Latanya Wilson is no stranger to life on the street. She’s been unhoused in San Francisco, California, on and off, for 15 years.
But sleeping outdoors during a pandemic is unlike anything she’s experienced.
“I’m really scared being out here,” says Wilson, who is living in a green two-person Coleman camping tent in the Mission neighbourhood. “You can go to sleep and anyone can come up and unzip the tent”.
Wilson says there are far fewer pedestrians on the street to ask for food or change, although occasionally people drive up and offer help. Going to the long-established Mission Neighborhood Resource Center, where showers and case workers are available, is a newly harrowing effort because the entry line is so long.
“I know they are helping,” Wilson says of city authorities. “But help a little more, please, help a little more with the food and the resources”.
San Francisco quickly and aggressively adopted strategies that have since become the coronavirus playbook for addressing homelessness, moving many of the most vulnerable and potentially exposed people into hotel rooms before other cities did.
But Wilson is largely unaware of these interventions, perhaps because at the age of 42 she doesn’t meet San Francisco's criteria for vulnerability. She’s heard rumors about the city’s efforts to help the homeless during the pandemic, but hasn't seen much outreach from aid workers.
“When I was downtown, this one girl told me about the Ramada or somewhere, that they were helping out couples and a few other people,” said Wilson.
San Francisco was the most aggressive jurisdiction to take up California Governor Gavin Newsom’s Project Roomkey, which funnels federal and state funds to local governments to rent unused hotel rooms to house the most vulnerable homeless residents. To get a room, a person has to test positive, be over the age of 60, or have been exposed to an infected person.
Over 1,500 rooms have been rented by the city to house the homeless and other needy populations, where residents can get three meals a deal and their own bathrooms. That’s far beyond what other cities in California have accomplished so far. About 25% of the hotel rooms obtained for the state’s homeless population, so far, have been given to individuals in San Francisco, according to Mayor London Breed. San Francisco accounts for approximately 5% of the state’s overall homeless population.
“The work of opening a permanent supportive housing site, which are very similar to the hotels that we are opening, can take nine months to a year on a regular basis,” says Emily Cohen, interim director of strategy and external affairs for the city’s Department of Homelessness and Supportive Housing. “Now, we're opening these things in three or four days”.
The city also set up 15 outdoor bathrooms and 30 hand washing stations in addition to the existing 25 locations in the Pitstop Program. It ended its policy of breaking up encampments of homeless people, in line with recommendations from the Centers for Disease Control and Prevention.
San Francisco's blueprint is similar to programs that have since been set up in many major cities. Outdoor restrooms are being installed, shelter populations thinned, encampments policies softened, and hotel rooms rented for those who have to quarantine.
These strategies aren’t unprecedented. In recent years, municipal governments have rolled out public hand washing stations and easily cleaned outdoor bathrooms in an effort to ameliorate the pre-pandemic homelessness crisis. In cities such as New York and Boston, with cold winters and large unsheltered populations, authorities have rented small numbers of hotel rooms when shelters get overwhelmed.
But these pandemic-related interventions are on a different order of magnitude.
“[Renting hotel rooms] has never been used at the scale that we're seeing now and with the speed of procurement,” says Samantha Batko, a research associate with the Urban Institute in Washington, DC. “We are also seeing a level of personal hygiene accessibility for unsheltered people being deployed at a scale that we have not previously seen”.
San Francisco's response is one of the most aggressive in the US, but advocates and the city’s Board of Supervisors argue it isn’t nearly enough to address the full scope of the challenge presented by Covid-19. In early April, an outbreak rapidly spread through the Multi-Services Center (MSC) South, the city’s largest homeless shelter, resulting in over 100 residents and 10 staff members being infected.
Advocates had been warning such an outcome was inevitable as long as shelters remained the principal way the city housed the homeless. Covid-19 appears to be especially virulent in confined, congregate settings like prisons, nursing homes, and homeless shelters.
That’s why an April report from the University of California Berkeley’s School of Public Health recommended that hotel rooms be used “not just for quarantine and isolation,” but for housing all the region’s homeless people.
The alternative is leaving unhoused residents in shelters, where outbreaks like the one at MSC South are a continual danger despite the city’s effort to de-densify the population. On the streets, meanwhile, people like Wilson are exposed to the elements and cannot access the levels of food and assistance that they normally would.
