Perlia Bell, an outreach worker with JOIN, talks to a woman about services after handing her gear.

Interim guidance updated June 3, 2021

Federal, state and local health officials continue to work with communities across the region to protect their residents from the spread of the novel coronavirus COVID-19. 

Local officials have also been working to protect people who are experiencing homelessness in particular, whether in congregate shelters, where close quarters can increase the risk of passing illnesses, or whether they're surviving without shelter.

At the same time, so many of our neighbors who've been experiencing homelessness have already been stepping up, checking on one another, and taking steps to protect and watch out for each other.

Even though many people will have only mild symptoms from COVID-19 and recover without medical intervention, it's also clear that some people — those who are older or have underlying medical conditions, including many people experiencing homelessness — face a higher risk of serious symptoms and need support from everyone in the community.

Following these steps can help protect vulnerable community members and lessen the chance of introducing or spreading diseases like COVID-19.

Basics about how COVID-19 is spread

COVID-19 or novel coronavirus has many possible symptoms. People can have a cough, difficulty breathing, muscle aches, headache, chills, or fever. Many people have no symptoms or mild symptoms.

The virus spreads mainly indoors from person-to-person, between people who are in close contact with one another (within about 6 feet). This happens by droplets from an infected person’s coughs or sneezes getting into another person’s mouth, nose, or lungs. 

The virus can also spread between people who are sharing the same airspace, and less often by touching surfaces that have the virus on it. People can be infected and spread the virus to others even if they don’t have symptoms. 

What we know about how the virus spreads (CDC)»

Most people recover without needing to go to a doctor or the hospital.

But certain people do face a higher risk of having more severe symptoms, including pneumonia. Those people tend to be older, have weakened immune systems or have underlying medical conditions (things like heart or lung diseases).

We have learned a lot about how to prevent COVID-19. Here are some steps to limit the spread of infections

If someone is sick, it will help them keep from spreading germs from their lungs or nose to other things they touch. If they are well, it will help them not pick up germs from things they touch and spread them to their mouth, nose or eyes.

  • People should do what they can to avoid touching their noses, eyes, and mouths

  • Cover coughs: Any cough, even if someone otherwise feels well, should be covered — not with someone’s hands but by a mask, scarf or bandana.

  • As much as possible, encourage those you’re working with to limit sharing personal items, particularly cigarettes, food, phones, utensils and other items.

  • Outreach workers and volunteers should not work when they are feeling sick and should not spend time with potentially vulnerable people. 

Hygiene and cleaning

Use disinfectant wipes that say “kills human coronavirus” on the back. Follow the instructions on the label.

Whatever is wiped will need to stay wet for the amount of time listed on the label. This step is important because that contact time is what is required to kill the germs. 

Wipes can be used to clean high-touch items like phones and other surfaces.

Medical Masks and Cloth Face Coverings 

We know that some people with COVID-19 never show symptoms and that some people can spread the virus before they show symptoms. A well-fitted face covering can block droplets from someone coughing, sneezing, or talking before they know they are ill. It protects the person wearing it AND those around them.

The State of Oregon provides detailed Statewide Mask, Face Shield, Face Covering Guidance. Face coverings are required in Oregon for everyone 5 and older, in specific indoor public spaces, including healthcare settings, shelters and transitional housing, and on public transit. The state’s mandate acknowledges that some people can request an accommodation due to health conditions, age, or differential ability.

In addition to the State mask requirements:

  • Multnomah County Public Health strongly encourages everyone to wear masks in all indoor public spaces, whether vaccinated or not. 

  • OHA strongly recommends that individuals who are unvaccinated or who are at risk for severe COVID-19 disease continue to wear a face mask when in outdoor crowded areas and in outdoor large gatherings of individuals and maintain physical distancing.

Masks and face coverings should fit snugly to cover the mouth and nose. Simple ways to get the best protection.

Medical masks

Medical masks, also known as surgical or procedure masks, are effective when they are used properly:

  • The colored side of the medical mask faces outwards.

  • Any strings or elastic bands should be positioned properly to keep the medical mask firmly in place.

  • The medical mask should fit snugly over the face and cover both your nose and mouth.

  • The metallic strip should be molded to the bridge of your nose.

When taking off a medical mask, fold it in half, inside in, and throw it away. 

Watch this video ( about correct medical mask use.

Cloth face coverings

If someone doesn’t have a medical mask, a bandana or other cloth face covering is fine. Here are some tips for creating and wearing face coverings:

  • The tighter the weave, the thicker the cloth, and the better it fits your face, the better the protection. In a pinch, you can use bandanas or scarves.

