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Lessons from How We Prevented COVID-19 from Ravaging Our Homeless Clients


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Food distribution during the covid crisis (photo: Ed Reed/Mayoral Photography Office)


COVID-19 has taught us painful lessons about inadequate disaster preparedness and a vulnerable health-care ecosystem. In the midst of access obstacles, insufficient resources, and a limited federal response, a virus of moderate virulence and lethality has taken an appalling toll — over 140,000 Americans have died of COVID-19 including more than 700 health-care workers. Local providers and governments have had to scramble and improvise to manage the onslaught to prevent an even worse disaster. 

At the Center for Urban Community Services, one of New York City’s largest health-care providers to people who are homeless, we have managed to scramble and improvise effectively for our clients and workforce. Our client infection rate has remained below 5 percent, well under the estimated 15-20 percent infection rate for New York City residents. We have also managed to keep our staff infection rate low, and even more importantly, we have had zero staff fatalities.

As COVID-19 cases continue to surge across the American South and Southwest, and in anticipation of influenza season, which we fear will exacerbate the pandemic, lessons of the spring in the Northeast can mitigate a possible second coronavirus wave. Here is some of what we learned:   

Communicate, including about your ignorance.  
Effective action always starts with accurate, relevant information people trust. A crucial ingredient of earning trust is to also be open about one’s ignorance. An early challenge of COVID-19 was that so much was unknown in the early spring about how SARS-CoV-2 transmits, causes illness, and leads to death — we didn’t really know what we were up against.

It was difficult to strategize about reducing transmission when it wasn’t clear how the virus was spreading, and it was difficult to screen people when it wasn’t clear what symptoms reliably correlated with infection. Furthermore, a lack of testing meant we didn’t even know how widespread a problem we were facing. The first thing to be up front about, then, is what you don’t know.

In March and April we communicated frequently with our clients and staff about our plans for trying to keep people safe, but also that we were committed to changing course as new information and understanding developed. An important example of this was the shifting understanding and recommendations about the value of face coverings. Early on we recommended against mask-wearing but shifted gears as evidence mounted about the effectiveness of face-covering. Because we prepared people for course changes, however, our clients and staff embraced mask-wearing easily and quickly.    

Another example of ignorance we allowed ourselves to be open about was the lack of clarity about the symptoms of COVID-19 and about the relative importance of asymptomatic and presymptomatic spread.

Realizing that confusion about these issues made it impossible to reliably identify who might be contagious at any given moment profoundly influenced our strategy in a way that we believe kept our infection rate low. Since we understood we could not completely prevent people who are contagious from being at our workplaces, we transformed our programs and operations to be safe even if people were contagious.

We eliminated as many “close contacts” between client and staff and among staff as possible. A contagious person cannot infect you if you keep your distance, avoid prolonged interactions and wear a mask. We believe our workplaces are currently safer than people’s homes.

Get ahead of the problem and on the side of caution.
By the time there was a first confirmed case of COVID-19 in New York City, we had been closely monitoring developments in China and Italy and we had already started educating our staff and clients about the seriousness of the situation. Sensitizing people to the grave nature of the crisis prepared our team to rapidly develop protocols that we ended up executing well before the city and state began issuing guidance.

We had decided how we were going to respond to the closing of the New York City school system and the stay-at-home order before those measures went into effect. Given how quickly SARS-CoV-2 can spread, we believe this foresight and rapid mobilization prevented a significant outbreak at our agency.  

In mid-March we transitioned most staff to remote work, a significant challenge for a client-facing service-provider. Much of our medical team shifted to two-week, staggered rotations to limit the number of providers who would be risking exposure at any given time while also ensuring our clients access to necessary care. Acting swiftly and decisively, with healthcare workers’ well-being driving every decision, minimized the number of clinicians who became infected and allowed us to keep providing care to people. 

Although COVID-19 prevalence in New York City is currently quite low, and the city has moved on to phase 4 of reopening, we recognize this is a fragile state of affairs and that we cannot let our guard down. Our protocols continue to be informed by the assumption that everyone you might interact with might be contagious. SARS-CoV-2 can spread easily and case counts can quickly grow exponentially. We move forward assuming that might happen any time, and we believe this is the only prudent assumption until there is a widely available, effective vaccine. 

Be flexible.
A significant, unanticipated early challenge of this pandemic was the shortage of personal protective equipment (PPE) — just as toilet paper disappeared from the stores, so did face masks from our suppliers. To address this unprecedented challenge, Center for Urban Community Services formed an informal team to become equipment hunters and importers. For example, we deputized procurement officers who had no such previous experience.

This team collaborated with different organizations in a national, and in some cases international, effort to obtain face masks for frontline workers on our outreach teams and shelter and housing programs. People from all over the country supported this cause, mailing in hand-sewn face masks not only from New York City and State, but also from as far away as Alaska, California, and Washington State.

