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The city of Phoenix set heat records in summer 2023, with high temperatures that topped 110 degrees Fahrenheit (43 degrees Celsius) for 31 consecutive days[1] and at least 54 days in total[2]. In such conditions, providing basic services – including cool spaces – for people experiencing homelessness is lifesaving.

In 2022, 420 people – many of them unsheltered – died in Phoenix from heat-related causes[3]. Estimates are not yet available for summer 2023, but given this year’s extreme conditions, the toll is expected to be higher.

For the past two years, we have worked as researchers with the Human Services Campus[4], a 13-acre complex in Maricopa County, Arizona, where 16 nonprofit organizations work together to help people who are experiencing homelessness. The campus includes Central Arizona Shelter Services[5], or CASS, Phoenix’s largest homeless emergency shelter, which assists 800 people experiencing homelessness on any given night.

Our work includes talking with staff and clients to better understand their challenges and identify possible solutions that draw from our work in the fields of architecture[6], health and social innovation[7].

Dormitories at CASS protect residents from extreme heat with a bunk to sleep in, day rooms for socializing, case management services, and sanitary shower and restroom facilities. But CASS struggles to provide dignified spaces that offer privacy, storage space and quiet environments. People need this kind of environmental support in order to battle recurring physical and mental health issues that often accompany homelessness and can hinder or prevent healing.

Homelessness spiked in 2023 in major U.S. cities with the end of pandemic eviction moratoriums.

Overflowing shelters

As of 2022, the U.S. Department of Housing and Urban Development estimated that the U.S. had nearly 600,000 homeless people nationwide, with about 60% living in emergency shelters, safe havens or transitional housing. The other 40% lived outdoors or in places such as abandoned buildings and public transit stations[8].

Homeless centers must conform to architectural standards for emergency shelter[9]. These standards have historically been influenced by institutional building design, which prioritizes attaining minimum conditions needed to keep people alive. Today, many homeless shelters struggle to provide even that level of care.

The Human Services Campus was originally constructed in 2003 to provide consolidated services and a coordinated entry plan for people experiencing homelessness. However, it was intended to be part of a larger system of shelters, not the sole service provider for Phoenix’s estimated 9,000 homeless people.

The city’s homeless population has grown, in part because of unprecedented rent increases[10] and a lack of affordable housing[11]. During this summer’s heat wave, nearly 1,200 unsheltered homeless people[12] lived on sidewalks surrounding the campus, many in tents, with limited access to bathrooms and sanitation facilities.

Homelessness and mental health

When asked about causes of homelessness, policymakers and members of the public often point to mental illness and addiction[13], as well as a lack of affordable housing[14]. They tend to pay less attention to the underlying impacts of past trauma other than noting that many women become homeless to escape domestic violence[15].

In a 2005 study, an alarming 79% of homeless women seeking treatment for mental illness and substance abuse reported experiencing a past traumatic event such as physical or sexual abuse[16]. More recently, a 2020 study showed that nearly two-thirds of homeless women and almost half of homeless men reported that they were homeless because of trauma[17]. Shelter design can affect homeless people’s ability to recover from past trauma and to battle addiction and other mental health issues that perpetuate cycles of homelessness.

For example, one woman who currently lives in CASS told us about trying to get a full night’s sleep while living in a day room where the lights were kept on around the clock and there was constant activity. Because she had several bags of personal items that were too big to store in the dormitory, she could not get a bed there.

“When they don’t turn the lights down at night, I start to feel like my body is vibrating,” she said. “I start to see people walking around, and I’m not sure if they are even really there.”

Brandi Tuck, founding executive director of Portland Homeless Family Solutions in Oregon, explains how trauma-informed design can transform shelters.

Routinely sleeping less than seven hours per night can be harmful to health[18]. It lowers immune function, increases chronic pain and raises the risk of heart disease, high blood pressure, diabetes, stroke and death. For homeless people battling mental health challenges, addiction and past trauma, rest and recovery are essential to getting back on their feet.

CASS staff have tried to create healthier sleep spaces, such as dorms that remain dark, quiet and cool at all times. Priority access goes to people with jobs. These sections can house only about a third of CASS’s residents, leaving others to sleep in dorms where there is more noise and light.

More supportive spaces

Simply feeding people and providing them with places to sleep is a major challenge for shelters in cities where homelessness is rising. But some have found ways to think more broadly.

In San Diego, Father Joe’s Villages[19], a nonprofit network with a central campus and scattered-site programs, houses more than 2,000 people nightly. San Diego’s more temperate climate makes it less urgent to maximize the number of people they shelter indoors, so staff at Father Joe’s can use its decentralized design to create shelters with private and quiet spaces.

