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'Stunning' asymptomatic coronavirus spread among Boston homeless

WBUR reports on the results of "universal" Covid-19 testing at the Pine Street Inn - a high rate of positive results among people who are mostly not showing any symptoms. Because the Pine Street Inn is in 02118, that explains why the South End now has the city's highest rate of infection.

To prepare for a possible Covid-19 epidemic among the Boston's homeless, the city and local hospitals and homeless-healthcare agencies have taken a number of steps. An effort that started with isolation tents on Southampton Street has since turned into a full-scale healthcare and recovery system that includes the re-opening of a shut state-owned building on the Boston Medical Center campus for homeless patients, the use of a Suffolk University dorm to provide individual rooms for people who want a place to quarantine themselves, the set aside of half the beds at the 1,000-bed field hospital at the South Boston convention center for homeless people who are recovering from major Covid-19 infection and the re-opening of a closed hospital on Commonwealth Avenue in Brighton for additional beds for the homeless who need care.

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Comments

A tent doesn't seem like it would be very effective at curtailing the spread of the virus. Why not allow these people some dignity and let them quarantine in some of the thousands of empty hotel rooms in the city?

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We're not Las Vegas where they just mark off some spaces in a parking lot.

The tents were the first response, back before we knew how serious and widespread this would get. Since then, the city and healthcare organizations have done way more serious work, as described in the rest of that paragraph. I'll rewrite that to make it clearer.

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I'm glad to hear that. Those pictures of the parking lot in Vegas were heartbreaking.

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Even people cleaning hospitals and doing other jobs don't have sufficient PPE. This would make perfect sense if they can keep hotel staff paid and protected. Maybe they can make it happen.

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The state should consider the idea of using MBTA commuter boats to transport the homeless
population who have tested positive to the islands provide them with housing and food and medical care. This would be a lot more compassionate than letting them roam the streets and the subways and sleeping in gutters.

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Because one of the hallmarks of this disease is that people who seem to be on the mend suddenly crash. If that happened on an island in the middle of the harbor, how would you get them to a hospital for intensive care in time to possibly save them?

And as I mentioned in the answer above, it's not like people who are sick are just roaming the streets - they are getting care and isolation in actual buildings, within a short distance of more serious car should they need it.

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One of the dumbest ideas is to put people on a ferry at this point.

As someone who takes the Hingham Ferry from time to time, you don't want to be on it in cold weather. You have a massive amount of people crammed into a space with average to below average ventilation. We call it the Germ Barge for a reason. Summer and Early Fall are different when you can stand outside but taking a bunch of people, many of whom, are, sorry for this, already off their rocker, is not a good idea. The spread of the virus would increase coupled with people who can't seem to keep their mojo together now on a boat with waves and wind. The amount of support staff needed to handle this transport would take away from what is already going on at the Newton Pavilion and other locations.

Besides, Thompson Island is not a medical facility island, it is a school like campus. Long Island is, but because of the clown show of Quincy politics, there is still no replacement bridge. You would have to move the equipment and staff needed for this operation to the island by boat, a lot of boats. Would everyone please get the idea that a bridge to Long Island is needed? A ferry back and forth for medical reasons is asinine.

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A lingering issue of contention between the two cities (Quincy and Boston) was Boston's decision to designate Long Island an "economic opportunity zone" through a new federal tax-deferment program intended to spur economic growth in select low-income neighborhoods. -- Patriot Ledger, September 12, 2019 (three months before virus)

With federal help flowing and the Army Corps of Engineers building hospitals for every Mayor that has asked, has Mayor Walsh asked them to rebuild the already designed, shovel-ready, new Long Island Bridge? After all, rapid bridge building --strong enough to carry Army tanks and heavy equipment-- is the Army Corps specialty. It would save the city the massive cost to build it, estimated between $100 million to $500 million. There's no doubt that President Trump would have made it happen in record time and Mayor Walsh knows that. That's why the mega-developers rushed to build out the very temporary Convention Center "hospital" so that Long Island would never be considered, instead preserved as the future Hamptons for Boston's elite. Why else would Walsh now declare it an "economic opportunity zone" even though there's never been a private business on the island? The fact is, if the homeless are put back there, Walsh knows he can never get rid of them a second time.

