After spending days without a place to stay after Hurricane Ida, Elgin Barden boarded a bus from the Ernest N. Morial Convention Center to northern Louisiana on Saturday, as part of a city-assisted evacuation program. He arrived at a shelter in Shreveport later that day, he told The Lens, where everyone on the bus was given a COVID test.
A few minutes later, a man came back and told Barden, who is fully vaccinated, that he’d tested positive. Barden wasn’t surprised.
“I was on the street for days, I knew I had it.”
He said after his son caught COVID a few months ago, he started getting tested every two weeks, so he’s pretty sure he picked it up after the storm.
Barden boarded another bus, which took him to a medical shelter in Bossier City. Everyone else from his bus, he believes, went to the main shelter. He said there are only a handful of people there with him, and that staff are constantly checking in, wearing full protective gear. He has no symptoms.
“They treat me well,” he said. “I’ve been relaxing and enjoying the air conditioning and food.”
But, he said, “I’m ready to get back to my destination.” He’s said he’s in touch with his family back home, who now have power, but he wants to start working on storm repairs.
If it hadn’t been for the shelter, Barden probably wouldn’t have known he caught COVID. Within the city of New Orleans, COVID testing has been harder to come by since the storm, even as extreme heat and the need for food, ice, electricity, and water have driven some of the city’s most vulnerable residents to cooling shelters and distribution lines for supplies. That is a good recipe for future outbreaks, epidemiologists say, and it came right as the city was starting to show some progress lowering its infection rate during the delta surge.
“We’re in a big black dark box in terms of what’s happening,” said Susan Hassig, an epidemiologist at Tulane University. “Certainly COVID isn’t gone.”
On Aug. 27, more than 3,000 people were diagnosed with COVID in Louisiana, more than 2,600 were hospitalized and 479 were on ventilators. Since the storm, the number of hospitalizations has dropped significantly. On Sept. 1, hospitalizations were down about 200 since before the storm, but more than 200 died over the same period.
“I think if we hadn’t had a storm [that pattern] would have stayed,” said Hassig. “People were kind of settling into a routine. Maybe we’d reached saturation, some kind of brief herd immunity in our environment. But now our environment has been disrupted.”
Some COVID testing is available from healthcare providers in the city, and Dr. Jennifer Avegno, the New Orleans health director, said at a Monday press conference that the city has “been doing some limited COVID testing” at the Allie Mae Williams cooling center in Central City.
But without widespread testing, and with substantial barriers to primary care, it may be weeks before the COVID picture becomes clear.
Last year, the state relied heavily on non-congregate shelters in its evacuation plans in order to mitigate COVID transmission. More than 10,000 Hurricane Laura evacuees from Southwest Louisiana stayed in hotels in New Orleans through the state shelter program, and many stayed for nearly a month.
The state also ran a mega-shelter in Alexandria that housed hundreds, but many of those evacuees were also transferred to hotels.
But that policy was aided by the fact that hotels were nearly empty with the tourism industry on pause amid the pandemic.
There are no non-congregate shelters this year.
Mike Steele, a spokesperson for the Governor’s Office of Homeland Security and Emergency Preparedness, said that the state was following CDC distancing guidelines at state-run congregate shelters following Ida. According to the CDC’s website, that would mean six feet of distance between members of different households. Steele also said that masks were required.
Still, said Hassig, mitigation measures in mass shelters can only go so far.
“It’s a big volume of air, but they’re living there 24/7,” she said.
People don’t always space themselves out according to guidelines, and aren’t always wearing masks.
The city of New Orleans is also running cooling centers out of eight different community centers, and is circulating RTA buses as mobile cooling stations. The city has encouraged those vulnerable to heat, including elderly residents who can also be more vulnerable to COVID, to use the spaces.
Laura Mellem, a spokesperson for NOLA Ready, said that masks were required for people receiving evacuation assistance from the city and those using cooling centers, and that the city provides masks if people don’t bring their own.
While the cooling centers might be somewhat risky, in that they’re indoor, congregate settings, Hassig said that “the hierarchy of needs also comes into play.”
“If everybody’s masked, it’s as good a mitigation as you can do given the life-threatening heat,” she said. “Keeping people from dying of heat exhaustion trumps the chance of getting COVID. … It’s a really tough situation. It sounds to me like they’re trying to keep protocols in place that would help mitigation.”
Last year’s lessons
Since early in the pandemic, public health experts and emergency managers have warned that disaster evacuations might drive COVID outbreaks. But the lessons from last year—and particularly Laura and Zeta—are murky.
An analysis of COVID transmission models published in November 2020 suggested that transmission could take off after an evacuation, particularly if evacuees relocated to areas with high transmission, effectively adding fuel to an existing blaze.
