Unhoused, Sheltered in Place: Homelessness in Pandemic Times

San Francisco is being held as an exemplar in its approach to “flattening the curve” during the COVID—19 pandemic. But unhoused people and their advocates are saying the City is actually behind the curve when it comes to halting the spread among the homeless population.

As of April 24, the SF Department of Public Health has reported 134 positive cases among people with no fixed residence, which comprises exactly 10% of 1,340 cases citywide. The first case among homeless people was reported at the Division Circle navigation center in the Mission District. Around 100 people were later found positive among staying at MSC South, the City’s largest shelter. Other positive cases in the homeless population were reported at the Hamilton Family Shelter, Compass Family Services and Homeless Prenatal Program. 

It’s worth noting that while the Centers for Disease Control and Prevention recommend people to distance themselves at least 6 feet from others, doing so is next to impossible in institutional sites like shelters, jails and other congregate settings. San Francisco law mandates that City-funded shelters separate a minimum of 22 inches’ worth of space between sleeping units, be they beds or mats. Also, the City’s emergency shelter system’s capacity is for 1,203 beds for individual adults and 800 for families — room for only 1 in 5 homeless San Franciscans.

But there’s another CDC recommendation where the City lags — the provision of “isolation housing” where unhoused people can seclude themselves to prevent or limit infection. In once-heavily touristed San Francisco, that means deconcentrating the shelters and outdoor encampments and placing them in hotels. On April 23, the emergency hotel ordinance passed unanimously by the Board of Supervisors went into effect, but without the signature of Mayor London Breed, whose resistance to the plan has only been modified by community pushback.

The “shelter in place” order started on March 16. Almost six weeks later, the City has filled only 798 of the 8,250 vacant units allotted. 

And that doesn’t include the units secured proactively and unilaterally by such nonprofits as the St. Anthony Foundation, Hospitality House and the First Friendship Institutional Baptist Church for their houseless charges.

The remainder of the homeless populace is either in the shelters or on the streets.

The City’s statistics only tell the story in terms of quantity. The quality of the response to homelessness in pandemic times — good, bad and ugly — can be defined by the experiences of homeless people, service providers and public health officials, which Street Sheet is documenting.

Outbreak at MSC

Before COVID—19 broke out among clients and staff at Multi-Service Center South, the shelter already moved “Ken” to a boutique hotel in the Tenderloin at 8 in the evening. It was there that Ken —  the name he requested to be identified by for this story — was later tested positive and moved to another hotel in the South of Market neighborhood. He’s considered a “vulnerable,” which means his underlying health condition makes him susceptible to the coronavirus (the City’s definition also includes people aged 60 or older).

Ken said he observed Sheriff’s Department deputies, as well as private security, stationed in the South of Market hotel. Ever since, he’s been secluded in his room. But the lack of transparency by everyone involved has irritated him as much as the isolation. He hasn’t seen anyone since his quarantine.  

“We’re essentially under arrest,” he told Street Sheet through text messages. “On an equally interesting note, I haven’t had any medical examination since my arrival — a bit strange considering what I’m here for. There has been absolutely no contact with another human being other than over the phone.”

When Ken was later contacted by a social worker, he was asked if he was returning to MSC South.

“I questioned that since that is where I got infected,” he said. “He called back five minutes later and said I wasn’t being discharged yet.” 

Point of access

“Joey” is a City worker whom the Human Services Agency drafted as a disaster service worker. He’s currently assigned to a hotel on Lombard Street where people with behavioral health issues and psychiatric diagnoses are sent.

There isn’t a lot of drama at this place, Joey said. “If it was me, I’d be happy to be here. Overall, people are content with it. A lot of people ask if they can come and go, and they can. We just want to encourage the shelter in place.”

The hotel imposes few restrictions aside from a 9 p.m. curfew and requiring people to smoke outside, and offers amenities that guests almost never receive in a shelter. Joey said a clinician and nurse from the Department of Public Health staff the hotel. The nurse often checks guests’ temperatures. 

Also, workers contracted through HSA’s In-Home Supportive Services are available to help with seniors and disabled clients. Community organizations, such as Oshun, also drop in at guests’ rooms with food deliveries and check in on them.

