My Covid Story
Controlling Coronavirus in Tight Living Quarters
Since early March, COVID-19 has relentlessly infiltrated thousands of nursing homes, homeless shelters, prisons, and other tight-knit facilities across the United States (U.S.). The impact of the virus on these and other vulnerable populations has been overwhelming. In the state of Massachusetts, for example, the Department of Health noted that 384 out of roughly 400 long-term-care facilities in the state had been affected, resulting in more than 4,100 deaths. A similar story of infection and death has played out in other parts of the country as well. Although organizations such as the Centers for Medicare & Medicaid Services (CMS), have released a series of guidelines aimed to reduce the impact of COVID-19 on long-term care facilities, many institutions continue to struggle. The media has focused heavily on the large number of facilities with rampant spread and poor outcomes from the virus. But an equally important question is: how have a small number of facilities managed to keep the deadly virus out?
But an equally important question is: how have a small number of facilities managed to keep the deadly virus out?
Jaymes Sime serves as Executive Director (ED) of MICAH House, “a homeless shelter with two priority populations: families… and single women,” based in Council Bluffs, Iowa that had managed to remain COVID-free until late July. At the time of our conversation, Sime reported that they had not had a single case of COVID-19. When discussing their strategy for keeping MICAH House safe, Sime details three main areas of focus that contribute to that success: Design, Timing, and Communication.
Design: As Sime described, many shelters for people experiencing homelessness share a large open bunkhouse and/or common spaces for mealtimes, restroom facilities, and, at times, waiting lines for programs or services offered by the facility. Sime explains how that set up is “not conducive for [controlling] any type of virus,” not to mention the lack of privacy and dignity.
MICAH House offers a different structure. Although some rooms in the shelter are shared, five-foot dividers between each bed help maintain discretion while also limiting the transmission of illness among residents. Additionally, the number of women allowed in the facility was reduced by 20% at the start of the pandemic, providing spare, private rooms for residents awaiting test results.
Timing: The second part of Sime’s formula for the success at MICAH House revolves around timing. As soon as Jaymes and his team learned of COVID-19, they rallied into action. In early March, a plan to control the virus was set in motion. An eight-page document was written and circulated to outline “internal protocols, [discussion of] social distancing, isolation, and quarantine.” Sime also created a short video for those who process information differently.
Shortly thereafter, masks were issued to clients and staff, with staff setting the example by wearing masks throughout the day. In addition, stations were set up with hand sanitizers and thermometers. According to Jaymes, the practices and procedures are continuously reviewed and reinforced in a variety of ways, ensuring that both staff and clients appreciate the significance of the situation, including the virulence of the contagion, the ease and rapidity of its spread, and the importance of caring for and respecting one another. Sime believes that the swift call to action played a critical role in keeping COVID-19 at bay. Both the seriousness and the clarity of measures taken left no doubt for those living or working at MICAH House.
Sime believes that the swift call to action played a critical role in keeping COVID-19 at bay.
Communication: The MICAH house approach has prioritized both internal and external communication. Within the shelter, Sime consistently reiterates key messages to staff members and emphasizes the importance of open communication up and down the chain of command; this way, matters that arise can be quickly and easily addressed.
The culture of extra discussions and check-ins took some adjustment, patience, and understanding on the part of the staff.
The culture of extra discussions and check-ins took some adjustment, patience, and understanding on the part of the staff. For example, back in March, a woman in the shelter showed potential symptoms but felt reluctant, and nervous, to take a test. The staff member informed an on-call supervisor who addressed the situation but failed to immediately communicate the client’s concerns to ED Sime and others on the team. Luckily, the woman ultimately agreed and tested negative; but from that point on, Sime underscored that erring on the side of too much communication (rather than too little) was vital. He informed the staff that when issues arise, “…whatever the time. I need to be in the know.” That way he can make sure that the situation is managed as safely and effectively as possible, protecting all of the residents and staff, and minimizing viral exposure and spread.
Communication with shelters near MICAH House has also been extremely important in helping to curb the impact of COVID-19. The EDs of the five shelters within that same area hold weekly video meetings. This allows local leaders to gauge the risk by knowing the regional data and facilitates learning by each shelter from the actions of others. To date, three of the five organizations have needed to manage cases of COVID-19. Sharing and following best practices has helped ensure prompt action and less severe outcomes than have happened at many other facilities across America. According to Jaymes, “without that collaboration and without the ability to learn from a shelter that actively managed having their whole shelter tested multiple times… we would still be somewhat blinded.” Essentially, these weekly sessions provide Sime and his colleagues with ideas that he weaves into his work with the MICAH House team.
Internal and external communication complement one another.
While many long-term-care facilities and shelters around the U.S. have struggled to contain COVID-19 cases and complications, some places like MICAH House have managed to keep the virus out or at least the numbers down to a minimum. Diligence, attention to details, timely response, clear and frequent communication, and sharing of best practices form the components to improve pandemic management, now and in the future.
Written & Reported by Ella Gavin
Edited by Dr. Jacki Hart