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Covid On The Margins

Covid on the Margins

As the pandemic continues to unfold nearly a year after reaching the United States, we all continue to feel burdened by COVID-19 in one way or another. Unfortunately, as in most situations, those on the margins of our society have been disproportionately affected by the pandemic. This year I was given an opportunity to serve vulnerable populations in my community while helping to minimize the transmission of COVID-19 at an Isolation and Quarantine center in Seattle. This job opportunity has given me a better understanding of the experience of those on the margins during this time. 

I completed a year of service with Mercy Volunteer Corps in 2017-2018 at Pittsburgh Mercy’s Operation Safety Net (OSN), where I provided medical care as a Registered Nurse to those experiencing homelessness. I spent most of my time under bridges throughout the city and in shelters and day centers. After completing my year at OSN, my goal was to gain a couple of years of experience as an RN in a hospital to broaden my skill set before again working in public health. As job stability became uncertain for many this year, health care providers included, I questioned whether this would really be a good time to venture into something new. However, I was fortunately connected to an agency that hired me as one of three nursing supervisors for King County’s Isolation and Quarantine (IQ) centers at the end of March, just a week before they were set to open. 

The IQ center project was initiated by King County Public Health officials in the Seattle area. The IQ centers are in place to prevent and slow the spread of COVID-19 in our communities, and are available to those who have been exposed to or tested positive for COVID-19, are medically stable, and need a proper place to quarantine according to CDC guidelines. The centers consist of motels and trailers that have been transformed into facilities for quarantine. As with any public health initiative, prevention is the emphasis. Therefore, we do not function as a hospital, but instead, as a place to space out the most vulnerable, with health care workers present to assess patients’ need for a higher level of care at any time.

The need for these IQ centers in Seattle and across the country and world is obvious when we consider how densely populated shelters are. Those experiencing homelessness are at greater risk of being infected by COVID-19 due to increased exposure and inability to social distance. This population also has poorer outcomes due to comorbidities and lack of primary care. Although the IQ centers are set up for anyone who needs to use them, it’s typically only the most vulnerable individuals who show up at our doors, as they do not have adequate support systems to lean on, homes to quarantine in, or money for a hotel room for two weeks of isolation. In this case, making sure those with COVID-19 exposure or active infection are quarantined not only benefits that singular person, but also prevents the spread in shelters where people are sleeping in close quarters, and in turn slows the spread in the greater Seattle area. It also opens up hospital beds for those who require extra medical attention. 

When first organizing the IQ centers in March, the main priority was the safety of patients, staff, and the surrounding community. At the time, there was still so much to learn about proper personal protective equipment (PPE) usage and how to minimize transmission of a little-known disease. Almost equally as important as safety, however, was creating a low barrier environment for people experiencing homelessness. This meant making sure patients know that their belongings will be kept safe and locked, they have access to walk-in outdoor spaces at their own leisure, and substances and medications will be provided as needed to safely prevent deadly withdrawal symptoms from drugs and alcohol. Those on the margins of our society are often skeptical of our systems, as they have been suppressed by them for years. As community workers, it is our responsibility to lower the barriers that prevent people from receiving the resources they need for survival. 

Nearly eight months later, our IQ centers continue to staff nurses and nursing assistants, doctors on call, and a large behavioral health team that does a tremendous job of connecting patients to services for a safe discharge after their quarantine. It has been an incredible team to be a part of all year. When I first began as a supervisor, I had the opportunity to help create policies and procedures and change the flow of the organization as needed. My time as a Mercy Volunteer at OSN prepared me exceptionally well for this unforeseen opportunity. OSN gave me the skills to meet people where they are and to independently provide medical services to those experiencing homelessness. My time at OSN also empowered me to take on new leadership roles, as I was able to help manage the medical team and always encouraged by my colleagues to be innovative, creative, and independent, during my year of service… My first day at the IQ center brought me nostalgia for my time on the streets of Pittsburgh. I’m reminded every day that my time as a Mercy Volunteer will continue to influence my career for the rest of my life.  

As we all continue to adjust to new norms due to the pandemic, it is important to keep those at the margins in mind. Most US cities had a shortage of shelter beds prior to this year, which is exacerbated by social distancing requirements. Day programs are required to shut down when outbreaks occur in clients or staff. Job opportunities are scarce for many. The wealth gap that has kept people in cycles of poverty is only growing. Many do not have the benefit of working from home or taking sick time. Food insecurity is rising for families and children. 

The pandemic has also been a time for communities to come together and find innovative ways to protect those on the margins. We can serve vulnerable populations by donating our money, resources, or time to those in need. Most importantly, we can all serve and love one another by practicing social distancing, masking up, and doing our part to slow the transmission of COVID-19. 

Kelsi Bockenhauer: Pittsburgh Alumna

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