Sheltering in a time of COVID: Non-congregate sheltering

By DR. DAVID HOLCOMBE | Region 6 Medical Director, LDH Office of Public Health

Sheltering during a natural disaster has always been a responsibility of the State of Louisiana, in collaboration with a few other entities. General population shelters are opened by the American Red Cross and other private groups. Shelters for those without transportation (Critical Transportation Needs Shelters, or CTNS) and those for people with medical needs (Medical Special Needs Shelters, or MSNS) are provided by the State.

The Megashelter — or more properly, the State Emergency Shelter at Alexandria — was completed near LSU Alexandria in 2010, just in time for Hurricanes Gustav and Ike. At more than 200,000 square feet, this facility can hold up to 3,000 non-medical clients and up to 700 MSNS patients. This elaborate operation involves:

• Department of Children and Family Services: shelter management
• Office of Public Health: medical care
• Louisiana State Police: security
• Department of Agriculture: pet care
• Department of Transportation: patient movement
• Other public and private entities

The Governor of Louisiana, in collaboration with the Governor’s Office of Homeland Security and Emergency Preparedness (GOSHEP), chooses when and how the Megashelter will open. It has been activated in numerous hurricanes including Gustav, Ike, Isaac, Harvey, Barry and, most recently, Laura. It has housed thousands of evacuees over the decade of its existence.

COVID-19 posed a particular problem for the opening of any congregate (group) shelter during Hurricane Laura. This terrible pandemic struck Louisiana with full force during the spring and summer of 2020. In Louisiana alone, we have had more than 150,000 cases and around 5,000 deaths, with some of the highest per capita infection rates in the country. Positivity rates in some regions and even singular parishes exceeded 10% for weeks, indicating high community spread. These rates have only recently begun to decline.

Because over 50% of individuals with COVID have no symptoms at all, the risk of spreading this contagious disease becomes enormous, especially in large groups. To curb this, groups are restricted to 50 or fewer individuals, depending on the size of the facility and whether it is indoors or outdoors. These restrictions severely limit the number of people who can be safely transported and/or placed in any kind of shelter, especially a megashelter.

High rates of community spread and restrictions on group sizes led the State to develop a unique emphasis on non-congregate (no group) sheltering. Evacuees were directed toward reception centers where they received assistance locating available hotel rooms and vouchers to pay for them. This effectively separated family groups from one another and eliminated the need for a massive Critical Transportation Needs Shelter.

The Megashelter was made available for those with special medical needs. Beds in the MSNS were separated by a minimum of 6 feet, and masks were required of all patients and caregivers. A special sub-unit for known symptomatic COVID-19 positive patients contained separate pods where dedicated staff in more comprehensive personal protective equipment could provide care.

This solution redirected the bulk of evacuees to non-medical, non-aggregate locations such as hotels, friends or relatives rather than expose them to the dangers inherent in a group setting. Such flexibility demonstrates how policy and practice remain adaptable to new, challenging circumstances.

Although pandemics are not new, we have not experienced anything similar since the Spanish flu of 1918. Sheltering has also existed in one form or another for centuries. But the two together offer particular challenges requiring creative solutions, which have been demonstrated by the non-congregate sheltering plan developed by Louisiana’s disaster planners.