given in the agency’s May 11 letter to the county was the spread of COVID-19 among populations of people experiencing homelessness. In subsequent conference calls between the CDPHE and Montezuma County commissioners, the commissioners questioned the number, location and representation of these cases.

Near the end of a call on May 13, Keenan Ertel accused the state of holding the county and its businesses “hostage” over what he perceived as a small number of cases concentrated in the “homeless alcoholic population, that lives in our parks system, and in our sagebrush.” Shortly before hanging up, Ertel called the safer-at-home restrictions “unconstitutional,” and said he would “not say anything” to businesses that would choose to reopen in the face of the state’s regulations.

The case of Sebastian Yellow, who was found dead in a Cortez park in early May, has also provided a point of contention between county commissioners and the CDPHE. The state had included the man’s death in its total count of COVID-19 deaths in the county. However, County Public Information Officer Vicki Shaffer told The Journal that the county coroner and a pathologist found that he had died due to alcohol poisoning. The case drew wider attention on media outlets such as CBS-Denver and Fox News, and Suckla and Ertel have repeatedly expressed frustration about the tally during public meetings.

During a May 14 meeting to rescind the county’s health emergency declaration of the virus, Chair Larry Don Suckla indicated that public health officials have been manipulating the death count in order to magnify the problem and justify the extension of the social distancing regulations in the county. As of this article’s publication, the county’s COVID-related death count remains different from the CDPHE’s.

CDPHE officials have also expressed their willingness to work with Montezuma County to provide resources and support for populations of people experiencing homelessness. On May 18, Commissioner Jim Candelaria and other county officials met with state health officials, and CDPHE deputy director Karin McGowan gave suggestions for increased outreach and education among populations among people experiencing homelessness. In follow-up comments to KSJD over email, a CDPHE spokesperson said that Dr. Grace Marx, a homelessness expert with the Centers for Disease Control and Prevention, has also been involved with efforts to address COVID-19 among these populations.

Outside of the public meetings, a group of organizations and state and local government offices have been working to develop other sources of support for people who may be particularly vulnerable to the virus or its impacts, such as those experiencing homelessness. Dr. Kent Aikin, Montezuma County Public Health Department Physician and Hospitalist at Southwest Health System, told KSJD he had been working with a large group of people and offices from across the community to provide adequate care and contact tracing for vulnerable populations.

“We don’t want to put the people in the homeless population at risk, either by not having a good place to take care of themselves if they’re exposed, nor by being exposed to the virus,” he said.

Note: Southwest Health System is an underwriter of KSJD.

As soon as someone tests positive for the virus, he said, health department workers find others with whom that person has been in contact, and then provide tests and information to those individuals. This work also occurs among people who don’t have permanent residences. Representatives from the Navajo and Ute Mountain Ute tribes are also involved, he said.

Aikin also said that county plans to provide safe shelter to those exposed to the virus had been evolving over the past few weeks. According to Montezuma County Emergency Manager Jim Spratlen, current plans for housing now include two separate “alternate care facilities.” These locations will allow people who have tested positive for the virus, but whose condition is not critical enough to require hospital care, to safely isolate themselves from while still receiving food and medical attention.

Spratlen told KSJD his office is working with a large group of private business owners, healthcare providers, and officials at the state and local level to identify these facilities. One site, intended to house individualized cases, has already been chosen. A second, intended for groups of people, should be finalized in the coming weeks. These facilities will be used if the number of cases expands in upcoming months to an amount that could overwhelm local hospitals. However, Spratlen emphasized that access to these sites would be voluntary.

“This is not mandatory, there’s no court order, people are not going to be under arrest,” he said.

He also clarified that this site would be open to anyone, not just to those who don’t have access to permanent shelter.

“We’re trying to make sure that we’re not singling out just one population, race, creed, or anything like that.”

However, Spratlen said the county will not disclose the locations of these facilities to the public, based on concerns about the privacy and safety of the site and the people who stay there. He gave two main reasons for the privacy.

“One, if it is a private site, people will not go there ever again, [because] they’d be afraid the virus is still there,” he explained. “And two, there could be issues with public retaliation against people because they’re sick.”

People who need access to these sites must be referred by county or hospital officials, he said.

Though The Bridge is directly involved in these discussions, according to Knutson, it has not been identified as one of these facilities.

“We are in discussions about where best to shelter people who [test] positive, whether or not they are homeless,” she said.

As the physical impacts of the pandemic take their toll, a “secondary pandemic” of behavioral health issues will likely follow, according to Sarada Leavenworth, Director of Strategy and Engagement at Axis Health System. Though Axis has behavioral and physical health programs specifically intended for people experiencing homelessness, the chance for spread of the virus has made it harder for providers to work with these communities in person. They are instead working to expand access to telehealth opportunities for people experiencing homelessness, as well as other vulnerable populations. She said Axis and a large network of organizations in the community are working to make sure that people have access to the primary and behavioral healthcare that they need.

Leavenworth said that those experiencing behavioral or physical health problems can contact their offices in Cortez, but that Axis does not provide COVID-19 tests. She said that those needing tests should contact Southwest Health System. She also said they work with a large number of civic and government organizations to refer people to the resources they need.

A list of COVID-19-related news and resources is available at KSJD’s Coronavirus Updates and Resources page.

Correction (May 28, 2020): This article previously stated the county coroner performed an autopsy to determine the cause of death of Sebastian Yellow. An investigation was conducted by the coroner along with a pathologist.