To suggest Long Island isn't feasible because of a lack of rapid EMS transport is absurd in the age of Med-Flight and fast ferries that travel in any weather. Nobody cared about transport time in the "good old days" when the Boston EMS ambulance had to be dispatched from Dorchester or Southie (or further), then drive over the Neponset Bridge into Quincy all the way to the island and back again. How many died in transit? Why aren't Markey, Warren, Kennedy III, Lynch etc. demanding a free federal bridge, now? Did the developers say no to the homeless that would benefit now and long-term?

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Since you seem to support Quincy's political and law enforcement establishment at every single turn, you are beyond bias here.

The Mayor's Office, coupled with the Quincy police, you know, the group kept quiet on a murder committed (allegedly) by the two sons of a former police officer at the foot of the Moon Island Causeway only announced an arrest late in the day on election day, after Koch (pronounced Buffoon) had the votes needed. This, despite the fact that the murder was committed in a "cop bar" and right from the outset everyone said that there were police related people involved. Real class acts there in Beirut Sur Neponset I'd say.

The Med Flight Thing (Really - A helicopter having to fly within 3 Logan flight paths?), The Fast Ferry Thing, The Luxury Condos on The Harbor Thing, The Native American Grave Disturbance Thing is all a smokescreen to keep the wealthiest in Quincy from having to watch the 276 go by a few times a time, even though this same bus went by a few houses on Dorchester Street for over 70 years. Shame on Quincy.

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let alone 'make it happen in record time'?

Ignoring the quid pro quo which motivates pretty much all actions of Trump, what's an example of something he made happen in record time in terms of infrastructure? Not the border wall. Certainly no great infrastructure projects. But you think he's going to break the mold to benefit homeless people (aka super poor) in a Democratic party stronghold?

That's wild stuff.

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Hypothetically, let's say we had "universal" testing just over the bridge in Southie.

Everyone got tested; young, old, rich, poor.

My gut says the numbers for those being asymptomatic would be similar.

The focus on the homeless (not the helping them part, i mean focusing on them specifically as main contributor for the spread part) is kinda messed up.

I doubt anyone living on Southhampton St went to the BioGen conference but chances are someone in a million dollar condo just off of Broadway did.

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As the governor said yesterday, until we get a vaccine, the way to fight this thing is finding as many people as you can who are infected, get them to isolate until they're over it and contact everybody they know to get them tested, into quarantine if needed, etc., repeat over and over.

It's an old technique that was used to stop Ebola in West Africa a few years ago and, more locally and more relevantly to the testing we're discussing, used to keep a small outbreak of tuberculosis in Boston's homeless population in the 1990s from becoming a large outbreak (that one was one in some ways even tougher to deal with, because people who don't really want to be followed had to be followed for weeks to ensure they kept taking their medicine).

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You're right, I sorta went nowhere with that comment, didn't I?

Just worried about everyone right now.

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We have a testing problem. When "everyone" can and is tested, we'll have a much better handle on what the hell is going on out there. Right now it's all conjecture, based on testing among certain groups (mainly people who are symptomatic.) How many people are walking around feeling normal but are actually infected? We have absolutely no idea! Pine Street is a perfect location where you have lots of people in one place who can easily be tested. The fact that they were homeless and getting "special treatment" should be applauded.

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I think the idea is that people staying in shelters are at much higher risk of exposure to the virus. So the proportion of infected people asymptomatic might be similar in another community (or maybe not, due to differences in age and prior health status) but the proportion of the community who has the virus is almost certainly going to be a lot higher among people in shelters. Plus, if someone is staying in a shelter you really need to know their status in order to help them find a place to isolate -- much more so than someone staying at home. I very much agree with the goal of not stigmatizing people for being homeless, but universal testing in shelters does seem to make public health sense.

