Daniel Ball, a Street Sense Media artist and vendor. Photo by Will Schick

Daniel Ball woke up cold and wet on the morning of Friday Feb. 25, following a rainy night with a low of 34 degrees. D.C.’s Hypothermia Alert was activated the night before, but was deactivated by Friday afternoon. His brown puffer coat was darker near the bottom where water had seeped through.

When it’s cold outside Ball wakes up early and catches the Metro, he said. 

Most weekdays, trains operate from 5 a.m. to midnight.  

“This morning I was up since four,” Ball said on the Friday he woke up cold and wet. “I think the bus comes at 4:10 or 4:26 around the corner here.  So I ride that down to Minnesota, then I ride back, then I get on the Metro.”

“I ride up and down, up and down until the church opens up,” he said in reference to a church he frequents during the day.

Ball, a Street Sense Media artist and vendor, sleeps in front of a church in a tent on the sidewalk. A tear in the tent window had allowed water to get in until he covered it with plastic. The cot inside which he sleeps on is secured to the tent so that the tent does not blow away. Sometimes he uses a plastic bag as a pillow. He had been given two pillows which both got wet, he said. “There’s no use to trying to dry them and stuff, so I had to throw them away.”

Not only is it uncomfortable to live outside in cold weather, but there are serious health concerns related to cold exposure. 

Seven people died due to causes associated with hypothermia or cold exposure during the last hypothermia season, which lasted from Nov. 1 2020 to March 31, 2021, while experiencing  homelessness according to the DC Interagency Council on Homlessness. That season, the city called 114 hypothermia alerts. In the previous five seasons, there were two or fewer deaths associated with hypothermia or cold exposure.

The D.C. Shelter Hotline, 202-399-7093, is designed to connect people with resources related to cold weather concerns. It operates 24 hours a day, seven days a week during hypothermia season, 

According to the ICH winter plan, seasonal shelters which operate from 8 p.m. to 7 a.m. may be opened during this time of year. Once they have been opened they continue to operate for the remainder of the season. This is in addition to year-round, low-barrier, shelters. If these are at or near capacity, overflow shelters should open.

The plan also states that scheduled or unscheduled transportation to shelter is available during hypothermia season. Scheduled transportation is intended to provide morning transport from shelters to specified locations in the District, then to provide return transit to shelters in the evening. Schedules and the locations that individuals are transported to varies by shelter. Unscheduled, on-demand, transportation can also be requested using the shelter hotline. This will transport individuals to shelter regardless of alert status.

Temperatures forecasted at or below 15 degrees with windchill, or 20 degrees with windchill and other weather conditions such as precipitation or snow accumulation, may trigger a cold weather emergency. When this is called, additional overnight warming sites are open from 7 p.m. to 7 a.m.

Street Sense Vendor  Donté Turner expressed hesitancy about staying in shelters. Most shelters wouldn’t pass a health inspection, he said. Turner discovered he had bed bug bites following a shelter stay. He cannot stay in housing offered through the Pandemic Emergency Program for Medically Vulnerable Individuals because of its 7 p.m. curfew. 

HopeOneSource CEO Tim Underwood acknowledged the limitations of hypothermia alerts. HopeOneSource is primarily a text message based platform. In partnership with the Department for Human Services, they provide D.C. residents with text notifications whenever hypothermia alerts or Cold Weather Emergencies are called. But currently this is a one-way messaging system.

“HopeOneSource, as we’re doing elsewhere, has the capacity for two-way communication between the provider, D.C.’s Department of Human Services, and the resident,” Underwood said in reference to HopeOneSource outreach in the District. In other regions, the texting platform allows for users to respond. Underwood’s goal is that this will eventually be the case in D.C. too.

“The alerts as they are shared now only leverage a small portion of our offerings of what HopeOneSource can bring to the table,” Underwood said. 

In addition to text alerts, HopeOneSource runs a mobile outreach van which connects D.C. customers to internet access or their most immediate needs, such as job training, shelters and access to legal resources, he said.

But for now, unhoused residents such as Turner feel dissatisfied with the services available to help with his housing situation. He says he hasn’t heard from his social worker in three months. And because of his negative experience with shelters he sleeps in a tent despite the winter weather.

Although a tent provides more shelter than sleeping in the open air, there are still a number of health concerns associated with cold weather exposure, such as hypothermia and frostbite, which can be especially dangerous for unhoused people who are more likely to have preexisting health concerns.   

“A lot of underlying medical conditions that aren’t managed well can make people more susceptible to being in the outdoors,” said Tara Cross, an emergency medicine physician assistant in Harrisburg, Pa., with experience working as an EMT in multiple U.S. cities. Cross has also worked as a trip leader and environmental educator for Outward Bound in Northern Minnesota, Philadelphia, and Baltimore.

