Inside Bangor’s heated debate over how to protect its homeless in an outbreak

When the new coronavirus officially arrived in Maine in March, it crept inland and up the coastline, closer to Penobscot County. In Bangor, local officials prepared to curb the spread of the virus, following some of the strictest early measures to shut down public places and encourage people to stay home.

But when it came to protecting people who are homeless from getting and spreading infection, city officials clashed with Bangor’s largest shelter, the Hope House Health and Living Center, over how to develop a strategy that was both prudent and fast.

They disagreed over whether to expand the number of shelter beds in the area and whether the shelter should keep providing them to people coming from away — a heated conflict that caused friction while the shelter searched in April for an additional location for some of its residents to comply with social distancing guidelines.

The Bangor Daily News requested email exchanges between city officials and the shelter to better understand how leaders in the community prepared to safeguard a vulnerable population that cannot follow orders to stay home to protect themselves and others.

The emails don’t encompass the entirety of communications or planning that took place, but they show how the city and shelter disagreed over how to interpret competing public health guidelines, causing tensions during the early weeks of the pandemic when the community had little time to waste.

“We had some passionate disagreements because people tend to be passionate about these issues. We wanted the same things but with different tactics,” said Lori Dwyer, president and CEO of Penobscot Community Health Care, which oversees the Hope House.

It didn’t help that Bangor was still uncertain of how severe the pandemic would be, some of which has become clearer now, Patty Hamilton, the city’s public health director, said. Even then, “There isn’t always an easy answer,” she said.

The Hope House did eventually see an outbreak of COVID-19 among 16 clients and four staff. By the time it was confirmed April 29, the community had formed a plan to shelter and care for those without homes, but it took longer in Bangor than in other Maine cities such as Portland and Presque Isle.

Cities should take a community-wide approach to protecting people experiencing homelessness, meaning city officials and organizations should collaborate on a response plan, according to guidelines from the U.S. Centers for Disease Control and Prevention.

As part of their planning, the agency recommends that shelters create “overflow sites,” so they can accommodate more people amid expected increases in demand, residents can sleep farther apart to avoid transmitting infection and people can quarantine if they’ve been exposed to the virus. Hotel rooms are also an option, depending on the availability of resources and staff.

In the weeks after the virus began spreading in Maine, the state government offered to help local communities find ways to spread out people who were homeless and accommodate a rise in demand. The Maine Department of Health and Human Services, Maine State Housing Authority and the University of Maine System offered overflow sites to cities such as Portland, Presque Isle, Lewiston and Bangor.

In Bangor, the Hope House, a low-barrier shelter, reached out to accept an offer that would have allowed up to 50 shelter residents to stay in the gymnasium of the University of Maine at Augusta’s Bangor campus. Not only was the shelter full, but it was unable to follow social distancing guidelines without more space to spread out residents’ sleeping mats.

City officials, however, were immediately wary of the plan.

Increasing the amount of shelter space risked creating “a regional shelter where other municipalities will dump individuals. If the goal is to reduce the amount of congregate housing and social distance, asking 50 additional people to live in a gymnasium [at] UMA is a huge problem for us,” City Manager Cathy Conlow wrote in an April 1 email to the city council, after the city was invited to join the state and the shelter on a conference call to discuss the concept.

She explained that the city had already taken a number of steps to find people shelter in spaces that didn’t draw people to Bangor or group them together. The city’s homeless outreach worker, for instance, had been working to find permanent housing for people still living outside, succeeding with 15 of them. Still, about 20 people remained outside, many of whom had refused help or been banned from area shelters, Conlow said.

The city had also worked with Penobscot Community Health Care to ready the Columbia Street Baptist Church as a quarantine location for anyone who fell ill with the virus. At the time, it was empty.

“We are going to advocate for not [expanding the shelter] and having each of the communities develop a plan to deal with their homeless. Creating for aggregation of vulnerable people is going to be a big problem and demoralizing to a [city] staff that has singehandelly worked to find these folks housing,” Conlow wrote. “We are quite frustrated.”

