San Francisco Chronicle, July 10, 2020
By Kevin Fagan
When the corononavirus first hit the country, experts feared the disease would rip through homeless populations like a tsunami. Living outside in terrible sanitary conditions and with no safe place to hide, the feeling was that if COVID-19 got into even one camp there would be no way to stop it.
Those fears have fallen flat. So far.
It turns out that homeless people in San Francisco, and throughout the country, are contracting the coronavirus at about the same rate as housed people. Apparently, isolating people in hotels and thinning out shelters has helped — and for those left outside, the fresh open air is a greater protector than experts anticipated.
Nobody’s saying disaster still can’t hit, but doctors and homeless policy managers say they are heartened by the numbers to date.
“This is encouraging, but I remain very concerned,” said Dr. Margot Kushel, who has been helping test homeless people in San Francisco. “We need to remain very vigilant. We can’t rest on our laurels. One thing COVID has taught us is that it’s not over yet.”
In San Francisco, 6,100 homeless people have been tested for the coronavirus since early March, and 225 — or 3.6% — tested positive. That’s compared with 3% in the general population, where 5,158 of the 171,964 people tested came out positive.
Kushel, director of the UCSF Benioff Homelessness and Housing Initiative, is analyzing results of the testing “to figure out the secret sauce” for what has been most effective in preventing infections among the homeless.
“We’re still looking at everything, but there’s no question that the hotel rooms and downsizing the shelters helped a lot,” she said. “I’d love to see more hotels being used. I also think we got very lucky.”
Like most major cities in the nation, San Francisco has leased a large number of hotel rooms to shelter vulnerable and older homeless people during the pandemic — more than 2,500 to date. It’s also thinned out its shelter population by more than 70% to create safer distancing.
Several city supervisors and homeless advocates argue that the city should lease enough hotel rooms to shelter all of its 8,000-plus homeless people, but program managers say it’s too expensive to do quickly.
In early March, when the coronavirus began rippling across the country, federal and local officials named homeless people as among the five most vulnerable segments of the population, along with prisoners, college students, nursing homes and military personnel. A study led by the University of Pennsylvania found that homeless people, whose immune systems are generally more battered than normal, were four times more likely than the general public to need intensive care if infected and three times more likely to die of COVID-19.
In San Francisco, homelessness program directors created a special unit to tackle prevention in the street, worrying that an infection in just one camp or shelter could mushroom. And sure enough, in early April the virus exploded at the Multi-Service Center South homeless shelter, the city’s biggest, infecting 96 clients there to become the biggest cluster of homeless positives in the western United States.
But then city officials got a grip on the spread. As did other localities, not just in the Bay Area, but across the nation.
According to a report released this week by the U.S. Interagency Council on Homelessness, just 4,845 cases of COVID-19 have been reported nationwide among the homeless population, which is estimated at about 600,000 on any given night and as much as 3 million throughout the year. Of those, 130 have died, the study concluded.
Local experts, including Kushel, say the report probably underreports the numbers because of inconsistent data reporting throughout the country. But it does give the only national snapshot of its kind.
“The number of positive cases and fatalities within the community of homelessness is dramatically and significantly lower than originally predicted,” the federal report said.
The report did not list a national compilation of coronavirus rates, but contended that in most communities, the rate of infections among homeless people tested has turned out to be about the same or lower than that of the general population, which in the Bay Area is around 3%. In Atlanta, for example, 1.2% of homeless tests came out positive. In Los Angeles, 1.9%.
In addition to San Francisco’s numbers, the same encouraging ratios have emerged Santa Clara, Alameda and Contra Costa counties, which are struggling the most with coronavirus in the Bay Area.
In Santa Clara, the percentages of people who tested positive are 2.7% for both homeless and housed people. In Alameda, it’s an estimated 3% homeless versus 4.7% housed. And in Contra Costa, it’s 4.4% homeless versus 4.7% housed.
“There are a couple of bright spots there for us, and I think a lot of it has to do with us being really aggressive early on getting people out of congregate settings, like shelters, and into hotel rooms,” said Will Harper, spokesman for the Contra Costa County health department.
Deb Bourne, who directs homeless coronavirus efforts for the San Francisco Department of Public Health, said that even without detailed analysis, three factors have become clear in helping homeless people avoid the disease.
“The first, and most important thing, is to socially distance from other people, cover your face with a mask, have good hygiene and get tested if you have contact with the disease or symptoms of it,” she said.
Bourne’s second takeaway is that living in a crowded environment, like a packed shelter or a small room in a single-room-occupancy hotel with too many residents, puts a person at greater risk. Lastly, she said, sleeping on the street is not as good as being in a hotel room, but it does appear to be safer than being in a crowded place — although she and Kushel both point out that sleeping on the street is never an ideal way for anyone to live.
“The air quality is better outside and there’s less chance of spread,” Bourne said. “And if they are living outdoors, we have to help people get access to hygiene stations and bathrooms. And to keep social distancing — which means having a tent if possible. Tents are good in an emergency situation like this. It’s a barrier, like your room.”