Through this effort, Center for Urban Community Services was able to distribute over 8,000 face masks to frontline staff and our clients who are homeless. Our investment in this effort has built new supply chains to ensure we have sufficient PPE to protect our staff and clients in future surges. 

Anticipate
Although New York City is experiencing a brief respite, it would be unwise to become complacent. COVID-19 is surging through much of the country and people travel from hot spots to New York every day. The onset of influenza season will almost certainly exacerbate whatever COVID-19 is prevalent in the city this autumn and winter. COVID-19 safety and preparedness has become embedded into all that we do — it must be inherent in our new normal — in order for us to keep people safe and to continue to provide the care and services that are so crucial to our clients.  

As scientists and physicians learn more, and COVID-19 has become less mysterious, it has become clear that good old-fashioned, basic public health measures can reverse outbreaks and control the spread of SARS-CoV-2. Social distancing; testing, tracing and isolating; hand hygiene; and mask-wearing are unfancy interventions well within the capacity of a country with the political will to resource such efforts.

By now there are dozens of examples of whole populations of people who, with clear, consistent communication and leadership, are happy to work together to protect everyone. A coordinated effort by government and citizens to employ simple, straightforward tactics could allow this country to enjoy a semblance of normalcy — being with loved ones, going to school, helping one’s neighbors — until an effective vaccine can finally put an end to this pandemic.  

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Dr. Van Yu is Chief Medical Officer at the Center for Urban Community Services. On Twitter @CUCSnyc.

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The Path to Better Policing and Safer Communities in Brooklyn and Beyond


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Brooklyn DA Eric Gonzalez, center, is one of the authors (photo: @BrooklynDA)


Brooklyn is at a turning point for public safety and criminal justice reform. Through hard work, creativity, and trial and error, both law enforcement and citizen-powered organizations like East Brooklyn Congregations have achieved a sustained, historic drop in crime—but this year has seen troubling shifts. The recent spike in shootings and homicides – coinciding with the COVID-19 pandemic and the protests that followed the killing of George Floyd by police in Minneapolis – has thrown people off balance. It’s led to questions – some in good faith and others in service of long-standing political agendas – about whether there is an unavoidable tradeoff between safety and fairness. We believe there is not. Our communities deserve both safety and fairness. 

Now is not the time to retreat, but rather to refocus on what works, and where it can improve. We measure what we value. Our communities value a justice system that continues to reduce crime while also reducing incarceration, racial disparities, and police misconduct. But achieving those reductions will require measuring all the things we care about, so we can target our resources and efforts most effectively and hold both law enforcement and our own communities accountable.

We know from experience that when we accurately track where crime is happening, through a system like the NYPD’s CompStat, we can use police resources more efficiently to drive down crime. And when we carefully gather and analyze intelligence on the small number of individuals who commit the majority of serious violent crimes, as the Brooklyn District Attorney’s Crime Strategies Unit does, we can reduce such violence even further. By conducting focused, long-term investigations of gangs and crews that drive most of the shootings, and breaking up out-of-state gun trafficking rings that funnel guns onto our streets, the DA’s Office and the Police Department helped drive murders down by a third and shootings down almost 40% in the last five years.

Good, focused police work has been critical – and our communities can’t afford for police to pull back simply because activists are rightly demanding accountability for law enforcement misconduct and changes in the way communities are policed. If we care about police misconduct and encouraging positive police behavior, we should measure just as carefully incidents of excessive force, as well as positive interactions between the police and communities and make the data public.

The same CompStat principles that reduced crime so dramatically should be applied to misconduct by police officers. If we truly care about reducing racial disparities in the justice process, we should measure disparities at every step -- from arrest, to charging, to bail requests, to convictions, to sentencing, and post-conviction outcomes like granting parole. Then we can craft policies that advance racial equity. If we care about diversion and meeting people’s needs for counseling, mental health services, education and job training, we should measure how often we divert people and which programs are most effective.

We know that we can reduce the numbers of people arrested and prosecuted for low-level offenses and still drive down serious crime; we don't need a return to old stop-and-frisk practices, which communities certainly do not want. Dramatic reductions in arrests and prosecutions for crimes like marijuana possession, for which 95% of those arrested in 2014 were Black or Hispanic, will hopefully strengthen community trust in the justice system. And programs already created by the DA’s Office to offer substance use treatment, job training, and other services instead of jail, have driven down incarceration while addressing underlying causes of harmful behavior. That has made the community safer while honoring the human dignity of the individuals affected.

