What Miami's Homeless Can Teach Us About Surviving The Pandemic

MIAMI, FL — It was just a few days after Easter and Passover when Ronald L. Book got a call on a Saturday morning telling him that a 26-year-old man became the first homeless person to die of the coronavirus in the Miami area.

"I literally cried for two days," Book, who chairs the Miami-Dade Homeless Trust, shared in an interview with Patch. "We got through — I don’t know, six weeks or so, seven — we hadn’t lost any lives. I don’t even think at that point we had three people, four in the hospitals."

The homeless man, who was living at the Chapman South Homeless Assistance Center, a shelter in rural Homestead outside Miami that borders the Florida Everglades, visited the facility's health clinic with a fever on April 17. He was taken by ambulance to Jackson South Medical Center in Kendall that same day.

"Five, six hours later he was dead," Book said. "I had reached a point where I was convinced we were going to save everybody, not going to lose any lives."

Since then, there have been three more deaths among Miami's homeless population, including two people who sheltered at the same facility. But, if Miami followed the experience of other U.S. cities, there could have been many more deaths.

"Those first weeks it was very common to read stories out of New York and California — about this homeless shelter and that — having 70 people hospitalized today out of one shelter, the next day 40 people, the next day 60 people," Book said.

3 Percent Positivity Rate

New data compiled by the Miami-Dade Homeless Trust, which is responsible for administering public funding for 20 organizations that work with the homeless around Miami, finds that Miami's homeless population and the 300 support staff who work directly with them, have had only a 3 percent infection rate since April 1 based on 3,400 tests to date.

Put another way, while Florida's most populous county of 2.8 million people struggles to gain control of a positivity rate hovering around 15 to 20 percent at times, some of the most at-risk people — people who don't always have a place to wash up during the day — appear to be faring much better than the average Miami-Dade resident.

Officials will be conducting tests and retests on 700 shelter residents and staff at three emergency shelters with nasal swabs provided to the Homeless Trust through the Florida Department of Emergency Management. The test results will be provided by the Florida Department of Health in Miami-Dade in the coming days.

The state of Florida's mobile COVID-19 testing unit already conducted more than 400 tests on July 15, which confirmed the low positivity rate.

Tests have also been conducted by the Lazarus Project, which focused on unsheltered people with severe mental illness who are among the most service resistant. Miami Fire Rescue conducted other tests as did Camillus Health Concern and Community Health of South Florida.

Book said his organization rejected the use of rapid tests early on, which he feared would have produced too many false negatives.

"I took a load of garbage from people for my unwillingness to take the tests," Book recalled. "A test that throws off false negatives is a garbage test."

People who tested positive for the coronavirus were moved to one of five designated sites as space permitted, including the Dunns Josephine Hotel, an historically Black hotel in the Overtown section of Miami, which welcomed the business opportunity.

Not Without Criticism

Despite the success with respect to the test numbers around Miami, the process was not without criticism. The Dream Defenders organization held multiple demonstrations in Miami to advocate for wider use of hotel rooms during the pandemic.

Many homeless people refused to go to shelters or hotels, according to the trust. The organization's strategy was to get the most vulnerable people off the street and keep them safe.

Samantha Batko, a senior research associate in the Metropolitan Housing and Communities Policy Center at the Urban Institute in Washington, D.C., told Patch it will be difficult to sustain the use of hotels and other forms of temporary lodging once the current health crisis has passed.

"Lots of places are doing similar things that Miami did," she said. "They are concentrating on decentralizing or deconcentrating their shelters. They are concentrating on making sure that they are isolating people who get sick. They are concentrating on isolating people who might be in populations who are particularly vulnerable to COVID-19."

She pointed to project Roomkey in California and an effort in Austin, Texas, to move people out of shelters during the pandemic while encouraging the homeless to be tested for the virus.

"The number of hotel and motel rooms that are being used in jurisdictions are dwarfed by the overall number of people who are experiencing homelessness," Batko cautioned.

The problem of homelessness will only get worse after the pandemic, she said. More Americans are likely to become homeless once eviction moratoriums are lifted around the country.

Never Imagined Life On Streets

At 63, William Renfroe wasn't always homeless and broke. He said he fell on hard times little more than two years ago when he took a trip from Miami to Richmond, Virginia, with his girlfriend, Joyce. She suffered a medical emergency and never returned.

She started to say she wasn't feeling well, and then dropped to the floor in mid-sentence. "She went to the hospital, and three hours later, she was no longer with me," he recalled. "She passed away in the end of 2018 — two years, a month and six days."

