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Every major city has a virtual suburb for the homeless. Homes consisting of tents, scrap wood, shopping baskets and cardboard boxes. In shelters, a family dwelling might have a common kitchen and bedrooms with bunk beds. Others may have a large room filled with dozens of bunk beds or canvas cots. Some have dozens of rubber-coated thick pads placed a foot apart in rows laid across a concrete floor.

Chronic diseases are higher than normal in the best of times. The ideal terrain for a virus, such as COVID-19, to take hold and spread.

A 2012 report by the U.S. Interagency Council on Homelessness found that American Indian or Alaska Native people make up only 1.2 percent of the national population, but up to 4.8 percent of homeless people in shelters. The report goes on to say that homelessness is rooted in poverty, substance abuse, behavioral health disorders, trauma, and violence. It says almost twice as many American Indian and Alaska Natives live in poverty and eight times as many live in overcrowded homes compared to all U.S. households.

(See our COVID-19 updates and coverage: Indian Country's COVID-19 syllabus.)

Seattle has been the epicenter of the pandemic in the United States. There have been 1,187 COVID-19 cases and 66 deaths in Washington as of March 19. (New York City has more cases, 4,000, but fewer deaths, 22).

“It's been a crazy time,” said Abigail Echo-Hawk, Pawnee, chief research officer at the Seattle Indian Health Board. “I'm just trying to put out as many resources as I possibly can and serve my community to the best of my abilities. I’m just grateful to all my ancestors that came before me, who have taught us how to be strong, resilient people.”

The Seattle Indian Health Board offers medical, dental, and behavioral services as well as elders and youth services. It provides resources to prevent homelessness. It also runs the Urban Indian Health Institute, one of 12 tribal epidemiology centers in the nation.

In King County, where Seattle is located, American Indians and Alaska Natives are seven times more likely to be homeless than whites. Ideally, Echo-Hawk said, officials would figure out housing for everyone and the homeless could isolate in their own spaces. “If that's not a possibility, then how do we keep continuing to mitigate the harm and the risk that can come to our homeless relatives?” Echo-Hawk said.

She said the Seattle Indian health board is working to live up to CDC guidelines that, for now, are beyond its reach. “If we shut down our programs [involving more than ten people], our elders have nowhere to go for shelter and they have nowhere to go for their meals, which we provide. So from that harm reduction approach, we are making sure that there is distance between them of six feet.”

Echo-Hawk said she wants to see American Indians and Alaska Natives, as well as all homeless people, given top priority for placement in any quarantine and isolation facilities that may open. Advocates are also trying to ensure the homeless can keep their pets; animals they see as family.

Echo-Hawk noted although the largest outbreak was in an affluent suburb, the first quarantine and isolation facility opened in one of Seattle’s lowest income neighborhoods.

She said, in the interests of equity and social justice “we have to ensure that all of the risk is not just taken by low income communities.”

Regardless of income, race, or ethnicity all citizens have a role in ensuring that this virus does not continue to spread, she said. “And that means we're going to have to have isolation and quarantine facilities in affluent neighborhoods, in low income neighborhoods, in the middle of the city, taking over places that maybe were being used for something else. We have to recognize it is now the time for the community as a whole to come together and to support one another.”

Echo-Hawk also serves as director of the Urban Indian Health Institute.

“We're trying to use any lessons learned of what we have experienced to get those to our tribal partners on the reservations, in the villages, and in the urban settings so that they can learn from the response that we've had to make and that we share any resources that we have,” she said.

Echo-Hawk didn’t mention finances, but the Seattle Indian health board website projects a monthly loss of hundreds of thousands of dollars to protect staff and community members for the duration of the pandemic.

The unexpected and costly burden of serving people during a pandemic has also impacted the Central Arizona Shelter Services in Phoenix. That nonprofit serves almost 5,000 people annually, seven percent of them self identifying as American Indian or Alaska Native. The agency offers 470 beds, meals, and case management for a range of services. With COVID-19 now in the picture, it has added screening of people entering the shelter, shares information to educate staff and clients, and increased the distance between beds.

Dayna Gable, chief development officer for the non-profit, wrote they’re ramping up and doing everything they are able to do to follow CDC guidelines for homeless shelters. But, like the Seattle Indian Health Board, the agency cannot be everywhere it needs to be.

“Of greatest concern are the numbers of folks who are elderly and/or have disabling conditions that would make them more vulnerable,” wrote Gabler. “Today we have 184 people over age 55 in shelter, many with chronic health conditions.” Of those, 112 are aged 55 to 61 and 72 are 62 and older.

In addition to a shortage of testing kits, both Echo-Hawk and Gabler said personal protection equipment needed to protect health workers caring for people infected by COVID-19 is in short supply.

That problem is compounded by the lack of direct access by tribal and urban Indian organizations to the Strategic National Repository, which provides medical equipment and supplies to federal, state, and local agencies. Echo-Hawk said a bill introduced by U.S.Sen. Elizabeth Warren (D-Mass.) and Senate Committee on Indian Affairs Vice Chairman Tom Udall (D-N.M.) would provide Indian Country with access to the repository.

Anchorage, Alaska’s largest city, has more Alaska Natives than any other single community and 44 percent of its homeless population is Alaska Native. Homelessness has been in the Anchorage news regularly for several years.

Tuesday Anchorage mayor Ethan Berkowitz spoke as a guest on an Alaska Public Media call-in show. He said the homeless population is in shelters. “The problem is that the shelter sleeping arrangements are much closer than CDC recommends. In order to get to the spacing CDC recommends, that is, six feet per person, we need more space than we have, and not just at Bean’s Café, St Francis [local shelters]. In order for that to happen we’re going to be using some of the municipal facilities so we can spread people out.”

Tuesday evening at a press conference, municipal manager Bill Falsey said, “The sheltering capacity for homeless individuals in Anchorage was a challenge before COVID-19. The new issue is that our homeless community includes many individuals with underlying health conditions. An outbreak of COVID-19 in a homeless shelter could be particularly severe. That would be terrible for the residents, but it also potentially affects everyone.” Such an outbreak would make it difficult, said Falsey, to have enough beds available for people having heart attacks or experiencing car crashes or other medical emergencies.

On Thursday, Anchorage municipal Communications Director Carolyn Hall wrote saying the municipality soon will have a signed agreement to allow for a temporary homeless shelter and meal facility at two local sports arenas. However, she said, that’s not a long-term solution. “The Municipality of Anchorage is working with community partners to house as many individuals as possible and to reduce the demand for emergency shelter.”

Meanwhile, in New York City, the first positive case of a homeless person with COVID-19 was identified on Wednesday. By Thursday, the number of homeless people in New York City who tested positive for the disease had risen to seven.

Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a long-time Alaska journalist.

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