People Experiencing Homelessness (PEH)

Under Title 17, Section 2500, California Code of Regulations all suspected outbreaks are reportable. COVID-19 outbreak definitions are determined based on risk of transmission in particular sites, and are as follows:

Congregate residential sites associated with PEH such as shelters, encampments, or recuperative care centers:

At least 3 confirmed cases of COVID-19 in residents or staff within a 14-day period.

Outdoor congregate areas other than encampments (e.g., Safe Parking sites):

At least 3 confirmed cases of COVID-19 in residents or staff from 3 different households within a 14-day period.

Semi-congregate or non-congregate residential sites associated with PEH such as Single Room Occupancy housing, Tiny Homes, Project Roomkey or Project Homekey housing or shelters for which the layout is discrete apartments:

At least 3 confirmed cases of COVID-19 in residents or staff from 3 different households within a 14-day period.

Non-residential sites providing homeless services such as hygiene centers, food distribution centers, case management or other access centers for PEH:

At least 3 confirmed cases of COVID-19 in clients or staff within a 14-day period.

Medical shelters for isolation of persons diagnosed with COVID-19 (e.g., Isolation/Quarantine (IQ) sites):

At least 3 confirmed cases of COVID-19 in staff within a 14-day period. Residents are not included in the outbreak definition because IQ sites are specifically for isolation due to COVID-19.

Retroactive Outbreaks:

Outbreaks that are 14-28 days old may be opened for CFS investigation if either of the 2 following criteria are met

1. There is a COVID death at a facility
2. There is evidence of high transmission (>30% attack rate in residents/staff in 14 days have tested positive for COVID-19)

The ACDC MD to review the outbreak with ACDC RN before opening outbreak. In deciding whether or not to open an outbreak, the ACDC MD would review the facility's response (e.g what percentage of staff/residents were tested when cases were identified). The PEH MD would also review if there was any recent history of an outbreak at that facility. 

In congregate settings, accurate exposure histories and contacts may be difficult to determine, and all residents may be considered exposed.

Quarantine of close contacts is no longer required. Masking and testing instructions can be found here.

Staff

Work Considerations

• Staff who are close contacts may continue to work as long as they do not develop symptoms or test positive. It is strongly recommended that they test upon identification (but not earlier than 24 hours after exposure), and if negative, on Days 3 and 5.
• Staff who are close contacts must wear a well-fitting mask around others for 10 days.
• If staff develop symptoms after returning to work, they must be excluded from the workplace and should test as soon as possible. If staff test positive, they follow the isolation instructions for cases. 

1. May admit new residents while doing initial assessments, including assessment of outbreak magnitude and environmental health evaluation if needed.
2. Notify staff and residents of COVID-19 outbreak while maintaining patient privacy and request all to observe infection control measures across the facility.
3. Initiate standard airborne precautions. Ensure that the site has sufficient mask supplies.
4. Define an isolation area. Movement of residents within the facility should be thoughtful and aim to minimize transmission.
5. A Department of Public Health Call Center has been established to assist healthcare providers, homeless service providers, street outreach teams, and law enforcement to find isolation beds for PEH. Call (833)-596-1009 from 8am to 8pm for bed availability.
6. Rapidly move symptomatic PEH into an isolation area within current setting if possible (ideally in an area with a designated bathroom or to a medical shelter site/IQ site.
7. Place clear signage outside all isolation areas for staff and clients to properly identify these areas.
8. Designate a separate area for non-symptomatic PEH contacts who are high-risk (age over 50, chronic medical problem, pregnant). Consider placing high-risk clients in less densely crowded areas or in rooms with fewer than 10 beds.
9. Review current status of all PEH to identify symptomatic residents and relocate to available isolation locations per protocol.
10. Increase environmental cleaning throughout the congregate setting to three times a day with emphasis on high touch surfaces, particularly in the unit where the case was located. Ensure the use of an EPA registered disinfectant appropriate for SARS-CoV-2.
11. Determine covid vaccination status of residents and staff. Provide vaccine education and offer referrals for COVID-19 vaccination to unvaccinated or incompletely vaccinated residents or staff.
12. Clients who met the criteria and are unable to access oral COVID-19 therapeutics through their own provider or who do not heave health insurance can be referred to a Test to Treat program or the DPH Public Health Call Center/Tele-Health service, which provides testing, consultation, and prescriptions at 1-833-540-0473 open 7 days a week, 8:00 am-8:30 pm.
13. Ensure adequate and easily accessible supplies for good hygiene, including:
1. Tissues and trash receptacles
2. No touch hand sanitizer dispenser near customer entrances if feasible
3. Hand sanitizer with at least 60% alcohol
4. Handwashing stations
5. Soap
6. Paper towels
14. Initiate temperature and symptom checks at entry to the shelter. Initiate symptom checks daily for staff and residents.
15. Discontinue all group events:
• Serve meals "to go" if possible, or stagger dining times to decrease the size of the groups and maintain 6 feet of distance between diners.
• If smaller group activities are medically necessary, keep the same group together to decrease the risk for virus spread.
• Signage should be posted in the facility to reinforce frequent hand washing, cover your cough, and maintaining social distancing.
16. Follow the LAC DPH Guidelines for COVID-19 Cases (Isolation) and Close Contacts.

Continuing admissions to shelters and other PEH facilities while under initial outbreak assessments

PEH sites under initial assessments may continue to accept new residents or readmissions. Consider closing the facility to admissions if any of the following are concerns:

1. Inadequate infection prevention and control at the facility.
2. Concerning rates of hospitalizations, deaths, or other adverse outcomes.
3. High proportion of unvaccinated residents or staff.
4. Concerning transmission rates based on response testing of residents.
5. Inability to effectively cohort new admissions and readmissions from outbreak investigation cohort of residents. This would require facilities to have separate areas and separate staff.
6. Shortage of staff or inability to designate staff for new admissions.
7. Inadequate supply of PPE for residents and staff.

Additional guidance and resources:

• Guidance for Homeless Shelters
• Homeless Shelters Assessment Tool
• Infection Prevention Basics for Homeless Shelters
• Guidance for Bed Positioning
• Guidance for General Cleaning in Group Settings
• Print Materials for Facilities