A homeless shelter made up of tarps, chairs and signs sits in the median of Colfax Avenue in downtown Denver on Oct. 2, 2020. (Forrest Czarnecki/The Denver Gazette)

Experts and advocates are pondering their next steps as a COVID-19 outbreak continues among Denver’s homeless population.

According to data from the Colorado Department of Public Health and Environment, as of Wednesday, 131 people experiencing homelessness in Denver tested positive for COVID-19, another 16 are probable positives.

In addition, 11 staff members at homeless shelters tested positive and two are probable positives.

The outbreak was first reported by CDPHE on May 1.

Cathy Alderman from the Colorado Coalition for the Homeless said the organization is “anxious” about the cases.

“Community spikes mean spikes across all populations,” Alderman said. “It doesn’t surprise me … but it is alarming.”

Alderman said people experiencing homelessness are especially at risk for COVID-19.

Congregating in homeless shelters increases the risk of transmission. In addition, much of Denver’s homeless population is employed but cannot work from home, meaning they have to travel more than most residents.

People experiencing homelessness are also more likely to have health conditions like diabetes and respiratory illnesses, making them more likely to require hospitalization if infected, Alderman said.

In July, the Department of Housing Stability (HOST) found that Denver’s homeless population was disproportionately affected by COVID-19.

While making up less than 1% of Denver residents, people experiencing homelessness accounted for 5% of positive COVID-19 tests and 2% of deaths attributed to COVID-19.

Since then, the city has implemented several measures to protect the population.

The city changed operating hours of homeless shelters to 24/7 to allow for less travel and established sanitation resources like hand sinks in public parks.

Before entering Denver shelters, people are screened for temperatures and COVID-19 symptoms. Those who display symptoms are separated from the rest while they await testing.

Shelters also provide residents with hand sanitizers and face masks. While refusing to wear a mask will not usually get one kicked out of a shelter, wearing one is strongly recommended.

“I think the measures that we have taken are very effective,” said Britta Fisher, executive director of HOST.

One of the city’s most substantial changes is the use of motel and hotel rooms to house those who test positive or are presumed positive. This provides individuals with shelter and treatment without infecting others.

Fisher said there are 107 of these rooms available and 57 currently in use.

Positivity rates among the homeless population have decreased on a consistent basis since the rooms were established, Fisher said.

“As we see the cases rise in the general population we certainly know that that is more opportunity for exposure,” Fisher said. “We stand ready to have more rooms as needed for persons experiencing homelessness.”

HOST is also involved in the city’s task force that provides COVID-19 testing at homeless shelters and encampments on a monthly basis.

Fisher said it is difficult to know whether cases come from shelters or encampments because people often alternate where they sleep; however, advocacy group Denver Homeless Out Loud disagrees.

“The data for months during the pandemic has shown that the majority of the cases in the homeless community have been among those who use the shelter system,” said Benjamin Dunning from Denver Homeless Out Loud. “Those who do not, rarely test positive.”

Among 650 people living in Denver shelters, 9% tested positive for COVID-19 compared to 3% of 281 people living in Denver tent encampments, according to data from Dr. Sarah Rowan of the University of Colorado and Bernard Gipson Sr. of Eastside Family Health Center.

Similarly, 24% of shelter users tested positive for COVID-19 antibodies, a measure of previous infection, compared to 8% of encampment users.

Dunning said the answer to stopping the outbreak is to stop sweeps so people aren’t forced into shelters.

As encampments have arisen around the city during COVID-19, Denver has responded with regular sweeps in which the campsites are moved.

The Centers for Disease Control advised against clearing encampments when no other housing is available to avoid spreading the coronavirus; however, the city has continued to conduct sweeps during the pandemic.

“We would recommend that the city stop the sweeps and work within CDC guidelines by allowing folks to avoid the highly contagious shelter system,” Dunning said.

Others believe shelters are the solution to issues caused by COVID-19, not the problem.

“Our guests have faced the challenge of accessing services and housing across Denver that were available before the pandemic,” said Brad Meuli, president and CEO of the Denver Rescue Mission.

Meuli said shelters have been stepping up to make up for this lack of services during the pandemic while implementing as many safety measures as possible.

“Since the beginning of the pandemic -- and no matter what the positivity rate is --  the Mission’s front line staff has continued to work vigorously to provide services that prioritize cleanliness in our facilities, masks for each of our guests and social distancing as much as possible,” Meuli said.

For Alderman, the answer is providing space for people experiencing homelessness to recover from illnesses, even those other than COVID-19.

She said, even after the pandemic, the goal should be providing the population with a 24/7 location with medical staff to increase overall health.

“When people are sick, they don’t have a place to go,” Alderman said.