In the following days, Hamilton, with the city’s public health department, debated the best path forward with Dwyer, of the Hope House, who provided answers to her questions about demand, staffing, security and how to enforce compliance of shelter rules among guests. Kara Hay, president and CEO of Penquis CAP, a local social services agency, was also part of the discussion.

Hamilton came to agree there was a need for better social distancing at the shelter’s 54-bed Corporate Drive location, but she resisted adding more beds at an overflow location. She preferred solutions that avoided the creation of congregate settings of more than 10 people, given the outbreaks occurring at nursing homes and Gov. Janet Mills’ order that prohibited gatherings greater than that size.

She also asked the shelter to limit its existing beds to people who had visited the shelter within the last 90 days, as Portland did, she said. She wanted to know, too, how the Hope House would ensure its clients abided by rules to stay inside during the day, as other shelters in Bangor had imposed.

“I think the hospitals deserve this,” Hamilton wrote in an email on April 3, fearing an outbreak could overwhelm the local health care system.

Her thinking was informed by what many feared during the early weeks of the pandemic, she said: that Maine should prepare for the possibility that its hospitals would be inundated. At the same time the city was deliberating how to protect the homeless, it was also in talks to turn the Cross Insurance Center into a potential field hospital. It even contemplated signing a multi-million dollar contract to build more hospital space, Hamilton said.

Dwyer, however, worried the city’s demands would put her shelter staff in the difficult position of refusing people help during a crisis. She also didn’t think the shelter had the staff or time to find multiple, smaller overflow sites around the city, when they were already struggling to find one.

And there was likely going to be a challenge with converting the university gym into a shelter since it didn’t have a sprinkler system, Rindy Fogler, with the city’s health department, told the group on April 3.

“I honestly believe that one larger location is going to have to be good enough,” Dwyer wrote. “The longer we wait, the less effective this will be.”

She also pushed back on limiting the shelter to its current clients.

“I just worry that in the meantime a lot of people will suffer because we have no alternative plan for them (not that it’s our responsibility, but it is in fact our responsibility in the moment),” she wrote on April 6.

“Those are moral dilemmas I want to avoid for my staff,” she continued. They were already turning people away because the shelter was at capacity. She didn’t want to put them in the position of denying people because of where they came from. Many people were already showing up to the shelter frightened by the virus, she said. At the time, it was still cold at night.

Hamilton sympathized. “I know you usually run full so this must be even more stressful now,” she replied.

But she held fast to the city’s concerns, especially in light of more and more reports of the virus sweeping through congregate living settings.

Advertising a shelter in Bangor might also draw people to the city at a time when public health officials were discouraging movement. The city has long supported the needs of the region, but the parties differed on whether that role should continue during the public health crisis: Hamilton believed smaller towns should step in with more support to keep people at home, while Dwyer felt the challenge required Bangor to take the lead.

“In times of great disruption, what we have done in the past may not be the best approach right now. Maine has done well so far because of the extreme measures we have taken. We have the significant advantage of learning from what has happened when well meaning people across the county congregated homeless individuals in large group locations and the disastrous results,” Hamilton wrote in an email on April 8. “We can do things differently.”

As the parties continued back and forth, Hamilton decided she wanted to put the city’s position more formally in writing, not just in fragmented emails. On April 9, she sent a letter of concern to Dwyer, asking a series of questions about how the shelter would run a temporary overflow facility safely. She copied 10 others on the email, including the director of the Maine Center for Disease Control and Prevention and the commissioner of the Maine Department of Health and Human Services.

“I would like to make it clear that the City of Bangor is not in support of any shelter efforts you

undertake beyond those to achieve social distancing among current Hope House guests. Furthermore, I strongly advise that any plan you put into motion limits groups of individuals to no more than ten and institutes policies similar to those of other congregate living facilities,” Hamilton wrote.

“Placing people in smaller groups in different locations — although harder to manage — would be most humane and would result in reduced infection and spread,” she said. “Should you choose to move forward with a plan that exceeds our recommendations, we would like further details given the fact the facility will have a significant impact on our community.”