Sen Pei, who researches infectious disease transmission at Columbia University and helped lead the study, said that this happens largely because “as people move around, evacuate to other locations, they need to buy supplies, need to stay in a hotel, maybe live in a public shelter. Those are occasions where you increase interaction with other people.”
Hassig said that big social changes are bad news for disease transmission.
“Everyone was in their stable communities more or less, and now the storm has shaken the box up again. There may have been people who weren’t particularly affected by this fourth surge. And we’re moving people from the southern part of the state to the northern, moving people to Texas, [linemen] coming from other places.”
But Pei also pointed to a study from May 2021 that found that evacuations from Hurricane Zeta didn’t lead to a surge in cases. (The study has not yet gone through peer review, and Pei said he wasn’t yet familiar with its methodology.)
There are a few reasons that might be the case, he said. For one thing, his team’s research found that mitigation measures during an evacuation — including mask mandates, social distancing guidelines, and sending evacuees to places with few COVID cases — could “sharply limit” the spread of COVID, and that outbreaks weren’t a given.
But it could also be that outbreaks fly under the radar, because the people most vulnerable to infection during an outbreak may also be less likely to get tested.
“We have to recognize the inequality of getting healthcare service,” Pei said. “Usually the most impacted population are those people with bad socioeconomic conditions. If they move to other locations, and there’s no relative, or people to stay with, they need to stay in a large shelter. And those people are usually the most impacted personally, and have less access to healthcare. So that’s another reason you make it difficult to surveil the outbreak.”
After Hurricane Laura, for example, COVID cases in Southwest Louisiana didn’t spike. But the region also didn’t have much infrastructure to catch cases.
“The region where Laura hit didn’t do a lot of testing, didn’t do a lot of vaccination, didn’t do a lot of mitigation to begin with,” Hassig said. It also struck last fall, during a relative lull in transmission, and well before the emergence of the highly contagious delta variant.
“I was somewhat surprised that nothing was detected [in southwest Louisiana], but a lot of people left. Where people went, where they got counted if they got tested—who knows?”
And, Pei said, it’s hard to draw conclusions from just one evacuation event.
Even if Zeta didn’t lead to outbreaks, as the recent paper showed, this time “people will have to have a longer evacuation period,” he pointed out. “And this year, with the more transmissible delta variant, it’s much more difficult to control with the same level of mitigation.”
Heading off the outbreak and testing
The good news, Pei said, is that his modelling work showed that evacuation-related outbreaks can be stopped.
“I think the most important thing is to test,” Pei said. “Because if we don’t know how many people are infected, we will never quantify the impact of the evacuation.”
Currently, very little testing is available in the city of New Orleans, particularly for people who need free testing or don’t have access to a vehicle. The Lens will maintain a list of those options here until regular healthcare services are open.
Since the storm, testing in New Orleans has declined from a 7-day average of about 4,000 tests a day to just below 2,000.
“Who generally does COVID tests? It’s the National Guard, the health department, healthcare facilities,” said Avegno on Monday. “Right now we’re all focusing on the immediate needs of Ida, and don’t really have staff to pivot just yet. As soon as the need goes away from cooling centers and the door-to-door [work] like we’re doing now, I’d really like to get testing up and running, but we’re kind of running on a shoestring.”
She said that the situation would be helped by school-based testing at schools, once schools reopen. Ben Franklin Charter High School said it plans to increase testing when school resumes because so many staff and students had evacuated.
Avegno said that requests for take-home tests, which don’t require staff to administer, would need to go through the state and federal government. Abbott Laboratories, which manufactures one of the most popular rapid, off-the-shelf COVID tests, BinaxNOW, destroyed millions of the tests in June and July — when transmission was low and demand for tests was down — which The New York Times reported was slowing down testing efforts nationwide.
The Louisiana Department of Children and Family Services, which runs most state shelters, didn’t respond to questions about their testing and isolation procedures over the phone or email.
However, Avegno said that state shelters were performing tests on entry to shelters, which lines up with Barden’s account.
It’s not clear if the shelter system is quarantining people who have been exposed to COVID, however. Barden said that others who had been on the bus with him, but who tested negative, appeared to go into the regular shelter.
After such a long bus ride, “I’d be very worried about that,” Hassig said. “Even vaccinated people could have been infected.”
“I’m not faulting them for not testing at the Convention Center, but it seems like it would have been a better point to do testing. I get that staffing is an issue,” said Hassig. “Testing before they go into the congregate shelter is absolutely essential, but it might be even more advantageous if it were possible before the long distance transportation process.”