  • See the CDC webpage for images and directions showing how to make a homemade cloth face covering.

  • Homemade cloth face coverings should be washed daily or as often as possible with warm water and soap.

  • Make sure you can breathe easily through them.

  • Cloth face coverings can be itchy. Don’t reach under the mask to touch your nose or mouth.

Setting up a campsite to limit the spread of infection

As much as possible, people who are camping should work to separate individuals with respiratory illness symptoms (coughing, fever, shortness of breath or difficulty breathing, muscle aches, headache, or chills) from those without. This will stop the sick person’s respiratory droplets from getting into a well person through the air.

This is helpful even if coughing people are wearing masks or face coverings.

As much as possible, people who are sick should avoid sharing a tent with those who do not have symptoms of respiratory illness (like coughing). 

If space is constrained, then the guidance that Public Health has provided shelters and other congregate spaces can be helpful. Create a six-foot buffer to separate those who have symptoms of respiratory illness from those who do not.

As much as possible, people who are coughing should try to keep their tissues, bedding and worn clothes and trash separate.


The risk of companion animals, including pets, spreading COVID-19 to people is low, based on the information available to date.

To be safe, the CDC recommends that we treat pets as we would other humans – do not let pets interact with people or animals outside your family or group. As much as possible, keep pets away from people who are actively sick. 

Caring for someone with respiratory symptoms

Most people with COVID-19 recover without medical intervention. People are probably most contagious when they have symptoms like cough and fever.

Someone who’s mildly sick may have the following symptoms: coughing, sneezing, sore throat, a fever and aches.

Offer care as if the person has the flu:

  • Ensure they rest. And offer non-prescription medicines, like acetaminophen (Tylenol) and ibuprofen (Advil) for symptoms like fever and aches.

  • Keep the sick person in a separate, well-ventilated space and apart from other people and pets as much as possible. If that’s not possible, keep a distance of at least six feet from people who are well. People who are sick should avoid sharing a tent with people who are well.

  • Avoid sharing bedding and clothing if someone’s been coughing or sneezing on them. 

  • A sick person who is coughing or sneezing should wear a medical mask or cloth face covering. Everyone around that person, especially the person taking care of them, should wear a mask or face covering or cover their nose and mouth when close to the ill person and especially inside a small space like a tent.

When to seek additional medical care 

Testing for COVID-19 is available at various sites around Multnomah County.

Someone should get medical help right away if they develop any of the following symptoms: difficulty breathing, pain or pressure in the chest or abdomen, or if they’re unable to drink or keep liquids down.

An ambulance will come like usual when someone calls 911. The paramedics will be wearing extra masks and coverings to keep themselves healthy so they can keep working.

If someone knows someone who needs medical care but won’t seek it, they should urge them to do so — ask them to wear a mask or face covering and help them stay at least 6 feet away from others. 

Guidance for caregivers

The risk of catching a virus from a sick person is highest for their direct caretaker. But others who share space with a sick person should also take the same precautions to limit risk.

First, people should check their own health regularly, as best they can, to watch for the development of similar symptoms.

Caretakers and close contacts should always follow guidance around wearing masks, hand-washing and sanitizer, and touching their faces — particularly after sharing space with the ill person and handling their belongings.

Properly clean all frequently touched surfaces on a regular basis, using everyday cleaning products.

Avoid sharing personal items, utensils, towels or bedding with an ill person.

If laundry access is available or is being provided, items from a sick person and someone who’s not showing symptoms can be shared. But to avoid germs, people should avoid shaking dirty laundry or “hugging” dirty laundry to their chests to carry it.

Additional questions

What if someone asks why they should take these precautions if they feel well right now?

It’s true that many people who get COVID-19 may never develop serious symptoms or may never even know they had it in the first place.

It’s also true that the reality of trying to survive outside, day in and day out, all year, is life-threatening and deeply traumatic and challenging all on its own. 

It’s important to acknowledge that.

But because some people do face a higher risk of serious symptoms from COVID-19, including some of the people you might be camping with or spending time with, we’re asking everyone across the community, no matter where they live and who they are, to do their part and do whatever they can to limit the spread of infection.

We also know that so many people have already been stepping up, checking on their neighbors and campmates, taking steps to protect and watch out for one another.

They have been taking those steps all on their own, caring for another with a deep sense of community, without waiting for official guidance. That agency and initiative is powerful and it will continue to be important in the days to come.