Mayor Martin J. Walsh
1 City Hall Square, Suite 500
Boston, MA 02201

Governor Charlie Baker
Massachusetts State House
24 Beacon Street
Office of the Governor, Room 280
Boston, MA 02133

 
Dear Mayor Walsh and Governor Baker,
 
We write as the resident physicians who are currently staffing the hospitals that serve Boston and the greater Boston area—the “House Staff” of our community. We are proud to serve on the front lines taking care of patients with coronavirus disease (COVID-19), where we are already seeing a profound strain on hospital systems as more and more individuals are admitted with the disease. Alongside our nursing and respiratory therapy colleagues, we are taking care of the rapidly increasing number of patients as best we can, and attempting to maintain our commitments to both clinical excellence and everyone’s safety in the face of limited resources.

We appreciate the regulations already in place to promote social distancing, which are integral to minimizing the spread of COVID-19.  

At the same time, we are acutely aware that there are many people in our community for whom social distancing by staying at home is not a feasible option—namely, those individuals experiencing homelessness, as well as individuals currently incarcerated in prisons and jails in the greater Boston area. We also acknowledge that, as carefully as we might screen individuals prior to entry to shared communal spaces like shelters, asymptomatic shedding of the virus prior to developing symptoms is likely to occur undetected, rendering our best efforts at screening unable to completely halt transmission among vulnerable populations.

As the National Health Care for the Homeless Council recently published, homeless adults are high-risk: an aging population with often poor baseline health status, spending time in congregate settings with limited access to hygiene supplies and experiencing frequent discrimination. We know that seasonal influenza and tuberculosis disproportionately affect our homeless patients here in Boston in normal times, and it is therefore unsurprising that our COVID-19 testing guidelines also consider lack of housing an epidemiologic risk factor significant enough to allow for testing even in a resource limited setting. A research report released by the University of Pennsylvania this week estimates that homeless patients with COVID-19 may be twice as likely to be hospitalized, two to four times as likely to require critical care, and two to three times as likely to die compared to housed individuals.

Unfortunately, we are seeing spikes in laboratory-confirmed COVID-19 among homeless patients this week, and we worry that these cases are just the beginning should we continue on our current path. We appreciate our city and state’s ongoing efforts to create safe and dignified spaces for persons experiencing homelessness to heal when they have COVID-19 but are not sick enough to be hospitalized. Yet we know that these measures will not be close to enough to protect our homeless neighbors as local transmission continues to accelerate. Time is running short: the Institute for Health Metrics and Evaluation now estimates that our state’s epidemic will peak in the second week of April 2020.

We applaud local efforts to create and fund safe, heated, and dignified options for the isolation and care of patients experiencing homelessness, including the reopening of Newton Pavilion at Boston Medical Center, the Boston Healthcare for the Homeless Program’s transformation of the Barbara McInnis House into a COVID-19 treatment center, and the two new medical tents operated by the City of Boston. However, these measures do not provide safe options for homeless Bostonians who are either currently healthy or who may not know if they have been exposed (and thus do not currently qualify to stay in existing COVID-19 monitoring or treatment facilities).
 
We propose that the state of Massachusetts and the City of Boston immediately follow the examples of cities in Washington and California and use emergency state and federal funding to partner with now-vacant hotels and motels to alleviate the burden on shelters by housing individuals experiencing homelessness.

Such measures, coupled with support for training and provision of adequate cleaning supplies and protective gear for hotel employees, could also economically benefit our struggling service and hospitality industries in a time of steep reductions in tourism and business travel. Additionally, ensuring that evictions and encampment clearings are prohibited during this time can prevent sudden housing loss for many families and individuals affected by social distancing practices and job loss. At the very least, we propose a dramatic increase in emergency funding for the construction and operation of additional safe and heated shelters for at-risk Bostonians, to enable them to reduce their risk of falling sick and to empower them to contribute to shared social distancing efforts by decreasing resident densities in shelters.

The state and city are already collaborating with the Social Determinants of Health Behavioral Health Community Partner (SDH BH CP) Consortium and Massachusetts Coalition for the Homeless, and we believe that they will be well positioned to offer civil society leadership in these efforts. We will continue to need their expertise—linked to adequate resources—to help guide the next phase of Boston’s response to the challenge of COVID-19.

