A health worker preparing to extract a dose of vaccine from a vial. Asian Development Bank / Flickr

On Wednesday, about 30 community leaders logged onto a 1 p.m. conference call to discuss a letter. 

Each participant represented a different organization from across North Carolina, all of them devoted to serving the nearly 10,000 people in the state who experience homelessness on any given night. 

The letter they met to discuss was addressed to Dr. Mandy Cohen, secretary of the N.C. Department of Health and Human Services, and the message was clear: It asked for homeless shelter staff and residents to be given immediate prioritization for COVID-19 vaccination. 

Ryan Fehrman, executive director of Families Moving Forward, a shelter in Durham and the principal author of the letter, said this was “an invitation to people across the state to sign on to this letter and to start the conversation” around vaccinating shelter staff and guests. 

Ferhman had already sent his own letter to Cohen and DHHS last week asking that shelter staff and residents be prioritized with a Group 1 vaccine designation. Now he hopes that this letter, which, as of this publication, has been signed by more than 150 individuals and at least 50 organizations, will sway NCDHHS. 

“I just feel like this is an opportunity for statewide advocacy,” Fehrman said. “We’re going to have a much better chance of success if we act on this collectively rather than just one letter from a shelter in Durham.”

Changing plans and health risks

Several months ago, advocates for the homeless did not expect to be in this position. Early versions of North Carolina’s vaccine distribution plan placed high priorities on homeless shelters and other congregate living situations like migrant camps and prisons along with residential groups like long-term care facilities. 

That original plan has since been updated several times, usually to mirror guidance from the national Centers for Disease Control and Prevention. By January, North Carolina’s new distribution scheme placed shelter staff in Group 3 with other front-line essential workers and shelter guests in Group 4 as “adults at high risk of exposure and increased risk of severe illness.” 

That downgrade came as a shock to many in the field, including Brooks McKinney, who serves as the director of vulnerable populations at Cone Health in Greensboro and is a board member of both the N.C. Coalition to End Homelessness and the National Health Care for the Homeless Council.

“I was such a bragger about what we were doing,” McKinney said. “We even got (North Carolina) published in a white paper because of our prioritization of shelters. Then it ended up that North Carolina did not follow through with that. I was just disappointed that they didn’t fulfill their promise.”

Although North Carolina updated its vaccination plan to align with CDC guidelines, several states, including Illinois, New York, Rhode Island and Virginia, have prioritized shelters and are already vaccinating shelter staff, if not vaccinating residents as well. 

“I recognize (DHHS officials) say they are following CDC guidelines — that’s fine,” McKinney said. “But the problem is these other groups that are getting vaccinated, they’re not representing people that are as vulnerable as the homeless or as sick as the homeless population.”

People experiencing homelessness tend to have higher numbers of comorbidities than those living in homes. These comorbidities include diabetes, hypertension, mental health disorders and cardiovascular disease, many of which are linked with more serious diseases in those infected with COVID-19. 

“The mortality rate for those who are homeless is already extremely (high),” said Trisha Ecklund during the conference call. “Many don’t reach 65, but they are just as vulnerable.” Ecklund is the vulnerable populations program coordinator at Blue Ridge Health in Hendersonville.

Along with these health disparities, it is often very difficult for those living and working in shelters to properly socially distance, meaning it is much easier for the disease to spread. 

When outbreaks do occur, shelters have to find a way to isolate those who are positive while also testing and tracing potential contacts and keeping staff safe. 

In his letter, Ferhman also pointed out that this is not only a health issue but also a financial one. 

“Many shelters have been forced to move to a two-site model, and we’re spending a lot of FEMA dollars to underwrite the costs of hotels and other COVID-positive housing,” Ferhman said.

“Vaccinating our staff and our residents isn’t just right for our health. It’s also being responsible stewards of North Carolina’s and FEMA’s resources.”

Ecklund said her staff members saw all of these issues firsthand when they experienced an outbreak in December. Over half of their residents ended up sheltering in isolation over Christmas, and the clinic became short-staffed because so many had to isolate for fear of continuing the spread. 

She compared the experience to “moving the furniture on the Titanic while it was sinking.” 

Why now

Though shelter staff members are set to become eligible for vaccination with the rest of Group 3 on March 10, Ferhman still wants to see his staff and residents prioritized. 

“I was somewhat encouraged when Gov. (Roy) Cooper said the Group 3 would start on March 10,” Ferhman said. “But I’m under no illusion that my staff is going to be getting vaccinated close to that time. There’s still a very real supply-and-demand challenge.”

Plenty of reasons favor pushing for homeless prioritization as soon as possible, McKinney said: “It’s overall such a low number of vaccines needed for the whole state, 10,000 people. That is so low compared to when they open up the doors for front-line workers (who number) in the millions.

McKinney also pointed out that vaccinating homeless populations during the winter might actually be the most efficient time to do so because it could solve some of the logistical challenges associated with delivering two doses of vaccine to a population that tends to be relatively transient and difficult to locate. 

“If you look at the major cities like Raleigh right now, there’s a lot of winter shelters that are open right now, and people stay there until March,” McKinney said. “If we had already gotten the vaccine, we could have given them the first and second doses … while they were all in for the winter. The longer we wait, the more difficult that becomes.”

Carolina Public Press emailed DHHS to ask, among other things, if the agency was aware of calls to prioritize homeless populations and if any discussions were taking place regarding a possible update in prioritization. 

DHHS responded but did not comment on those specific questions. 

The N.C. Coalition to End Homelessness plans to deliver the group letter to NCDHHS sometime next week.

“I do want to say very clearly that I think Secretary Cohen and DHHS have done a pretty good job given the circumstances,” Ferhman said. “In this circumstance, I absolutely think they got it wrong and I’m hoping that we can prevail upon DHHS to make some corrections.”

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Christian Green is the lead Carolina Public Press contributing writer reporting on healthcare and health policy in North Carolina. He obtained a master’s degree in neuroscience at Wake Forest University’s Graduate School for the Arts and Sciences, where he worked in the Laboratory for Complex Brain Networks. He is based in Raleigh. Contact him at cgreen@carolinapublicpress.org.