What happens if the coronavirus sweeps through Kensington Avenue?
That’s the fear on everyone’s mind in a neighborhood that has no equivalent elsewhere in America, a few square urban miles overwhelmed by a vast open-air drug market and its customers: the hundreds of young people with addiction, many of them homeless, who live and use opioids, huddled on the main thoroughfare.
Here, vulnerable people shoulder at once the effects of several devastating public health crises: The grip of addiction. The diseases that can follow — like last summer’s hepatitis A outbreak. The gun violence sparked by the drug trade, outmatched only by the staggering fatal overdose rate.
And now, as Philadelphia prepares for the peak of COVID-19 cases — and the waves that could come afterward — advocates and residents worry that Kensington is positioned for devastation from the pandemic. City officials are aiming to get more resources to people in addiction in the neighborhood to help them isolate better. As citywide cases spike to 5,000, they’ve discussed the legalities of a forced quarantine, not necessarily just for Kensington but for people around the city who need to isolate and refuse to do so.
The worry about an outbreak in Kensington stems not just from the fact that the neighborhood’s homeless population has almost nowhere else to go and cannot effectively socially distance — not to mention risking overdose if they use drugs alone.
It’s because many residents with homes are unable to stay there. They are low-paid essential workers required to report for duty. They don’t have enough money to shop in bulk, and must make daily forays for supplies. Many have precarious health care, or are dealing with underlying conditions worsened by poverty and potentially made deadly by the virus.
“No one deserves what’s brewing in Kensington,” said Councilmember María Quiñones-Sánchez, who represents most of the neighborhood.
The rate of COVID-19 infection in 19134, Kensington’s zip code, is so far average compared with the rest of the city. But community leaders point out that there are scarce testing options in the area, and are calling for help to prevent the spread of the virus in the neighborhood.
“It makes the situation more urgent when you have a community in deep poverty, a large number of seniors, a large number of people permanently disabled,” Quiñones-Sánchez said.
“We knew that all of the different situations in Kensington created a potential hot spot. And I don’t want to be four weeks from now, or two months from now, looking at the data sets and saying 19134 was severely impacted, and we’re not doing everything possible to meet that need in a more urgent way.”
City officials say they are working quickly to address some of the unique challenges of battling COVID-19 in Kensington, such as looking to open a feeding site and increase testing.
They are searching for a location to house a 24-hour respite center in an effort to break up the crowds gathering outside the few outreach organizations that are still open in the neighborhood.
In the age of social distancing, that’s even more challenging. City officials would need a 66,000-square-foot space to hold just 100 people — a fraction of the homeless who flow through the neighborhood.
People will be allowed to come and go from the respite center. But city officials have also discussed forced quarantine, said Eva Gladstein, deputy managing director of health and human services.
“There might be a number of different instances in which someone who needs to quarantine or isolate really is not willing to do that,” she said. “So we’re not thinking that applies only to people in a particular part of the city or who are unsheltered.” She said the city is examining a legal mechanism of forcing people to stay inside.
“People do have civil liberties, and we have to balance that with a public health crisis,” she said.
The situation has exacerbated longstanding tensions between how the city cares for residents in Kensington and the people in addiction on its streets. Forcing people inside is not a new idea here. Long before the pandemic, some neighbors were calling for legally compelling people into treatment.
Last year, running for reelection, Quiñones-Sánchez said the city should explore the legal options around involuntary commitment for people with addiction. (Gladstein said the legal process for involuntarily committing someone to a mental health ward is not part of the city’s discussions around forced quarantine.)
It’s something neighbors have echoed amid the pandemic. Rosalind Lopez, a neighbor whose employer considers her an essential worker, said she’s alarmed by the crowds she sees by the El station at Kensington and Allegheny Avenues. And it’s not just people in addiction outside; it’s some of her neighbors, too, she said. She says the city needs to better educate people on the dangers of going outside, and said that if they won’t go inside, someone needs to make them.
Carol Rostucher, who runs Angels in Motion, an outreach organization along the avenue, said the fear of contracting the virus is just as present for people living on the street in addiction.
“They don’t want to be sick, they don’t want to die, they don’t want to spread the virus,” she said. But they are concerned about getting treated for addiction in an isolation scenario.
Brooke Feldman, who runs Clean Slate, a Port Richmond branch of a national chain of addiction treatment clinics, said that rather than forcing people into quarantine, the city should make it easier for people to quarantine voluntarily. “We look at what other cities are doing, we see things like tons of hotel rooms made available,” she said. “If you want people to quarantine, you should give people the resources to do it.”
The city has leased 150 rooms at a hotel in Center City for people with COVID-19 symptoms or who have tested positive and who have nowhere else to stay. So far, 12 people have opted to stay there; the city is finalizing plans to provide medication-assisted treatment for people with addiction living at the hotel.
Gladstein said the city is looking at opening more quarantine centers. Feldman added that people without symptoms and with no other housing options should also be given places to safely isolate themselves.
The Rev. Adan A. Mairena, a pastor whose West Kensington Ministry hands out food near Norris Square, said he understands the fears in the neighborhood, and the tension that can exist in a place where seemingly everyone is vulnerable to the virus.
But the only way forward is to accept that those with homes and those living on the streets are part of one neighborhood, and to advocate together for help, he said.
“It’s not about the I anymore,” he said. “It’s about the we." People living on the street "are called transients — but transients are always on the move, and these people are part of the community. Now we have to embrace them and accept them, and offer them healing and restoration and rehabilitation.”