The Father Joe’s network includes multiple smaller-scale facilities where clean bathrooms are easily accessible and homeless people can use basic amenities like laundry and storage. One example is Mary’s Place, a collection of diverse shelters that provides emergency and long-term support in smaller facilities modeled after the simplicity and comfort of a home.

People experience less stress and can more easily navigate the challenge of ending their own homelessness when they can get a restful night’s sleep in a quiet environment, with spaces that allow them some privacy. We are encouraged to see other U.S. shelters moving in this direction[20] – but there’s a long way to go.

A man sits on a bed in a large room divided into individual spaces with low partitions. His area has storage compartments with locks and a skylight provides daylight.
This homeless shelter in Wilmington, Calif., a neighborhood of Los Angeles, provides residents with natural daylight, storage and privacy. Natalie Florence, CC BY-ND[21]

Steps toward better design

To address the lack of privacy at CASS, we have proposed subdividing the day room into more private spaces to accommodate activities like online telehealth appointments, counseling and job interviews. To tackle long-term impacts of overcrowding, we also have recommended introducing sanitation amenities, such as laundry facilities, “hot boxes[22]” to sanitize clothing and bedding, more bathroom facilities and reliable trash removal to reduce the spread of infection and pests such as bedbugs and lice.

For new facilities, designers could consider small changes, such as increased storage and more diligent regulation of temperature, light and noise.

Hospitals, nursing homes and retirement communities[23] have found many ways in recent decades to use design to support patients’ health[24]. Many of the same concepts can be applied to emergency shelters and help turn these facilities from institutional warehouses into spaces of health and opportunity.

Read more …Shelters can help homeless people by providing quiet and privacy, not just a bunk and a meal

A blue-gloved hand holds up a COVID-19 booster shot syringe.

On Sept. 12, 2023, the Centers for Disease Control and Prevention recommended the newly formulated COVID-19 vaccines[1] for all Americans ages 6 months and up[2], hours after its expert advisory committee voted 13 to 1 in favor of recommending the vaccines.

The CDC’s broad recommendation comes one day after[3] the Food and Drug Administration approved Moderna’s and Pfizer’s updated mRNA vaccines[4] that target a previously dominant variant of the omicron family called XBB.1.5. The updated shots will be available to the public within days.

The Conversation asked Prakash Nagarkatti[5] and Mitzi Nagarkatti[6], a husband and wife team of immunologists from the University of South Carolina, to weigh in on how the new vaccines might stand up against the latest COVID-19 variants that are swirling across the globe.

1. How are the new vaccines different from the previous?

When the first vaccine against COVID-19 was rolled out in December 2020, it was designed as a monovalent vaccine, meaning that it was formulated against only the original SARS-CoV-2 virus. That vaccine, as well as the updated ones, target the spike protein, which the virus uses to infect our cells and cause the disease.

That design made sense before the virus began mutating into a complex family tree[7] of variants and sublineages[8]. But as the virus structure shifted over time, the antibodies produced in response to the original vaccine became less effective against the new variants.

This necessitated the development in 2022 of new “bivalent” vaccines[9] that targeted both the original strain of SARS‑CoV‑2 and new viral variants such as the omicron BA.4 and BA.5 lineages[10] that were dominant in mid-2022[11].

But, not surprisingly, new variants of the virus continued to emerge.

In June 2023, the FDA asked vaccine developers to formulate new fall shots[12] to target the then-dominant XBB.1.5 subvariant.

The FDA approved that monovalent mRNA-based vaccine[13] based on the overall efficacy data presented by the vaccine manufacturers.

Unfortunately, XBB.1.5 is no longer the dominant strain in the U.S.; it has been displaced by other variants from the XBB lineage, thereby raising concerns about the potential efficacy[14] of the new shot. As of mid-September, the dominant variants nationwide are[15] EG.5, also known as Eris, followed by FL.1.5.1 – called Fornax – and XBB.1.16.6.

Meanwhile, a new highly mutated omicron offshoot, BA.2.86, nicknamed Pirola[16], is making its way across the globe – albeit so far in small numbers.

2. Who should get a new shot?

The CDC recommended that everyone ages 6 months old and up should get an updated COVID-19 vaccine so that they can be better protected against developing serious outcomes from COVID-19, including hospitalization. The agency noted that people who received the 2022-2023 bivalent COVID-19 shot “saw greater protection against illness and hospitalization than those who did not.”

Most Americans will be able to get the newly formulated vaccine at no cost[17], according to the CDC.