“A lot of homeless people that come into the hospital come in because of foot problems,” Cross said. “It’s cold out so they don’t want to take their shoes and socks off, they don’t really have the opportunity to have a clean dry space to do that and I’ve definitely had individuals who have had frostbite, even lost digits, because of a lowered ability to care for their feet.”

Without access to soap or clean water it can be hard to treat scrapes and blisters on the feet. 

If a patient has unmanaged diabetes it may cause nerve damage, known as diabetic neuropathy, in the legs and feet. This results in numbness and tingling which makes it more difficult to tell when the feet are injured, Cross said. 

Foot infections and amputations can occur even in patients with access to medical treatment for their diabetes.  “This is definitely heightened for someone who is homeless and lacks the ability to properly manage their diabetes,” she said.

Wind makes it especially difficult to manage cold weather challenges. The body loses heat faster because of the evaporative cooling effect, Cross said. Moisture adds to wind’s heat loss effect, so staying warm and dry is key to keeping safe.

“The wind really don’t bother me,”  Ball said. “See I’ve got my blue cover in front of my tent and that kind of keeps that wind from blowing in there”

His feet were cold Friday morning despite wearing two pairs of socks.

Graphic by Jem Dyson

“Having access to a couple of layers of clothing, preferably things that aren’t cotton but can be more like polyester can provide warmth even if they get wet,” Cross said. “Putting up a proper tent and putting it up properly can go a long way in terms of keeping it from falling down and providing that wind protection.”

Dome-shaped tents which are low to the ground with sturdy poles are ideal, a consultant with a camping gear retailer said. She asked for the name of the company she works for to be omitted. The shape and structure allows wind to pass over the top and prevents precipitation from accumulating. When rain accumulates on a tent it may leak through the fabric. Heavy snow may also leak or cause a tent to collapse.

This January, a 73-year-old woman was stuck in her tent near New Jersey Avenue and Fourth Street for an hour after snow accumulation caused it to collapse. 

“A lot of tents they’re not really designed to stand the weight of snow, unless it’s a tent for winter camping,” Cross said. Securing a tent properly with stakes helps with weather protection. On hard ground where stakes can not be used heavy rocks may be used instead. Regular maintenance by removing precipitation build up daily can help too. 

Having outdoor gear resources and education on how to use it properly could be useful for unhoused populations, Cross said. 

Improper tent set up could put individuals at more risk for cold-related health concerns. Tent floors can be reinforced for winter weather using a ground cloth or tarp that goes underneath the tent. This will prevent small rips. By creating a barrier between a person and the ground, heat is preserved too. 

“The best way would be to use a closed-cell foam sleeping pad which would be more durable than inflatable options,” the outdoor gear consultant said. 

Closed cell foam pads are often significantly cheaper than inflatable ones. A thick yoga mat or layered extra blankets could work similarly. To stay warm while sleeping it is also recommended to change into clean, dry clothes at night. This includes clean socks. 

“Even if you feel you haven’t perspired during the day you might have,” the consultant said. So changing out of day clothes into clean night clothes is a way to stay drier and warmer. But not too many layers, she said. Excess clothing can restrict the air flow when sleeping in a sleeping bag. 

“Your sleeping bag is trying to capture your body heat,” she said. “And it needs air to get to it.”

Draping warm items such as jackets over top of a sleeping bag can be more warming than wearing a jacket in the bag. Hats will keep heat from escaping from the head.  Alternatively, wearing warm layers and insulating with an emergency blanket, tarp, or trash bag can be a way to conserve heat. 

Still, the best way to prevent cold-related illness is by finding shelter indoors. D.C. residents have a legal right to shelter when a hypothermia alert or a cold weather emergency is called. The winter plan states that overnight warming centers operate when cold weather emergencies are called. 

Alert status is available at dhs.dc.gov, or residents can sign up for text alerts at alert.dc.gov or through HopeOneSource. Alert status is also posted to Twitter at twitter.com/alertdc. A list of shelters is available at dhs.dc.gov, and a list of warming sites is available at snow.dc.gov.  

When asked if he knew about warming centers Ball responded, “No (laugh) where that at?” He warmed up at the Street Sense Media office during the day. “Might be cold again tonight but I don’t know.”

Graphic by Jem Dyson

Individuals looking for help on behalf of someone else may also call the shelter hotline at 202-399-7093, the Mayor’s call center at 311, or, for minors under 18, the Sasha Bruce Youthwork hotline at 202-547-7777. 

Individuals, community-based organizations and faith-based groups who have items to donate or wish to participate in cold weather outreach are encouraged by the Interagency Council on Homelessness (ICH) to contact Tom Fredericksen at The Community Partnership at 202-543-5298.