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People experiencing homelessness are especially vulnerable to disease and often live in close quarters. But vaccinating this population against COVID-19 presents unique challenges. NPR's Yuki Noguchi reports on one Baltimore clinic trying to overcome those challenges.
YUKI NOGUCHI, BYLINE: Peter Sulewski spent nearly four years drifting between homeless shelters after his house burnt down.
PETER SULEWSKI: I've seen people freeze to death out there.
NOGUCHI: Homelessness, Sulewski says, is itself a health risk.
SULEWSKI: I would hate to be in a shelter during a pandemic. You're walking through doorways at the same time with people who share the same bathroom that nine or 10 other people might be using.
NOGUCHI: He now lives in an apartment, but still feels his health is at risk. He's 66, limps from arthritis and has urinary problems. Things like riding the bus to the community health center where we meet frighten him.
SULEWSKI: And the people are, like, packed like sardines in three-quarters of the bus with no masks. I mean, that was a scary experience.
NOGUCHI: Ironically, it's a risk he did take to mitigate his chances of getting sick.
SULEWSKI: I just got the call yesterday, said, you want to get the COVID vaccine? I said, yes, of course.
NOGUCHI: So Sulewski awaits his dose in a lobby with chairs lined up like a checkerboard. Health Care For The Homeless' Baltimore clinics see 10,000 patients a year. Now, they're trying to immunize them. Vaccines are in short supply, but some states, including Maryland, prioritized homeless populations because they're vulnerable. The Centers for Disease Control and Prevention last week urged vaccination at soup kitchens and shelters. But here, the pandemic halted mobile clinic outreach and visits to homeless encampments. Patients scattered or avoided the clinic for fear of infection. Kevin Lindamood, the clinic's CEO, says that makes the task harder.
KEVIN LINDAMOOD: If they're experiencing homelessness, all bets are off. It's incredibly hard to reach people even in non-COVID times.
NOGUCHI: Few have Web access, addresses and phone numbers change and the need for a booster makes vaccination more complex.
LINDAMOOD: How do we make sure that we get our clients back for that dose? Four weeks from now, that can seem like an eternity if you don't know where you're going to be tomorrow, if you're living transiently from place to place.
NOGUCHI: And, says Lindamood, COVID isn't even the biggest threat.
LINDAMOOD: People already dying from hypertension and diabetes, addiction and mental illness - Black and brown people are significantly more likely to experience homelessness. COVID-19 is layered over all of those pre-existing emergencies.
NOGUCHI: Joseph Taylor is 72 and ticks many of those boxes.
JOSEPH TAYLOR: I got diabetes. I'm hypertensive. I got a pacemaker. I got through two bouts of pneumonia.
NOGUCHI: Taylor arrived at Health Care For The Homeless after a stint in prison. He says he's a big promoter of the vaccine.
TAYLOR: People in general seem to me distrust hospitals and doctors and all that kind of stuff. I don't understand it.
NOGUCHI: Especially because he's lost friends and family to COVID.
TAYLOR: The ones that I know that lived through it described it. I'm not easily frightened, but I couldn't wait for the vaccine.
NOGUCHI: Eager patients like Taylor fill slots on the first day of vaccination. Then again, the clinic is administering only one vial of the Moderna vaccine today, containing 10 doses. Catherine Fowler is the clinic's head nurse. She anticipates that will become more difficult as vaccination ramps up.
A big reason is the vaccine itself. Open vials go bad after six hours, so patients must be managed in groups of 10. When there are no-shows, spare doses must quickly find their way to other patients. That again raises the communication and transportation hurdles for those without stable homes.
CATHERINE FOWLER: You need to have a nimble system to then find more people and get those 10 doses into arms.
NOGUCHI: They might have to get public transport here.
FOWLER: Exactly.
NOGUCHI: So Fowler keeps tabs on other patients in the building or nearby.
FOWLER: Oh, and we just got a text from someone, said, I know a patient who can be here in five minutes if needed (laughter).
NOGUCHI: Meanwhile, back in the lobby, Peter Sulewski received his shot.
SULEWSKI: I feel relieved.
NOGUCHI: He wants others to follow suit, but worries they won't.
SULEWSKI: I talked to my girlfriend last night, is she going to get the vaccine? She said no. I said, why? She said she's scared of needles.
NOGUCHI: That's why he fears COVID-19 might be here to stay.
Yuki Noguchi, NPR News, Baltimore.
(SOUNDBITE OF JON BRION'S "SPOTLESS MIND") Transcript provided by NPR, Copyright NPR.