The FDA approved a single shot of the updated vaccine for anyone ages 5 and older[18] – regardless of whether they were previously vaccinated or not. The agency also approved unvaccinated individuals 6 months to 4 years of age to receive three doses of the updated Pfizer vaccine or two doses of the updated Moderna vaccine.

For most people, doctors recommend getting both the COVID-19 and flu shots before the end of October.

3. How effective could the updated shot be against the latest variants?

Based on its current assessment, the CDC indicates that the BA.2.86 variant may be able to cause infection[19] even in people who have been previously vaccinated or those who have had COVID-19 infection in the past. But the CDC says it still expects the updated fall 2023 booster shot to be effective at reducing severe disease and hospitalization.

Moderna reported in August 2023 that the new monovalent mRNA COVID-19 vaccine gave a “significant boost” in antibodies[20] that are protective against two of the currently circulating variants: EG.5 – which is responsible for most cases in the U.S. as of mid-September – and FL.1.5.1. Then, in early September, Moderna announced that its most recent data from human trials showed an 8.7-fold increase in neutralizing antibodies against the newest variant, BA.2.86, following vaccination with the updated shot.

Similarly, new pre-clinical data from Pfizer shows[21] that its version of the new mRNA vaccine produced antibodies that were effective at neutralizing the XBB.1.5, BA.2.86 and EG.5.1 variants.

This early research suggests that the new mRNA vaccines – although developed specifically against XBB.1.5 – are still effective against some of the most prevalent variants.

Novavax, which specializes in traditional protein-based vaccines, also announced in August[22] that its updated COVID-19 vaccine directed against the XBB variant produced a broad neutralizing antibody response against key variants in animal studies. However, the company does not yet have data on its vaccine’s performance against two other key variants, FL.1.5.1 and BA.2.86. The Novavax vaccine has not yet gone up for FDA review, but its approval is also expected within months.

It is important to keep in mind that while all three vaccines have been shown to trigger antibodies that can neutralize most of the currently circulating variants, it is unclear whether the vaccines will be able to effectively prevent COVID-19 infection in humans. Such clinical studies are time-consuming, so given the urgency and speed needed to develop vaccines against the ever-changing COVID-19 variants, vaccine manufacturers rely on antibody levels as an indicator of protection.

4. Is there a ‘right’ time to get the new vaccine?

Antibodies produced after a COVID-19 infection or vaccination last for about six months, and then their levels start declining[23]. This is called “waning immunity.”

About a year after getting a COVID-19 infection or vaccination, only a small fraction of antibodies can be detected. This is why health care providers recommend getting another shot if a year has passed since you were vaccinated or had an active infection.

It has become very clear that vaccines against COVID-19 do not provide 100% protection against catching a new COVID-19 infection[24], but they can make illness from the infection milder, shorter or both[25].

In addition, vaccines provide significant protection from hospitalization and death[26] and may help protect against developing[27] long COVID[28].

Viral infections normally peak in the winter, which is why experts advise[29] getting both COVID-19 and flu vaccine shots in the months of September and October[30]. For convenience, the two shots can be safely taken[31] at the same time[32]. This is because the immune cells that produce antibodies against one vaccine agent are distinct from those that produce antibodies against the other vaccine agent.

However, taking two different vaccines at the same time could cause more side effects[33], such as fever, aches and pain. This is especially the case for people who have experienced such side effects in the past after taking the COVID-19 and flu vaccines separately.

In addition, a newly approved vaccine against the respiratory syncytial virus, or RSV, is now recommended for people ages 60 and up[34].

5. Should some people wait for the updated Novavax vaccine?

The Moderna and Pfizer vaccines use the more recent vaccine technology based on mRNA, which instructs the body to produce a protein from a small portion of the SARS-CoV-2 virus. The immune system responds by producing antibodies.

In contrast, the Novavax vaccine relies on a more traditional approach to vaccine production, injecting the viral protein directly into the body to stimulate antibody production. So while the two vaccine types use different pathways to trigger antibodies against the virus, the end result is the same.

The CDC has reported rare cases of myocarditis[35], which is inflammation of the heart muscle, following vaccination with the Moderna and Pfizer mRNA vaccines. However, the same is true[36] of the Novavax vaccine[37]. So all three vaccines carry this very rare risk.

It is noteworthy that myocarditis is most frequently seen in adolescent and young adult males[38].

Although some people may have a preference for the traditional protein-based vaccine by Novavax, those who are at higher risk of catching COVID-19 should not wait for the approval of the Novavax vaccine to get their shot.

Read more …CDC greenlights two updated COVID-19 vaccines, but how will they fare against the latest variants?...

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