Quarantining patients at Pa. drug treatment centers could pose risk, but many have nowhere else to go

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As drug and alcohol treatment centers in Pennsylvania continue to operate and accept new clients, they’re searching for the answer to a critical question: What happens when someone inside a facility needs to be quarantined because of the coronavirus?

Treatment centers can house anywhere from a handful of patients to more than 100. If one person contracts COVID-19, it could spread quickly, which is particularly concerning since people with substance use disorder could be at greater risk for severe complications.

But quarantining someone in a treatment facility, with dozens of other residents, is not easy. And often, it’s not an option to send a patient away because they don’t have another place to go. With some recovery houses and homeless shelters closing to new entrants, alternatives are dwindling.

“We have people who do not have a home to go back to,” said Paul Bacharach, president and CEO of Gateway Rehab, which owns 14 treatment facilities across Western Pennsylvania. “We would never just put them on the street. We’d have to find an alternative location. But I don’t think anyone has a clear answer on where that is.”

As of March 23, the state Department of Drug and Alcohol Programs said it had no reports of COVID-19 cases within treatment facilities. But many providers say it’s only a matter of time.

That’s why they’re turning to public officials for help. Some are raising the idea of public quarantine spaces run by the state or county governments that could house sick individuals, while allowing treatment facilities to keep their doors open for other patients.

“We don’t have the ability to quarantine someone without endangering staff or other patients,” said Fred Baurer, medical director of the Kirkbride Center in Philadelphia, which houses about 250 patients. “That’s not what our facility is set up for, so we’re looking for help from public health officials.”

Across the country, several local governments have set up public quarantine sites for people who are homeless, as well as those living with older adults or people with immunodeficiency disorders who are at high risk. New York City and San Francisco have bought hotel rooms for this purpose. King County in Washington, where the virus spread rapidly through a nursing home and soon to the rest of the community, has leased at least two motels and is working to construct extra hospital beds on a soccer field. The federal government is also converting military bases into quarantine sites in California, Georgia, and Texas.

At a news conference on March 23, Pennsylvania Department of Health Secretary Rachel Levine said that plans are underway to provide lodging for individuals who can’t quarantine at home.

“For safety’s sake we’re not announcing where those facilities are,” Levine said, “but they do exist and will be used when necessary.”

The sites are not officially open yet, according to a statement from the Department of Human Services.

For now, addiction treatment facilities say they’re trying to decrease the risk of having a coronavirus case by barring visitors and screening any new patients for symptoms such as cough or fever. However, growing research on COVID-19 indicates that up to half of all infected people may be asymptomatic but can still be highly contagious.

“Screening new patients is definitely better than not screening,” Baurer said, “but it would be naive to think that screening will prevent the possibility of a case from happening.”

In preparation, many treatment centers are looking within their facilities for areas that could be used to quarantine patients. Erin Pressel — chief strategy and business development officer for Gaudenzia, which owns nearly 100 rehab facilities across the state — said that might mean empty rooms at their larger buildings or unused suites at smaller rowhouse facilities.

Jonathan Wolf — CEO of Pyramid Healthcare, which owns 12 residential treatment centers in Pennsylvania — said the company is setting aside some patient rooms and lounge areas as “isolation pods.”

However, treatment centers are not equipped like hospitals with negative pressure rooms that isolate the contaminated air from a sick individual. And even keeping certain rooms empty for quarantine could become challenging as the treatment facilities fill up.

“We’re seeing a steady flow of people still coming in,” Pressel said.

Wolf, of Pyramid Healthcare, said he has received calls from a few hospitals that, in an attempt to make beds available for severe COVID-19 cases, are in search of other locations to transfer their patients in addiction treatment.

Pyramid is also recommending current patients stay at a facility for at least 14 days, in case they develop any symptoms of COVID-19. But as facilities try to care for existing patients longer and continue taking in new ones, staff and supplies could be stretched thin.

Wolf said many of his employees are working overtime and the company is hiring temporary staff to replace those who are sick or can’t come in due to child care concerns. With most schools and daycares closed, he has asked the state to consider allowing essential medical facilities to open temporary child care centers on-site. Hospitals in Michigan were recently authorized to do this.

The state Department of Human Services said it is not allowing new licensed daycare sites to open in hospitals, drug and alcohol facilities, or mental health care facilities at this time. But it is providing exemptions to allow some centers that serve the children of health care workers and first responders to stay open.

Gaudenzia has also asked the state to provide emergency staffing grants to help facilities hire more medical personnel and maintain required patient-to-staff ratios, Pressel said.

Bacharach, of Gateway Rehab, said supplies are another big issue. While facilities typically keep some thermometers, face masks, and sanitizing supplies on hand, they’re being used much faster now than normal.

“We were looking for additional thermometers, but from what we can gather, they’re back-ordered till the end of April,” he said.

Despite the challenges and the accelerating spread of the coronavirus, most treatment centers said they plan to stay open.

“We’ve been fighting another lethal pandemic for a long time,” Wolf said. “An average of 130 Americans die from an opioid overdose every day. We have to be here to save lives from that epidemic as well.”

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