Details on how the guests get connected to the hotel are fuzzy to Joey. “The access point is unclear. I’ve been trying to find out,” he said. “Apparently it’s through the (Homeless Outreach Team). I’ve been told 311 has been referring them to HOT, but nobody really knows.” 

From tent to hotel

Some nonprofits are bypassing the City when it comes to protecting vulnerables. St. Anthony Foundation raised money to rent hotel rooms for 22 people, including Rachel Elizabeth Haynes and her husband, Michael. 

Haynes, a 64-year-old retired bookkeeper now living on Supplemental Security Income, had been staying at St. Anthony’s winter shelter, which accommodates up to 60 people nightly. Before that, she and her husband camped out in a tent outside the neighboring St. Boniface Church.

The Hayneses’ disabilities put them at risk: her legs are swollen with ulcers, and she is in the first stage of diabetes, while he has a tumor next to his heart. But she added that her shelter placement was a stroke of good luck. A security worker at St. Anthony’s alerted her to a hotel reservation.

“She told us, ‘we got you covered,’” Haynes said. “We were asked for all this information, then they said, ‘We got a place for you to go to. It’ll be a 30-day hotel’ and they’re paying for it.” They were also provided with packages of food and blankets.

On April 9, Haynes’ birthday, she and her husband moved in at the Alder Hotel in South of Market where their health is continually monitored. “They’re taking our temperature each night, and ask us if our nose is running,” she said.

Haynes’ stay at the Alder is scheduled through May 9.

No ‘in and outs’

When the shelter in place order was issued last month, City-funded shelters began to stay open for 24 hours to encourage staying indoors among shelter residents. The Department of Public Health issued guidelines to promote social distancing, handwashing and mask wearing, as well as limiting exiting and entering of shelters.

The shelters also stopped accepting new reservations and extended existing ones. Capacity in the shelter system has been reduced by 30 percent.

But reports of new draconian policies reached homeless advocates. A photo of a sign outside an Episcopal Community Services shelter spelled out a new directive: “There are no ‘In and Outs’ except for ‘essential activities’ …  SFPD is getting more active in enforcing this Order … This Order is a Legal Order and issued under authority of California law; it is critical for everyone to follow the Order to prevent the spread of COVID—19.”

In effect, a 23-hour lockdown was instituted at The Sanctuary and Next Door shelters, both run by ECS.

“The pandemic is showing the differences between service providers — some people are rising to the occasion while other people are sinking to new lows,” said Ben Baczkowski, a shelter client advocate with the Eviction Defense Collaborative (EDC). “Two-thirds of the shelters are rising to the occasion and are doing good by the residents. It’s the other one-third we’re worried about.”

Baczkowski said that Next Door staff has been emboldened to keep residents shelter-bound and deny them services for low-level offenses, despite an eviction moratorium from the Department of Homelessness and Supportive Housing.

The exceptions to that moratorium include acts or threats of violence, possession of unchecked weapons and curfew violations. The advocate said that curfew violations drive most of the hearings EDC sends to hearing to defend shelter residents. Staying out of the shelter could be interpreted as violating curfew.

SF Public Press reported that at least two Next Door residents were bounced out on shelter in place-related grounds.

Baczkowski added that his organization recently represented clients who were denied services for such minor acts as laundry policy infractions and not washing their hands.

Medical and psychosocial 

Public health experts have recommended that unhoused people should be sheltered in place where they can separate themselves and have access to hygienic facilities and supplies. Additionally, they urge testing. Colette Auerswald, a faculty member of University of California, Berkeley, offered such guidance in a report that the university’s public health school released last week. 

At a video press conference, Auerswald drew a parallel between today’s response to COVID—19 and the early days of the AIDS epidemic in the 1980s. She said the discussion on HIV/AIDS was so focused on drug research to treat the disease that little attention was paid on the psychosocial factors surrounding it.

“FInally, we stopped talking about ‘are we psychosocial or are we medical,’ and realized we needed to do both,” she said.

Note: Some people quoted in this story are identified only by a first name at their request because of possible reprisals in the workplace or in homeless service delivery.