San Francisco’s early use of isolation and quarantine hotels for homeless and marginally housed residents who had been exposed to Covid-19, or showed symptoms, may have significantly freed up capacity at San Francisco General Hospital and prevented transmission to the rest of the city, a new study showed.
The Journal of the American Medical Association Network published the findings on Tuesday. The main authors were UCSF professor Dr. Jonathan Fuchs, who has been in charge of San Francisco’s testing strategy and directs the Center for Learning and Innovation at the Department of Public Health, and General Hospital emergency room physician Dr. Hemal Kanzaria, the Faculty Advisor at the UCSF Benioff Homelessness and Housing Initiative.
The study tracked 1,009 individuals from March 19 to May 31, 2020, who were referred to isolation and quarantine hotels, which have provided vulnerable residents, and particularly homeless individuals, a place to recover from Covid-19. The hotels also offered round-the-clock access to nurses, doctors, security guards, substance recovery counselors, meals, laundry service, accommodation for children, and a $20 gift card at the end of their stay. I&Q hotels during 2020 managed to serve 3,300 people.
“There was a critical need to establish” I&Q hotels to “contain the spread of [Covid-19] in these vulnerable communities while preventing hospitals from becoming proxy I/Q facilities,” the study states. “Without this option, persons might need prolonged hospitalization while they are infectious, straining valuable hospital capacity.”
“Really, this program specifically was to create a safe space that would help preserve hospital capacity and ensure those in crowded situations not go back to them fuel community spread,” Fuchs told Mission Local. “We want a safe space to recuperate.”
“Isolation and quarantine” hotels are not to be confused with “shelter-in-place” hotels. The former are for individuals who have been exposed to covid or develop symptoms; the latter are for vulnerable individuals, such as the homeless, regardless of exposure or symptoms.
Both Fuchs and Kanzaria said they could not conflate the results of their targeted study on I&Q hotels to draw larger points about the shelter-in-place hotels, which were a major source of friction between the Board of Supervisors and the mayor last year.
The health benefits of having a residence that enables one to self-isolate serves as another example of why San Francisco should address the urgent need for housing, the study asserts.
“I think these kinds of programs are essential,” Fuchs said. “Especially in the context of the pandemic, it reinforces the larger issue in the city— our need to support affordable housing.”
Of the total participants, 81 percent completed their entire recommended quarantine period, suggesting that these hotels curbed some viral transmission from entering the rest of the city.
Only 4 percent of the guests needed further investigation for potential hospitalization, when their disease appeared to get worse. None died in the hotels.
Fuchs said that those who were unsheltered were 4.5 times more likely to leave their I&Q hotel early, which the study surmised may be due to mistrust of services, and compounded symptoms of isolation and disruption to routine.
The addition of mental health and harm reduction services, and alcohol for those suffering withdrawal, likely played a key role in keeping infected people in their rooms. Of the 1,009 I&Q guests seen in the March to May period, 225 had comorbid mental health disorders, and 236 had comorbid substance-use disorders.
These hotels also seemed to clear space at the local hospitals and assist in preventing any from being overwhelmed. In the most recent winter surge, California counties shut down numerous activities as ICUs flooded with patients and regional facilities fell below 15 percent capacity.
“We needed to preserve precious hospital capacity to our patients with the sickest conditions,” Kanzaria told Mission Local. “We saw excess morbidity occur when hospitals are overwhelmed.”
The study showed that of the 546 Zuckerberg San Francisco General Hospital referrals to I&Q hotels, 327 people were eligible and attended, and 76 percent completed their entire stay. Of those, 62 percent had Covid-19.
“Over time, an increasing proportion of transfers came from the emergency department, urgent care, and ambulatory care clinics, which averted the need for hospitalization altogether,” the study states. By May, the last month of the study, 77 percent of referrals happened before someone reached the hospital for Covid-19.
“The I/Q system may have helped divert patients to hotels instead of requiring continued hospital-based isolation, thus preserving critical capacity in our city’s largest public hospital,” the report continues.
“Covid is a public health emergency. Homelessness was a public health emergency before covid,” Kanzaria said. “I hope we can use this opportunity to think about sustainable solutions for homelessness.”