When COVID-19 patients need to recuperate at home, but have no home

With Boston Medical Center’s coronavirus cases as high as ever, the hospital has found a way to help those who just need a place to sleep and heal.

A temporary gate provided entry to an eight-story building on East Newton Street, three floors of which are being used by Boston Medical Center as a place for the homeless to live while they are recuperating from COVID-19 or are in isolation after testing positive for the coronavirus.Pat Greenhouse/Globe Staff/The Boston Globe

Stephen Clark was shocked to learn last week that he tested positive for COVID-19. He felt fine — no fever, no cough, nothing.

Most people in his situation go home to isolate, resting there for seven days if they continue to feel well, or calling their doctor if they develop symptoms.

But Clark, a 49-year-old former restaurant worker, went straight to Boston Medical Center, one of the city’s busiest COVID-19 hospitals.

He is among hundreds of Bostonians with COVID-19 who can’t recuperate at home, because they lack a home to return to. They include people who had been hospitalized with severe cases but are now well enough for discharge, as well as people who were never sick enough for hospital care. Clark had been living in a shelter, which would not let him return as long as he could infect others.

People lacking good housing often end up relying on hospitals when they don’t need hospital-level care, and the pandemic has thrown this problem into high relief.

“It has opened a lot of eyes to that need,” said Dr. Joshua A. Barocas, an infectious disease specialist at Boston Medical Center. “We need better plans for how to manage medical problems in people who are unstably housed or homeless."

The pandemic has spurred Boston Medical Center and others to open new expanded services for homeless people, and Barocas said he hopes these initiatives filling an important societal need will continue after the COVID-19 crisis fades.

When Clark arrived Wednesday at Boston Medical Center, the city’s 410-bed safety-net hospital was contending with a census already dominated by coronavirus cases, with 261 COVID-19 patients inside, up by nearly 100 from the previous week.

Dr. Ravin Davidoff, chief medical officer, said that COVID-19 cases have surged to a high plateau, likely to stay high for the next week or two before very slowly tapering down. On Thursday, there were 90 patients in intensive care, 80 of them with COVID-19, he said.

So far the hospital has found the space and staff to meet the need, but every bed is precious. At the same time, Boston Medical Center has a long history of caring for the vulnerable residents of its surrounding neighborhoods, including those who, like Clark, live in shelters or on the street. More than one in eight of Boston Medical Center’s COVID-19 patients are homeless.

At Boston Medical Center, Clark said, “They didn’t do nothing but help me from the time I walked in the door.” He took a coronavirus test as required for admission to a shelter, and the results scared him. “I thought I had one foot in the grave and the other on a banana peel,” he said. “I thought I was a goner.”

The virus has spread quickly among homeless people, who live in crowded conditions and often have other illnesses that make them vulnerable. Tests of 408 homeless people in Boston found that 36 percent of them had the virus.

After one night at the hospital, Clark took a cab provided by the Boston Public Health Commission around the corner to an eight-story building on East Newton Street that until two weeks earlier had been vacant and locked up. Dubbed the East Newton Pavilion, the facility is one of three places where those without homes can go to recuperate.

The others are the Barbara McInnis House, which has long offered such respite care for people without stable housing, but could take only a limited number of COVID-19 patients, and the city’s new field hospital in the Boston Convention and Exhibition Center, which has 500 beds reserved for homeless people. (In addition, the Boston Health Care for the Homeless Program put up tents to quarantine patients with symptoms who were waiting for test results.)

As Barocas and others tell it, reopening the East Newton building, vacant since 2018, was a feat of teamwork and coordination that took place in a matter of days. That included getting permission from the state, which owns the building, and arranging for everything from Wi-Fi to oxygen.

Donations poured in: furniture from Wayfair, clothing from Ocean State Job Lot, 10,000 pairs of underwear from Hanes and Fruit of the Loom. The hospital’s COVID fund, which has raised $11.5 million, filled the remaining gaps.

Occupying three of the building’s eight stories, the new facility planned to start slow, with just a handful of patients for the April 9 opening. But that day a storm kicked up, and the convention center tents flooded. The East Newton Pavilion suddenly had to take close to 20 people.

“When they showed up, most of the people were very wet and very cold,” said Justin Alves, a nurse on duty that night. “A lot of them were hungry. The fact that we were able to get them some food, get some warm blankets, tuck them in as best we could — it made a world of difference.”

About 65 patients a day have been staying there for an average seven to 10 days. By doubling up patients and opening other floors, the place could accommodate as many as 180 if necessary.

Considering BMC’s chronically high COVID-19 patient load, Davidoff said, opening East Newton “has been enormously beneficial." Without it, he said, “we would have been so jammed.”

People who come to East Newton either have no homes, or can’t return to their homes because they can’t safely distance from at-risk family members in a small apartment.

“A lot are pretty sick,” said Mary Tomanovich, clinical project manager for the hospital’s COVID response. “We don’t have anybody who needs to be in a hospital, but they’re very tired. A lot have asthma on top of this. A lot are so, so tired.”

No one is discharged from East Newton to the street, Tomanovich said. The staff works to find a shelter bed or other arrangement for everyone.

When Clark arrived on Thursday he was still feeling well, and also appreciative of his new accommodations.

“At the end of seven days, as long as I keep feeling good, I should be able to get back to society,” he said in a phone interview. Originally from Florida, Clark had lived for months at the Pine Street Inn, where a training program led to a job at a Japanese restaurant. The restaurant closed down for the pandemic.

He hopes he can get back into Pine Street, but isn’t sure what the rules are. “I’ve got to cross that bridge when I get there,” he said.