SF struggles to help COVID-positive tenants living in group settings

Nonprofits running SROs are experiencing frustrating miscommunications with the San Francisco Department of Public Health

On Guard column header Joe

Besides San Francisco’s homeless population, single-room-occupancy hotel dwellers are among the highest risk to catch and spread COVID-19: Dozens of tenants living in single rooms in SROs often share kitchens and bathrooms, making healthy isolation nearly impossible.

Nonprofits running SROs are experiencing what they call frustrating miscommunications with the San Francisco Department of Public Health that may put those hotel-dwellers at risk.

Emails this columnist obtained between doctors, public health officials, city leaders, nonprofit SRO staff and others show a scramble behind-the-scenes to figure out just how to stem the spread of COVID-19 in SROs.

City officials want the Department of Public Health to notify them of buildings containing COVID-19 positive patients, so that quarantine measures can be enacted, but public health officials have refused, citing medical privacy laws.

Sources also tell this columnist the Department of Public Health has in some instances ordered SRO residents to shelter-in-place at home, despite The City’s stated practice of moving COVID-19 positive SRO residents into roughly 2,000 hotel rooms that have been obtained specifically for SRO residents and homeless people to be quarantined.

The lack of communication may also hamper contract-tracing, as public health officials have reached out to desk clerks instead of SRO property managers, in what officials called a demonstration of inexperience with SRO operations.

Interviews reveal at least one case of mistaken identity in an attempt to quarantine family members of a COVID-19 positive patient, and a lack of Cantonese-language speakers has hampered doctors’ ability to timely help SRO-living COVID-19 positive patients and their family.

Sheltering-in-place is nearly impossible in an SRO, where shared surfaces — like bathrooms, faucets and kitchen tables — mix the lives and fates of as many as 200 households in a single building.

There are roughly 500 SRO hotels in San Francisco, encompassing roughly 20,000 living units, some of which are home to families of three or more.

City leaders fear that without proper protocols, SRO’s may just be a powder keg. So far there have been relatively few COVID-19 positive cases in San Francisco, respective to the rest of the United States. But SRO residents remain particularly at risk.

That’s the fear of Mrs. Chen, a self-chosen pseudonym for one Nob Hill SRO tenant who spoke to this columnist on the condition of anonymity.

No quarantine possible

Mrs. Chen’s father and mother-in-law both tested positive for COVID-19, and her father-in-law even now is on a ventilator in Chinese Hospital. I this verified through public records showing communications between the Chinatown Community Development Center, Supervisor Aaron Peskin’s Office, and the Department of Public Health.

It was a normal day for Mrs. Chen in late March. Shelter-in-place orders had been issued, and a pandemic was sweeping through the world, but Mrs. Chen, a decade-long San Franciscan and hotel worker, was washing her family’s clothes at a Nob Hill laundromat. That’s when she got the call from her husband.

Her father-in-law had stomach pain and needed to go to an emergency room. By the afternoon, her father-in-law was admitted at Chinese Hospital and tested positive for COVID-19, but not her mother-in-law.

But here’s the rub: Mrs. Chen, her husband, and two sons, aged 16 and 10, live in the same SRO as her in-laws, just downstairs. The chance that they, and her mother-in-law, were exposed to COVID-19 was strong. They were terrified.

“Living in an SRO we weren’t able to quarantine ourselves,” Mrs. Chen told me Thursday in Cantonese, as translated by a nonprofit SRO staff member. “We didn’t know who to contact. We felt really helpless.”

The family eventually contacted the Chinatown Community Development Center, which oversees other SROs in Chinatown and the Tenderloin. But Chinatown CDC, as they are called, contacted the Department of Public Health on the Chen family’s behalf. That’s when more problems arose.

Matthias Mormino, director of policy and government relations at Chinatown CDC, described the communication with the Department of Public Health as fraught.

Five days after Mrs. Chen’s father-in-law tested positive for COVID-19, the mother-in-law also tested positive — which the family insists should have been caught sooner. She was then admitted to Chinese Hosptial, emails show.

But after her symptoms stabilized she was told she could quarantine herself in the SRO. They told the Chen family that “if you live in an individual room, it’s fine,” Mormino said.

Much of these discussions were so well documented because Chinatown CDC provided Cantonese language translation between Mrs. Chen’s family and the Department of Public Health, hours of time on the phone, even as city officials push public health officials to make more Cantonese-speaking doctors available, emails between city officials show.

When the family, with the help of a translator, told the Department of Public Health that the mother-in-law lives in an SRO, with shared bathrooms and a shared kitchen, and could not possibly quarantine without effecting others, the solution officials gave them was a portable toilet.

“Someone has to pour it out for her,” Mrs. Chen told me. But, “her own children are afraid to help her … She is in her 80s and she is pouring out her own toilet at night.” Mrs. Chen said her mother-in-law should be quarantined in a city-provided hotel, with available city staff.

The private SRO property manager informed the building of the positive COVID-19 cases, Mrs. Chen said. “We heard some people have requested my father-in-law and mother-in-law move away,” she said. “But they can’t afford to.”