Thank you for your consideration, and for serving our community with reason and compassion. Now is a time that calls for linking this solidarity to pragmatic actions that leave no one behind, in order to fight both against COVID-19 and for one another. We will commit together to holding the line inside our cities’ houses of healing, and we ask that our leaders commit to finding creative solutions now to house our most vulnerable neighbors.


Sincerely,
Boston’s COVID-19 House Staff for Safe Housing


Residents cosigning letter (Initial Draft Signees):
Nora Taranto, MD (Brigham and Women’s Hospital)
Cameron Nutt, MD (Brigham and Women’s Hospital)
Jessie Stuart, MD (Brigham and Women’s Hospital)
Prihatha Narasimmaraj, MD (Brigham and Women’s Hospital)
Dana Callahan, MD (Brigham and Women’s Hospital)
Vishal S. Arora, MD (Brigham and Women’s Hospital)
Kuo-Kai Chin, MD (Brigham and Women’s Hospital)
Maria Patanwala, MD (Brigham and Women’s Hospital)
Thomas Kuzmarski, MD (Brigham and Women’s Hospital)
Rose Olson, MD (Brigham and Women’s Hospital)
Vihang Nakhate, MD (Brigham and Women’s Hospital)
Desta Lissanu, MD (MGH/McLean)
Kathryn Corelli, MD (Massachusetts General Hospital)
Mike Diiorio, MD (Brigham and Women's Hospital)
Javier Suarez, MD (Massachusetts General Hospital)
Rebecca Abelman, MD (Massachusetts General Hospital)
Helen Knight, MD (Brigham and Women's Hospital)
Rahul Nayak, MD (Massachusetts General Hospital)
Jiby Yohannan, MD (Massachusetts General Hospital)
Danny Wong, MD (Brigham and Women's Hospital)
Luisa Paredes, MD Brigham and Women's Hospital
Lauren Merz, MD, MSc (Brigham and Women's Hospital)
Sean Murphy, MD (Massachusetts General Hospital)
Sagar Raju, MD (Massachusetts General Hospital)
Tiara Forsyth Calhoun, MD (Massachusetts General Hospital)
Elizabeth Kurtz, MD (Massachusetts General Hospital)
Rachel Erdil, MD (Massachusetts General Hospital)
Pooja Mehta, MD (Brigham and Women’s Hospital)
Allison Kratka, MD (Brigham and Women’s hospital)
Amanda PeBenito, MD (Massachusetts General Hospital)
Matthew Schoen, MD (Brigham and Women's hospital)
Robert M. Hayden, MD (Brigham and Women’s Hospital)
Chris Kearney, MD (Massachusetts General Hospital)
Omar Bayomy, MD (Brigham and Women's Hospital)
Amin Nassar, MD (Brigham and Women's Hospital)
Sophia Shimer, MD (Massachusetts General Hospital)
Amanda Garfinkel, MD (Brigham and Women’s Hospital)
Brian M Mugo, MD (Massachusetts General Hospital)
Fiona Gispen, MD (Massachusetts General Hospitalist)
Lauren Malishchak, MD (Brigham and Women's Hospital)
Hallie Rozansky, MD (Brigham and Women's Hospital)
Margaret Hayden, MD (Brigham and Women's Hospital)
-Parker Hollingsworth, MD (Brigham and Women’s Hospital)
Mara Feingold-Link, MD (Brigham and Women's Hospital)
Allison Vise, MD (Brigham and Women’s Hospital)
Raffi Tchekmedyian, MD (Brigham and Women’s Hospital)
Alexander Chaitoff, MD (Brigham and Women’s Hospital)
Dalia Larios, MD (Brigham and Woman's Hospital)
C. Nicholas Cuneo, MD (Brigham & Women’s Hospital)
Nicholas Spanos, MD (Brigham and Women’s Hospital)
-Jonathan Kotzin, MD (Brigham and Women's Hospital)
-Kaitlyn R. Shank, MD (Brigham & Women’s Hospital)
Allison Chang, MD, PhD (Brigham and Women’s Hospital)
Milad Rezvani, MD, PhD, Boston Children's Hospital
Rhodes Hambrick, MD (Boston Children’s Hospital and Boston Medical Center)
Katherine Marcus, MD (Boston Children’s Hospital)
Sarah Schlegel, MD, MS (Boston Medical Center, Boston Children's Hospital)
