CURRENT/EMERGING ISSUES & STRATEGIES FOR SUCCESS

1. Increasing surge of cases among people experiencing homelessness, including those who are fully vaccinated.
2. Increasing breakthrough cases among vaccinated people who are older, have preexisting conditions or are immunocompromised.
   
3. Decreasing interest in J&J vaccine due to recently added side effect warning as well as concern about decreased efficacy with new variants.
4. Evolving data on vaccine efficacy on new variants raises questions about which vaccines should be offered.
   
5. Identifying ways to motivate clients to get vaccinated is more difficult and requires a more varied approach than when vaccines were first available.
6. Growing positivity rate in those tested has staff concerned about the true level of growing cases because of inconsistent testing protocols across communities.
7. Observing low vaccination rates among people experiencing homelessness compared to their overall community.
8. Remaining unvaccinated people are less swayed by external motivation such as keeping others in the community healthy.
9. Ongoing data-sharing challenges in obtaining vaccination status for clients who get vaccinated outside of clinic settings.
10. Expiring vaccines are difficult to reallocate which creates an administrative burden and demoralizes staff.

1. Address concerns about vaccine side effects by providing resources to cope including Tylenol, soup, tea, and ideally hotel/motel stays.
2. Utilize health care students to staff vaccine clinics and serve as a recruitment pool for future employment opportunities.
3. Ensure all health center staff (to include volunteers and specialty care providers) --as well as shelter staff and other community partners--know how to refer clients to get vaccinated at your health center to increase vaccine uptake.
4. Educate clients on the increased dangers of the delta variant to motivate more vaccinations.
5. Offering new and creative incentives may create interest in vaccination as other incentives expire or are no longer available.
6. Train current Community Health Workers and other staff or consumer leaders to serve as vaccine ambassadors.
7. Talk with clients about the mortality rates between vaccinated and unvaccinated people – 97% of those who have died from COVID recently are unvaccinated.
8. Continue offering vaccines in multiple settings: such as within primary care visits, at pop-up vaccine clinics in the community, and on outreach.
9. Document reasons clients decline the vaccine in the EHR so that other providers can continue the conversation and try other approaches.
10. Advocate for I&Q and non-congregate shelter options to remain open while vaccine rates remain low and cases continue to rise.
    

POLICY DEVELOPMENTS

• HHS Secretary Becerra renewed the Public Health Emergency Declaration for an additional 90-days until October 20, 2021. This is the sixth time it has been renewed since it was first declared on January 27, 2020.
• U.S. Surgeon General Dr. Vivek Murthy issued his first Surgeon General’s Advisory warning people about the urgent threat of health misinformation. He states that misinformation that is misleading or false, especially on social media, is contributing to confusion and rejection of public health recommendations known to help stop the spread of COVID-19.
• While the American Academy of Pediatrics has recommended universal masking in schools, the CDC states that they do not plan to update their guidance.
• The CDC’s federal eviction moratorium expires on Friday, July 31, 2021. The Biden Administration does not plan to extend the federal moratorium further and instead is promoting available federal rental assistance funds.
• Nearly 60 health care organizations have issued a statement encouraging vaccine mandates. The Veterans Administration, the State of California, and New York City are all now mandating vaccines for public employees, and the Biden Administration is “considering” vaccine mandates for federal employees.
• HHS has released $1.6 million for COVID-19 testing to state health departments, to include $80 million for homeless shelters and other congregate settings.
  

NEW RESOURCES

• AAMC: The Principles of Trustworthiness
• National Alliance to End Homelessness: Alliance Resource Series: Using COVID-19 Federal Funding to End Homelessness
• CDC MMWR: COVID-19 Vaccination Coverage Among Insured Persons Aged ≥ 16 Years, by Race/Ethnicity and Other Selected Characteristics – Eight Integrated Health Care Organizations, United States, December 14, 2020-May15, 2021
• NAEH: Prioritizing People for Emergency Housing Vouchers
• NHCHC: Where Does Homelessness Happen? Understanding the Definitions of Homelessness
• Chicago Coalition for the Homeless: Unaccompanied Minors Access to the COVID-19 Vaccine
• Chicago Coalition for the Homeless: Memo - Minor Consent
• Vaccine Equity Cooperative
• Homeless Deaths Count
  

RESEARCH

• Health Affairs: Estimated Mortality Increases During the COVID-19 Pandemic By Socioeconomic Status, Race, And Ethnicity
• The Lancet: SARS-Cov-2 Prevalence, Transmission, Health-Related Outcomes and Control Strategies in Homeless Shelters: Systemic Review and Meta-Analysis
  

WHAT WE'RE READING

• WYPR: City Council Holds Hearing On Eviction Crisis
• The Denver Channel: Health Officials Make New Push to Get Vaccine to People Experiencing Homelessness
  

• The Commonwealth Fund: The Room Where It Happens: The Role of Primary Care in the Next Phase of the COVID-19 Vaccination Campaign
• CBS Atlanta: Atlanta Homeless Advocates Demand Housing, Healthcare And Input On Solutions
• KFF: COVID-19 Vaccine Monitor: In Their Own Words, Six Months Later
• KHN: The Delta Variant Thrives in a State of Political and Public Health Discord
• KHN: Analysis: Necessary or Not, COVID Booster Shots Are Probably on the Horizon
• KHN: "What the Health?": Delta Changes the COVID Conversation
• NPR: The U.S. Surgeon General Is Calling COVID-19 Misinformation An "Urgent Threat"
• NPR: California Turned Pandemic Rentals Into Permanent Housing for Homeless People
• USA Today: COVID Booster Shot ‘Would Be Helpful’ for Immunocompromised People, Advisory Committee Recommends
• The Press Democrat: Widening COVID-19 Outbreak Reported at Sonoma County’s Largest Homeless Shelter
• STAT: States Are Sitting on Millions of Surplus COVID-19 Vaccine Doses as Expiration Dates Approach
• STAT: Public Health Officials Have Tools to Beat Back COVID Again. Does Anyone Want to Use Them?
• Reuters: U.S. CDC Advisers Back J&J COVID-19 Vaccine Benefits Amid Neurological Illness Reports
• The Atlantic: America Is Getting Unvaccinated People All Wrong
• AP: Vaccinations Rise in Some States with Soaring Infection