He developed a heart condition and battled diabetes, although his diabetes is under control now, but he has not been the same since Joyce's death.

Unable to pay the rent without her wages, he got evicted and found himself homeless.

"I was robbed the third night out," he said. "The only thing I didn’t lose was my cell phone."

He said he tried to get back on his feet a number of times since and even landed a 38-hour-a-week maintenance job at the W Hotel on Brickell Avenue in Miami before being furloughed when the pandemic took away 90 percent of the hotel's occupancy.

"I got my clothes. I got my shoes," he said. "If you're going to get out and do this, you've got to look the part .... You can't go in wearing a pair of ragged up nasty shoes you got on the street."

He had a lead on a job that pays $15 an hour as an assistant to an electrician, but he wasn't sure if he could remain sheltered at the hotel if he had to go to work every day outside of the hotel, potentially putting others at risk for the virus. It will take time to save for an apartment even if he gets the job.

"Most of the time they want first month's damage, sometimes two month's damage," he said of the Miami rental market. "I try to get in these senior places, but the garbage comes out you're not 65."

Earlier in life, he spent 26 years working at the American Rolling Mill Company in Ashland, Kentucky, before his job was eliminated by a change in the production process for making steel.

Since the pandemic, Renfroe said he has been tested three times for the coronavirus and the results came back negative each time.

Life on the streets can be bleak and many people lose hope and take their own lives out of despair.

"When you’re homeless there’s no tomorrow. You see a blind nothing," he said. "Nobody helps you. The politicians talk, but that’s what it is — talk."

Eventually, he fears he will have to leave the Dunns Josephine Hotel even if he hasn't landed a job by then.

"Everybody's scared of the coronavirus. I'm 63 years old. What is the difference of dying of the coronavirus, or dying broke, or going back to the street and get sick," he asked. "These people here are super. They're super cool. The bottom line is eventually I'll have to go anyway. The money will run out."

U.S. Surgeon General's Visit To Miami

Book of the Miami-Dade Homeless Trust spoke with U.S. Surgeon General Jerome M. Adams during his recent visit to Miami and was quizzed about the low positivity rate among the homeless of Miami. Miami-Dade is considered the epicenter of Florida's coronavirus outbreak with 132,461positive cases and 1,865 deaths.

"He wanted to understand how we managed to keep it that low," Book shared. "It was all about communication, and all about showing people we cared."

The Urban Institute's Batko said early reports from Boston and San Francisco found much higher positivity rates within homeless shelters than those being reported from the Miami area.

"The one that sort of gained the most notoriety — the one that came out of Boston — showed that the spread within shelters was very rapid and extremely prevalent," she said. "It was over a third of people in the congregate shelter tested positive."

In San Francisco, one shelter found a positivity rate around 25 percent. "They did a second round of testing even after doing some decentralization and putting some people in hotels, and they found that it was about 60 percent of people had it," she said.

Despite those disheartening statistics, Batko said, she is aware of another jurisdiction that fared very well but has yet to release its findings.

"I have had conversations with one jurisdiction that made a distinct effort to test a large portion of their unsheltered population, and they, incidentally, did not find any cases of COVID-19," she said, declining to identify the jurisdiction except to say it has a large number of homeless who live outdoors.

Growing Numbers Of Homeless Seniors

One of the biggest challenges facing homeless organizations in Miami and others U.S. cities even before the pandemic was how to handle the growing population of seniors who cannot afford to pay market rent.

"The homeless population has been aging somewhat in place for a while now," Batko explained. "It's not that the people who are already homeless are getting older, but there appears to be a cohort of people who were born within about the same decade who have remained at a higher level of vulnerability to homelessness as they've aged."

She said many of those people in the United States have experienced homelessness for the first time.

"People sort of became marginally attached to the workforce, never really gaining a strong foothold within the workforce," she said. "As they've aged, they have maintained stability through being able to work sufficient hours, having partners, maintaining connections with family, but as they got older, perhaps their spouse passed away or their partner passed away, or they are no longer able to work within the industry — if it was a heavy labor industry — or their industry has disappeared."

Some 165 seniors who were living in Miami-area shelters were moved to hotels and other facilities under contracts with the Homeless Trust. They were joined by another 200 seniors who had been living on the streets, according to Book.

"We have had a real problem with senior citizens for the last 20 months or so," Book confided. "We have had senior citizens in our shelters for 900 days, 1,100 days, 1,200 days. There’s something wrong with that. It’s not OK. It’s not OK. It’s bad, and we’re working hard to do something about it, including working to acquire a building where we could house 75 to 100 (people)."

