Isolation Hotel Referrals Add to Strains of Slammed ERs

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Mayor Bill de Blasio on Thursday announced 11,000 free hotel rooms to help curb the spread of coronavirus, providing a safe isolation space for those who are recovering from illness but can’t afford a room of their own.

Until now, those hotel rooms have been available only to individuals referred by homeless shelters or by hospitals — a system that medical providers say has forced too many sick people to flock to already overwhelmed ERs to seek help.

“There are many people in multigenerational homes, particularly lower income communities that just don’t have a lot of space,” de Blasio noted, “and if there is a threat that someone might get infected in the home and it might spread amongst the members of that family, we have to guard against that.”

De Blasio suggested that the program, to begin Wednesday, will target crowded households in low-income neighborhoods.

Yet he also indicated the program would rely on hospitals and community health centers to provide referrals to the hotel rooms — continuing an existing system that medical providers say has already become a strain and prevents widespread use of the isolation rooms.

“Social distancing, if you already have symptoms, is reactive,” said Dr. Nicholas Gavin, an associate professor of emergency medicine at Columbia University Irving Medical Center and ER physician. “Allowing social distancing in a pandemic with widespread community transmission is proactive.”

Adding to the logjam, say Gavin and other providers, is a bureaucratic wall built between the city Department of Homeless Services and the Office of Emergency Management, which each operate their own hotel rooms and have separate referral systems.

“We’re dealing with one disease,” said Gavin. “We should be dealing with the entire population in the same way.”

Ordeal to Access

Hospital patients who’ve tested positive for COVID-19 and don’t have a place to go after discharge are isolated in hotel rooms provided by the city, according to Omar Bourne, a Office of Emergency Management spokesperson.

As with the homeless shelter isolations, they stay for seven days after the onset of symptoms, and until they’ve been three days without fever and are feeling better, according to protocols unveiled in late March.

“This includes anyone who cannot return to their homes for being sick with COVID-19,” Bourne told THE CITY on March 31.

The program has changed little since then, save for the admission of some individuals who have not been in a hospital but are referred by local health centers — the same system de Blasio noted Thursday.

Homeless people are placed in the Department of Homeless Services’ isolation units — many of them within homeless shelters — before they are transferred to hotel rooms for quarantine, according to the agency’s protocols.

DHS has its own block of 2,500 isolation hotel rooms. The mayor’s Office of Emergency Management handles the rest with its 11,000 rooms, which are also available to frontline workers.

But even for patients who are seen at hospitals, the rooms can be an ordeal to access.

Alphonso Syville, a resident of the Wards Island men’s shelter of 10 years, was referred to Mount Sinai Hospital by shelter staff after he exhibited COVID-19 symptoms on April 3.

Alphonse Syville said he waited in a shelter vestibule for seven hours before a van took him to an isolation hotel.

After getting tested for the illness, he waited seven hours on the floor of the hospital waiting room only to be kicked out by security, who said he was not allowed to sit on the ground.

“They’re not looking at us like we’re human beings,” Syville told THE CITY. “‘Oh, they’re homeless,’ we’re expendable.”

At around 2 a.m. on April 4 — suffering headaches, shortness of breath and chest pain — he walked back to Wards Island alone.

Once at the shelter, with no way to go back to his dorm, he waited an additional seven hours at the shelter vestibule for a van to arrive and transfer him to his isolation hotel in Long Island City, Queens, where he stayed for seven days. His test results came back negative.

Overburdened ER Docs

Physicians and other frontline workers can apply for a room online, but people who are seeking a way to avoid infecting those they live with cannot. If they call 311 or a hotline number to request an isolation unit, they will be referred to “a partner agency” — Department of Homeless Services or a hospital.

That’s preventing many of those who need to protect those they live with from accessing the rooms, say advocates seeking more isolation hotel rooms.

“We have to have a user-friendly, efficient and very rapid way for people to get access to isolation space and the care that they need, whether they’re in the streets, in the shelter, couch-surfing, doubled up in somebody’s house, or coming in from Rikers Island,” said Josh Goldfein, a staff attorney at The Legal Aid Society’s Homeless Rights Project.

OEM discharge protocols for hospitals with COVID-19 patients who can’t isolate at home.

“Until we can do that, we’re not going to be able to control the spread of the virus,” he added.

Meanwhile, the bureaucracy is adding more work for doctors and hospitals already overwhelmed with treating the sick and dying while trying to protect themselves from infection.

Where hospitals lack round-the-clock social workers, the burden of referring patients to isolation rooms — and even deciding which government agency to call to find out if a room is available — falls on the physician, especially on overnight shifts.

Doctors must even determine whether each patient is or is not already registered with the Department of Homeless Services.

“Because the process is fairly burdensome we cannot put this on frontline physicians,” urged Gavin. “It’s not tenable. It’s not reasonable.”

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