Beyond these specific programs, we know from social science research that the factors most strongly associated with positive, law-abiding behavior are social connectedness and having one’s basic needs met – health care, education, stable housing. EBC and other community organizations build power to demand these basic services from both government and the private sector every day.  That work – engaging a wide cross-section of the community and benefiting many over time – reduces feelings of isolation and marginalization and powerlessness. People feel like full citizens whose voices are heard and whose visions are realized. That makes us all safer.

Where do we most need support for people returning to the community from incarceration? Where do we most need more substance use programs, or mental health clinics, or youth programs? We don’t know, unless we measure.

As community leaders and law enforcement, we believe in accountability. We also believe that safety and fairness are not in conflict, but mutually reinforcing. We’ve learned a lot about how to make our communities safer while driving down incarceration and expanding non-law enforcement responses to social ills. We can make even more progress on these goals, and hold both law enforcement and civilians accountable, if we measure what we value and apply the lessons we learn to do better.

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Eric Gonzalez is the Brooklyn District Attorney; on Twitter @BrooklynDA. Rev. David K. Brawley is the Senior Pastor of St. Paul Community Baptist Church and member of the Governance Board and Strategy Team of East Brooklyn Congregations (EBC).

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The United States of America is Becoming a Failed State


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President Donald Trump (photo: Joyce N. Boghosian/White House)


In January 2018, President Trump disparaged African countries and Haiti by referring to them as “s---hole” countries. He asked why the United States would want more immigrants from these debilitated economies. Given the president’s comments, there is some amount of irony in the fact that the United States appears to be on track to join the same list of countries that he referred to. As a tweet by Jasmine Tyon aptly described it, the U.S. is a third-world country with a Gucci belt. You may not see it yet, but it is quickly becoming a failed state. 

Additionally, sentiments expressed by the president notwithstanding, our country isn’t heading towards failed statehood because it allowed entry to immigrants from under developed nations.

Some would argue that race -- in terms of Trump, racism and white supremacy -- has a lot to do with the United States’ march toward failed statehood. The fact remains that immigrants from under-developed nations have little to do with the failure that Trump has led this country to.

There are a number of factors that precede failed statehood. My focus here is accountability — in this case, the lack of it. 

A failed state is a country with a political economy that has become so dysfunctional that it can no longer function properly. Even if it appears to display functionality, it is not considered legitimate, and that is precisely what is happening to the United States. 

The federal government has many parts to play, but of the responsibilities entrusted to it, the two most essential are both intricately linked to accountability.

The first responsibility is to ensure appropriate segregation of powers so that we don’t end up with a King (having a Queen is unlikely, since as an enlightened, first-world country, the U.S. is still a long way from electing a female president). Even at this point we find ourselves under President Trump, we are unlikely to end up with a King because one cannot be a King while simultaneously abdicating accountability. We currently do not have a King, a Queen, or even, really, a President.

What we have is an aspiring despot — a ruler whose wish is mostly Congress’ command; a tyrannical, oppressive autocrat.

The second most central responsibility of the federal government is to ensure that the rights of U.S. citizens and, yes, undocumented persons alike, remain protected. How protected do you feel these days? 

So what is accountability? It’s rooted in one’s obligation or willingness to accept responsibility for their actions. Notice willingness. If a person does not deem something as their responsibility, then they cannot be held accountable. To deny responsibility and accountability can thus quickly translate into a perpetual state of denial, and that is precisely what our president does.

Trump denies the role he has played in leading one of the world’s superpowers to imminent disaster. From the Mueller findings on obstruction to the impeachment offenses to personally benefiting financially from his government position to introducing his Muslim travel ban and creating racial unrest to the ill-equipped and deadly responses to Hurricane Maria and the COVID-19 pandemic, the list of Trump’s failures is impossibly long and, thus far, with zero accountability attached to it.

In the case of failed states, the ineffective organization of political communities permits powerful individuals to skirt their duties and avoid accountability. That’s what is happening to the United States. American politics has become entrenched in tribalism and sectionalism. This has played an essential role in shaping the United States into a failed state. Individuals are no longer restrained by notions of basic morality. Cruelty gets normalized and combatants become increasingly inclined toward corruption. If this continues, the U.S., I advance, will finally be declared the failed state that our president wants it to be, so he can consolidate power to himself. 

It’s not too late, though. We are still a democracy. As people, we have the power to elect our next leader. If we don’t vote to install a new government that respects the appropriate segregation of powers and works to ensure that the rights of U.S. citizens and undocumented persons are protected, then we are equally accountable for what happens next. 

Come the fall election, you can either shun your responsibility or accept it as an obligation to your country. If we act decisively, we may still be able to reverse our rapid transition to failed statehood and begin to rebuild this country.

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Lessie Branch is an Associate Professor at Metropolitan College of New York; author of Optimism At All Costs: Black Attitudes, Activism, and Advancement in Obama’s America; and co-host of HERe ME Podcast. On Twitter @LessieBBranch.

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