The existing policy will make both homeless people and the general population more vulnerable, advocates argue.
“In past epidemics such as HIV/AIDS, tuberculosis, and hepatitis homeless folks would carry these diseases longer than the general population,” says Chris Herring, an organizer with the San Francisco Coalition on Homelessness and a Ph.D candidate at UC Berkeley who contributed to the School of Public Health’s report. “When we have something so contagious, I'm concerned that if we don't squash the virus [among this population], we might not be able to fully open up”.
San Francisco isn't the only city where debate is raging over hotel housing for the homeless. New York Council Speaker Corey Johnson and his allies want the city to do the same. Close to 6,000 people are already being sheltered in hotel rooms, but an estimated 17,000 remain in shelters. At least 43 homeless people have died of the disease in New York City so far. (San Francisco officials say they have not been tracking Covid-19 deaths specifically among homeless people.)
Mayor Bill de Blasio’s administration says the city cannot afford the expense of moving the entire homeless population into hotel rooms. The mayor’s office says it could cost the city $82 million a month, at a time when it is already facing a dire budgetary shortfall as the result of declining revenues and increasing service expenditures. In San Francisco, it would cost $58.6 million a month.
Federal aid would be needed to support such an outlay, city leaders argue. But signals from the national government have been mixed.
The CARES Act stimulus contained $12.4 billion to help cities address homelessness, and the Centers for Disease Control and Prevention have been issuing guidance to encourage cities not to break up tent encampments during the pandemic. But local jurisdictions have mostly been left to make their own way, and many cities have not been utilizing hotel rooms at all.
From Oklahoma City to Fort Lauderdale, many municipal governments have reportedly not yet rented rooms. The US's fifth largest city, Phoenix, only started utilizing hotel rooms last week.
“We're in a build-the-plane-while-you-are-flying-it mode here,” says Dennis Culhane, professor of social policy at the University of Pennsylvania. “Local governments have such limited capacity and there's not clear federal leadership on how communities should be doing this. Everyone's figuring it out on their own, which is not ideal”.
Back in San Francisco, officials say that for now they do not have plans to expand their hotel housing plan to shelter the entirety of the city’s homeless population. But they will soon move to open a hotel for unaccompanied youth.
Advocates like Herring say the city could “commandeer” the rooms, under a power that city and state executives have during public emergencies. But San Francisco officials are not in a rush to be the first to do so, despite a bill passed unanimously by the Board of Supervisors – San Francisco's City Council – which Breed refused to sign. (Breed has argued that it wouldn't be safe to acquire the rooms so quickly, and that the city needs time to ramp up its programme.)
“The city's approach has been to work with our Hotel Council and our hotel partners to lease as many rooms as possible,” says Cohen. “I don't think we've reached the ceiling on that yet… I strongly suspect that the vast majority of our focus will be on the unsheltered population who meet those vulnerability and age criteria”.
There is still a lot of outreach work to be done even among that population, says Anthony Marshall, who’s lived on the street sporadically for 23 years. He currently resides in a single-room-occupancy hotel called the Altamont.
“The city is doing a good job in terms of, if I raise my hand and say ‘I have it,’ they are right there for you,” says Marshall, a 59-year-old Chicago native. “They started the new hotels, they started a whole bunch of new [stuff] to try to deal with this Covid thing, and I respect them for it”.
But Marshall says that people he knows are apprehensive about going into the city-managed hotel rooms. Even some who meet the age or vulnerability criteria are choosing to remain on the street, unless they feel really sick, for fear of giving up their freedom.
“What I've been hearing, once you get up there you can’t go anywhere,” says Marshall. “If people are infected, they are treating them like segregation, and they gotta stay in there all day. No one really wants to come around them because they got the virus”.
There can be a complex array of rules at the hotels, depending on the location and company. In some, pets aren’t allowed at all. In others, security standards are strict, and residents are only allowed to leave for 20-minute increments each day.
Marshall fears that many homeless residents will avoid the accommodations being offered unless they desperately need it, even if they test positive. After all, they can’t be made to check in to a hotel.
“A whole bunch of homeless people got it, that's what I'm worried about,” says Marshall. “They’re not getting checked up on. These new hotels they’ve got, a lot of people are sceptical and scared about going up there”.