Emily Murphy (Brigham & Women’s Hospital, Boston Children’s Hospital, Boston Medical Center)
Amanda Marinoff, MD (Boston Children’s Hospital)
Emily Baumrin, MD (Brigham and Women's Hospital)
Nora Becker, MD, PhD (Brigham & Women’s Hospital)
Annelle Abatoni Kayisire, Wellesley College
Awino Odhiambo
Stephen Chrzanowski MD, PhD (Boston Children's Hospital)
James Smithy, MD (Brigham and Women's Hospital)
Gabrielle Bromberg (MGH)
Lisa Rotenstein, MD (Brigham and Women's Hospital)
Anna Bakas, MD (Boston Children's Hospital)
Neha Limaye, MD (Brigham and Women's Hospital/Boston Children's Hospital/Boston Medical Center)
Victor Quan, MD (Beth Israel Deaconess Medical Center)
Ali Corley, MD
Shana Rakowsky, MD (Beth Israel Deaconess Medical Center)
Audrey Li, MD (Beth Israel Deaconess Medical Center)
Sarah Ohnigian, MD (Beth Israel Deaconess Medical Center)
Nicholas Goodhope, MD - Beth Israel Deaconess Medical Center
Jaya Kanduri, MD (BIDMC)
Sean Schowalter , MD (BIDMC)
Jim Doolin (Beth Israel Deaconess Medical Center)
Divya Seth, MD MPH, Beth Israel Deaconess
Cristina Sorrento, MD (Beth Israel Deaconess Medical Center)
George Tang, MD (Beth Israel Deaconess Medical Center)
Calvin Lee
-Catherine Gardiner, MD (Beth Israel Deaconess Medical Center)
Danny Vazquez, MD, MPP (Beth Israel Deaconess Medical Center)
Parth Patel, M.D (Brigham and Women's Hospital)
Emily Harris, MD (Boston Children’s Hospital)
Darin Rosen, MD (Beth Israel Deaconess Medical Center)
Caitlyn Moss, MD (BIDMC)
Sabrina Karim, MD (Boston Children's Hospital, Boston Medical Center)
Thomas Quinn, MD (Beth Israel Deaconess Medical Center)
Victor Roy, MD PhD (Boston Medical Center)
Haitham Khraishah, MD (BIDMC)
Brooks Willar, MD (Beth Israel Deaconess Medical Center)
Katelin Blackburn, MD (Boston Medical Center and Boston Children’s Hospital)
Michael Fishman, MD (Boston Children's Hospital)
Daniel Sentana, MD (Beth Israel Deaconess Medical Center)
Arielle Urman, MD (Beth Israel Deaconess Medical Center)
Sam Joseph, MD (Beth Israel Deaconess Medical Center)
Rahul Maheshwari, MD (Beth Israel Deaconess Medical Center)
Alec Faggen, MD (Beth Israel Deaconess Hospital)
Benjamin Freedman, MD (Beth Israel Deaconess Medical Center)
Miriam Kwarteng-Siaw, MD (Brigham and Women’s Hospital)
Samantha Pop, MD (Beth Israel Deaconess Medical Center)
Ayrenne Adams, MD MPH (Brigham and Women's Hospital)
Nolan Priedigkeit, MD, PhD (Brigham and Women’s Hospital)
Taliya Lantsman, MD (BIDMC)
Rima Patel, MD (Tufts Medical Center)
Jon Thomas, MD
Lao Allan-Blitz, MD (Brigham and Women’s Hospital)
Yi Feng, MD (Beth Israel Deaconess Medical Center)
Laura McNamara, MD (Beth Israel Deaconess Medical Center)
Brooke Lubinski, MD (Beth Israel Deaconess Medical Center)
Rebecca Lichtin, MD (Brigham and Women's Hospital)
Erin Duralde, MD (Beth Israel Deaconess Medical Center)
Christine Shrock, MD (Boston Children's Hospital & Boston Medical Center)
Katie Vaughan, MD (Beth Israel Deaconess Medical Center)
Nathan Sairam, MD (Beth Israel Deaconess Medical Center)
Sagar Mehta, MD (Boston Medical Center and Boston Children's Hospital)
-Staci Saunders, MD (Beth Israel Deaconess Medical Center)
Maelys Amat, MD (Beth Israel Deaconess Medical Center)
Yvonne Okaka, MD (Brigham and Women’s Hospital)
Jasmyne Jackson MD/MBA (Boston Children’s Hospital and Boston Medical Center)
Trevor Barlowe, MD (Brigham and Women’s Hospital)
Colin Martz, MD (Brigham and Women's Hospital)