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I have been walking my dog past Kindred Hospital at 1515 Commonwealth Ave. in Brighton consistently - there were a lot of cars there when it was first mentioned in the news - now it seems quiet. No cars in the lot this morning at all. Is it still being used to treat homeless COVID patients?

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They have been moved to the big conference center. It is now going to be a shelter.

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They’ve been moved from Brighton to the convention center in the Seaport??

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Yes, the building is becoming a homeless shelter now

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Will they be held by force?
Telling an addict who isnt sick they have to stay put is going to be difficult, and when they start to withdrawal it will get worse.

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People who are infected will have access to various health services including addiction care.

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Comorbidities including addiction can be treated during COVID-19 treatment.

Unlike what happens in county lockups in most areas of the Commonwealth.

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The Brighton Covid hospital for the homeless has been moved to the convention center and it will be a homeless shelter, the last I heard.

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What is your source for the Suffolk Dorm being used for Covid positive but asymptomatic homeless people. I have a friend who called the city about the firm and she was told it was being used for homeless people who tested negative.

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Yes, the intent is to give homeless people in general more room to quarantine if they want, not to provide housing for people who have tested positive. I've changed the reference.

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Testing a slice of the population can give indications that can be cautiously generalized to the larger group. This information is valuable. Likely, lots of us are walking around with infectious but asymptomatic cases. This is why testing of the virus and, even better, the antibodies to the virus, should be widespread as soon as possible so that quarantine can be applied in a targeted manner rather than social distancing the whole population ad infinitum.

Iceland, with a population of about 365,000 has randomly tested 10% of its total population. 0.3-0.8% of those tested were positive. Half of those who tested positive were aymptomatic. The latest data from Johns Hopkins indicates 8 deaths in Iceland with a case fatality rate of 0.5%, as opposed to 4.1% in the USA. Of course, we really don't know how many people in the US are positive because our testing is so far behind.

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It seems to me like everywhere that we do a large population sample survey, we are finding at least ten times the number of past or present infections that were thought before based solely on "confirmed cases," which in practice might mean "highly symptomatic cases."

See: Gangelt survey, Columbia Presbyterian maternity admissions survey, Diamond Princess, USS Teddy Roosevelt, the nursing home in Cambridge that recently tested everybody, probably more I'm forgetting. These are a combination of PCR (active infection) and antibody (past infection) surveys, and every one of them points to >10% of the population having been infected, with some of them suggesting even more.

PCR tests of symptomatic individuals are useful tactically but to really see what's going on strategically we need broad surveys of key populations using both test modalities. I suspect all will find vastly higher incidence and this has many important implications for what we do next.

One of my contrarian suspicions is that the roll-off in growth that we're seeing in hot zones like Italy, Spain, and NYC has relatively more to do with growing immunity among the population versus social distancing. Much larger scale testing is needed though or else we are just guessing.

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Is a good term for it.

I have a sneaking (evidence-free) suspicion here that many in the homeless population have built enough immunity to the usual coronaviruses (aka "the common cold") by living rough and in congregate housing that their immune systems respond more specifically to the novel virus, and thus suppress symptoms - just not enough to suppress their ability to infect others. If that is the case then generalizing will be difficult.

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I had a conversation with someone a while back where I was told that because of the structure of it (big, fuzzy, I dunno) it might be easier to come up with a cure once infected than a vaccine against it.
I would call your suspicion the 'daycare kids' scenario. Hell, those little germobots lick each others shoes.

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of people like me who got sick in March, thought they may have it, doc says stay home, don't go anywhere, no test for you!

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Also maybe that conspiracy story was true about smokers having less issues with Sars-Cov-2.

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