Dwyer felt insulted. In her lengthy response, she didn’t hide her frustration with the city’s insistence on a plan she believed was rational but impractical, or her disappointment in its portrayal of the conflict.

“PCHC has had plans in place that have been shared with the City repeatedly for social distancing for over a month. Our mission is to serve everyone, including and especially the most vulnerable, and that is all we are trying to do as we plan for the surge and work to [provide a space to] socially distance,” she wrote in an emailed response.

Indeed, disagreement wasn’t the only thing stalling plans. The city and shelter were still struggling to find a temporary space that would, at the very least, allow the Hope House to socially distance its clients. Two alternatives to the gymnasium had fallen through, and, though the shelter had proposed staffing the gym around the clock to get around the sprinkler issue, the city did not budge on life safety codes. The shelter had some leads on hotels where the homeless could stay, but hotel operators were wary of taking in people after some poor experiences, as Fogler noted in one email.

“I remain hopeful this may work out,” Dwyer concluded in her formal letter of response, “making all of this letter writing and drama an unfortunate diversion and misuse of time.”

The following day, April 10, the city’s fire department nixed the possibility of using the university gym because it lacked sprinklers, though the shelter had hoped an exception could be made if they provided staffing around the clock. The following Tuesday, the Office of the State Fire Marshal double checked the space at the request of the state agencies trying to help Bangor set up a temporary shelter, but it found a few more code issues, including a lack of smoke detectors, that would have required repair.

By then, the coronavirus had been in Maine for more than a month, and state public health officials had determined it was spreading among community members in Penobscot County. So that evening, the shelter decided to move about half its guests into the Columbia Street Baptist Church, arranging the sleeping cots in two pods of 10 people. It left the city without an option to quarantine people if someone got sick, but it finally allowed for preventative measures to keep the virus from spreading as quickly.

It was fortunate, then, that the shelter found a local hotel where sickened residents could stay by April 18, when someone who stayed at the Hope House contracted the virus. More hotel rooms stood at the ready, funded by a contract with the Maine State Housing Authority.

But because of the state’s limited testing capacity, caused by a nationwide shortage of testing materials, the shelter didn’t move forward with widespread testing. Instead, it had to wait for a third person to get sick before the situation could be designated as an outbreak. It was a reminder that, for all the tension and debate that accompanied the community’s harried plans to safeguard the homeless, it lacked essential tools to protect them from catching and spreading the virus.

“We were waiting, as everyone did, for someone to become symptomatic,” Noah Nesin, chief medical officer of Penobscot Community Health Care, said. “It’s impossible to know what things would have looked like if we were testing everyone for the preceding six weeks.”

On April 27, just over a week after the first case, the shelter recorded its third case and moved ahead with universal testing. The results were striking. Over the next two days, the shelter uncovered another 17 people who had contracted the virus, 13 clients and four staff members. None of them had shown symptoms yet. Some never did.

It brought the total number of infections to 20. One shelter guest was hospitalized, and the rest received rooms at a local hotel, where staff from the shelter and Penquis cared for them.

“Whether a week or more of more social distancing [at the shelter] would have made a difference [in the number of cases] is impossible to say,” Dwyer said.

Since the outbreak, communication has improved and the tension has dissipated between the shelter and the city, Hamilton said. “It’s our job as leaders in the communities to express our concerns and our passions,” she said. “Both of us came from good places. It didn’t affect our relationship.”

Fortunately, as of Friday, there had been no new cases among the shelter’s staff or clients, and some have since recovered. The shelter did not ultimately adopt a policy of turning people away who are new to the area.

And because the state has since expanded its testing capacity, the community has been more proactive in tracing the path of the virus among the wider homeless population, Nesin said. On May 15 and 18, the shelter tested 33 people who were living outside along the Bangor waterfront.

One person tested positive, Dwyer said, but everyone was offered a hotel room to escape the outdoors.