Moving People With Higher Risk For Coronavirus

Over the course of the pandemic, the Miami-Dade Homeless Trust placed 847 people, including seniors and other people with a higher risk of contracting the virus, in hotel rooms and a leased assisted living facility called Mia Casa in North Miami.

"We’d test them and offer them a hotel room. Even those who wouldn’t test, we’d offer them hotel rooms," Book recalled. "We then started housing in hotels anyone with underlying health issues. We tried to force all of them to take tests. Most did — some didn’t. I think one of the hard challenges was getting those that we were putting in hotel rooms to take the placement and quarantine seriously."

Some people had to be taken out of hotels if they put others at risk through their actions, according to Book.

"You can’t just go and come, and go and come, the way you want," Book explained. "We need to send a message. You had to have the discipline."

Part of that discipline was getting the homeless population to understand they must use hand sanitizer or wash their hands at least once every hour. They were given hand sanitizer, as well as sanitary wipes, along with flyers reminding them what to do to survive.

"If you touch the ground. If you touch a wall. If you touch a railing. If you touch a bench, they’ve got to wash again in that hour," Book said. "I was frustrated all the time with the mask piece because I really don’t believe that I ever fully got the street population to fully embrace the importance of masks. But they wore them. They just didn’t wear them as much as I would have liked."

Conference Calls Helped

Another key piece of the pandemic strategy in Miami involved holding almost daily conference calls among the Miami-Dade Homeless Trust and its partner organizations.

Since the trust is responsible for dividing up funding, it has leverage to get the homeless organizations to follow the same rules.

"I fund their programs. They were inordinately cooperative and helpful in those early weeks, for many weeks," Book said. "We were in uncharted territory. None of us knew then what we know now. We knew that we were going to have people that were going to come and go from the shelters during the day.

"We can’t just let them back in because you don’t know who they were in touch with," he said. "If the message was about mitigating spread, then you had to know when they came back each day: Who did you see? Who did you touch? Who did you talk to? Did you wear a mask? Did you properly socially distance? All of those things we were developing literally as we moved along."

Strategy Paid Off

Book said he knew the approach was paying off when a woman who lives at Lotus House worked on a cleaning crew assigned to the Ruth K. Broad Bay Harbor K-8 Center, which was shut down in mid-March after an aftercare worker tested positive for the virus.

"When she came back to Lotus House that night, late afternoon. Hey where have you been? What have you been doing? 'Well I was cleaning a school.' Where was that school? 'Well it was Bay Harbor Elementary'," Book recalled. "They knew they couldn’t let her in. That was the day we knew for sure in those early stages that the questions we were asking — and we had our providers asking — were working."

Mixed Blessing

Sixty-year-old Phillip Roundtree of Miami has tested negative for the coronavirus more times than he can count. He gets tested twice a week — every time he takes chemotherapy for his prostrate cancer.

For him, the pandemic has been sort of a mixed blessing. Because of his medical condition, he must be extra careful to avoid the virus, but if not for the high prevalence of the disease in Miami, he might otherwise not have gotten a room at the Dunns Josephine Hotel three months ago.

"Homelessness is a No. 1 killer," he said. "The coronavirus, when it hit here, for me myself, it's not a bad thing because in some ways, and somehow it has helped me. If it weren't for the coronavirus, I'd probably be out there on the streets somewhere."

At one time he was in the military, but only for a couple of months before being diagnosed with bleeding ulcers. Later, in life he battled a cocaine addiction.

"I grew up here all my life," he shared. "I've never been out of the state of Florida."

Surprisingly, he said, he came from a wealthy family and has worked as a cook, in security and as a nurse's aide.

"I never was homeless a day in my life," he said of his family. "They are all successful. I call them all the time. I got six sisters and I got a brother, every one of them very successful. I call them because I want them to give me hope, share their life with me. But they never call me. I got three grown kids. They never call me."

When The Old Normal Returns

Book said there will come a day when life will return to the old normal for the homeless who have been fortunate enough to ride out the pandemic in a shelter, hotel room or Mia Casa.

"Let's face it, if COVID goes away tomorrow morning, nobody should think I’m putting people back out on the streets because I’m not," Book insisted. "I will find a way to find housing for a lot of people in relatively short order.

"I don’t have housing available right now for everybody, but I’ll find it," he said. "Anybody that wants to continue to stay inside, I’m not putting them out. That’s the opposite of what we are."