To add insult to injury, they asked to send documents by email. The mother-in-law, in her 80s, does not have an email address. The family also did not have access to email, Chinatown CDC staff told the Department of Public Health in an email.

At around the same time, Mrs. Chen’s family had not yet been quarantined. Public health officials mistook Mrs. Chen’s family for her brother-in-law’s family, who was already in contact with the Department of Public Health.

“They’re different unit numbers, different names, we’re telling you, you haven’t talked to them,” Mornimo recalled telling the Department of Public Health.

By April 3, Mrs. Chen’s family was quarantined and tested — negative.

Days later, Chinatown CDC obtained an email from the Department of Public Health saying the 50-unit building was “not an SRO,” Mornimo said. He admitted city accounting of SRO buildings are sometimes incomplete, with some private SRO’s — not ones run by nonprofits like Chinatown CDC — sometimes not showing up on city registered SRO lists.

But, he said, it was clearly an SRO hotel, with shared bathrooms, shared kitchens, and a high potential for outbreak should COVID-19 positive patients quarantine there.

“This is when we have a handful of cases,” he said, that required extensive email exchanges between roughly a dozen staffers from multiple city agencies and nonprofits to properly figure out. “If we get to an MSC South-level outbreak, they want us to email them about 70 cases? That’s not possible.”

Supervisor Aaron Peskin, who represents the neighborhood Mrs. Chen lives in, among others, is pushing for change at the request of nonprofits.

Health care clash

Department of Public Health Director Grant Colfax and Supervisor Peskin exchanged lengthy emails between April 10 and April 14, clashing on solutions to the pernicious problem posed by COVID-19 in SRO hotels.

While the list of tweaks to the process sought by Peskin and the SRO Collaborative, a partnership of SRO organizations, is lengthy, perhaps chief among them is more robust disclosure.

In situations like Mrs. Chen’s, SROs hope the Department of Public Health can inform them of a COVID-19 positive case so other SRO tenants can take precautions to avoid shared surfaces, like kitchens or bathrooms, and more effectively “contact trace” where the COVID-19 resident had been — what they touched, and who they talked to.

In one case, the Tenderloin Neighborhood Development Corporation, which operates 43 buildings with more than 5,800 San Franciscans living in them, told the Department of Public Health that notification was lacking.

“We were notified of a confirmed case at one of our SRO properties,” a TNDC staffer wrote to public health officials. But, TNDC was not informed of who the tenant was, whether they were at home or not, nor whether or not they had been assessed by The City’s Isolation & Quarantine Team.

“Much of this could have been done without necessarily disclosing the tenant’s name or unit number,” TNDC wrote, which also hampered giving information the Department of Public Health requested. “While we wanted to provide information about unit amenities to the Isolation & Quarantine team, we couldn’t do that because we didn’t know who the tenant was nor which unit they were in. This struck us as a flaw in the process.”

Peskin asked that Colfax reveal buildings with confirmed patients to his office and the Department of Building Inspection to provide oversight of the Department of Public Health’s efforts to quarantine SRO residents.

In an April 10 email to Supervisor Peskin, director Colfax said “building address and confirmation of the status of the tenants’ quarantine could not be provided because, “by law, we do not provide patients protected health information including addresses.”

When Peskin pressed Colfax to provide specific information to the owners and operators of SRO buildings of the specific residence of a COVID-19 infected person, Colfax replied, “Knowing that an individual is COVID positive does not protect residents or the public because SARS-CoV-2 is circulating in the community.”

Colfax added that the Department of Public Health is “planning to develop an internal database” of aggregated health information regarding congregate buildings, like SROs.

Peskin pushed back.

If revealing a building with a COVID-19 positive patient was against the law, Peskin said, “then the department’s announcement of the number of positive tests at Laguna Honda or MSC South Shelter was a gross violation of the law.”

When asked to comment on the heated exchange in the emails, Peskin said, “there’s nobody in this that is evil and bad,” but the communication breakdowns between the Department of Public Health and city SROs may “lead to deaths and hospitalizations that didn’t need to happen.”

Department of Emergency Management officials, who are responding to COVID-19 press inquiries, did not return requests for comment by press time.

As for Mrs. Chen, who herself lived through the tussles of bureaucrats high above her head, all the while worrying for the health of her family, she just wishes the Department of Public Health would fulfill San Francisco’s promises to residents: A hotel room for those infected, in a prompt and timely manner.

“I’m not satisfied with their work at all,” Mrs. Chen said. “Though we tested negative, we weren’t able to get quarantined for two weeks” before they knew for sure, even as her father-in-law lay in a hospital bed, hooked to a ventilator.

Impoverished people living in SRO hotels are depending on The City to help them, Mrs. Chen said.

But, she said, “I feel the government, they’re not treating everyone equally.”

On Guard prints the news and raises hell each week. Email Fitz at joe@sfexaminer.com, follow him on Twitter and Instagram @FitztheReporter, and Facebook at facebook.com/FitztheReporter.

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