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March 29, 2022

Homelessness and the pandemic: San Francisco

Athlyn Cathcart-Keays

San Francisco: first

US city to declare

state of emergency

In San Francisco’s 2016 street count, more than 1,000 tents and 30 large encampments were spotted throughout the city. On a daily basis, over 179 calls are made regarding homeless-related incidents (65,000 per year), relating to the violation of the City’s ban on tents, sitting or lying on the sidewalk, illegal lodging or asking for money. In parks, on city sidewalks, alongside highway bridges and in vacant lots, homelessness is a very visible issue in San Francisco, and in 2018, the Healthy Street Operation Centre (HSOC) was formed to coordinate the city’s response to encampments and ‘behaviours that impact quality of life in San Francisco’s public spaces’. With HSOC’s focus on responding to visible homelessness in the city, by April 2019, the number of tents and temporary structures fell to 381, with fewer than 10 large encampments.

The city's most recent estimates show that there are 8,035 people experiencing street homelessness in San Francisco. This puts it in 11th place among US cities for its rate of homelessness, at 397 per 100,000 residents. Alongside this population, the 49 sq mi metropolis is also home to the most billionaires per capita of any city in the world. The San Francisco Bay area includes four out of ten of the most expensive counties in the United States (US), and coupled with California’s crippling housing shortage, major cities attribute large numbers of people experiencing homelessness directly to a state housing shortage. Prior to the pandemic in February 2019, the average monthly rent for a 1-bedroom apartment in San Francisco was $3,668 (£2,785), making it one of the most expensive places to rent in the country, according to Zumper. To put this into perspective, in the state of California, a worker on minimum wage would have to work approximately 3.3 full-time jobs in order to afford a two-bedroom property at fair market rent, without paying more than 30% of their income. 

So when the pandemic hit in early 2020, San Francisco's existing challenges with homelessness were thrown into overdrive. On 25 February 2020, the city was the first in the US to declare a state of emergency, issuing a shelter-in-place order soon afterwards. Libraries, community spaces, food programmes and other resources once available were shuttered overnight, and there was little guidance on what the 8,000 individuals experiencing homelessness in the City could do to stay safe, healthy and sheltered.

To reduce Covid-19 outbreaks in crowded settings, shelter capacity in the city was cut by 76% and over 1,400 beds were rendered out of action to aid social distancing. But fewer beds didn’t mean fewer people in need of housing, and by April 2020, 1,108 tents and over 40 large encampments sprung up across the city – a three-fold increase from one year earlier in the space of six weeks. While there were no major Covid-19 outbreaks, deaths among people experiencing homelessness tripled compared to the previous year (48 in total) over an eight-week period from 30 March 2020, many relating to drug overdoses and worsening health issues. 

Out of encampments

The initial response was shaky, chaotic and slow as departments stuck to their silos and struggled to collaborate, explains Jeff Kositsky, former head of the Department of Homelessness and Supportive Housing. But soon after the pandemic rippled through the city, an emergency operations centre was launched, bringing City departments together under one roof to coordinate the pandemic response.

One such action was the implementation of an alternative shelter programme between March 2020 and June 2021, which ran three types of shelter: congregate sites, shelter-in-place (SIP) sites, and isolation and quarantine sites, serving over 9,000 guests in total. 

As the pandemic progressed, the City used available Federal and State funds to begin leasing hotels to provide shelter for people experiencing homelessness. These were coordinated by services providers like the Episcopal Community Services (ECS), who managed eight of the city’s 30 hotels. The $105 million (£77 million) operation – Project RoomKey – was 75% Federally funded, and implemented by California Governor Gavin Newsom, “to get people out of encampments and into environments where we can address their growing anxiety and our growing concern about the health of some of our most vulnerable Californians”. For individuals who tested positive, San Francisco rapidly and safely scaled a hotel-based isolation and quarantine model that reduced strain on inpatient capacity at other healthcare settings. One study of 1,009 hotel guests referred from hospitals, outpatient settings and public health surveillance found that 81% completed their recommended isolation course, ultimately reducing strain on the healthcare system. 

Utilising vacant hotel rooms and other empty beds as temporary shelter for those experiencing street homelessness was a move seen in cities across the globe. San Francisco was among the first cities to announce the use of hotels to house people experiencing homelessness on the March 19, with London and Los Angeles following closely behind. But one unique SIP intervention was to authorise a number of ‘safe sleeping sites’, essentially city-sanctioned encampments with social distancing, security and access to services and amenities like water, food and toilets. These sites popped up before the City got involved, located where people organically assembled their tents, and were soon designated as official encampments. 

Since the pandemic hit San Francisco, the total number of Covid-19-related deaths stands at 843. Of these, 11 (1.3%) were people whose status was 'homeless'. However, in the year starting 17 March 2020, more than twice as many people died while homeless compared with any year prior (331 in total). The majority of these deaths are associated with drug overdose.

Going forward, collaboration is essential, says Kositsky. While things were initially chaotic and slow due to siloed City departments, the emergency operations centre quickly pulled people together for a coordinated effort, and the pandemic magnified how effective this collaboration can be in times of crisis. 

Ban visits to shelters

Cooperation is key, too, for service providers like ECS who depended on City contracts to continue operations during the pandemic. However, the city also relied on ECS, and the organisation’s ability to quickly pivot to the changing landscape in the early stages are what kept them afloat, explains Beth Stoke, ECS executive director. When cases began showing up in nearby Washington state in January 2020, Stokes and her team acted ahead of public health advice to ban visitors to shelters – a move that may have been in opposition to their funders. “We were bold, focused, and clear-eyed”, says Stokes, who also had the foresight to acquire PPE for staff and clients ahead of it becoming a scarce commodity. Eight months after the pandemic began, the organisation’s efforts proved successful, with only four positive cases out of a client population of nearly 900, and eight among their 600 staff.

As the mayhem of the early pandemic began to calm down, in July 2020, Mayor Breed launched her Homelessness Recovery Plan, leveraging $500 million (£369.4 million) from federal, state and local sources. This includes state funding for Project HomeKey (which follows RoomKey) to establish permanent housing facilities for people experiencing homelessness. Committing to rehousing the 2,000-plus individuals as they come out of hotels, the City has a big task on its hands. Some of the spaces leased during the pandemic have been bought and transformed into permanent supported housing, but there still remains a huge demand for housing in San Francisco.

As for the safe sleeping sites, in early 2022 three still exist on San Francisco’s streets. But due to the security and on-site amenities, the initiative comes as a huge price. Each tent costs the city $5,000 per month (£3,700), and unlike the SIP hotels, the sites are not eligible for federal reimbursement. In June 2021, the bill for the 260 tents came to $18.2 million (£13.4 million) for the City, and the homeless department is now considering another $15 million (£11 million) for a similar number of tents to keep people off crowded sidewalks and in a place where they can socially distance. But however they choose to clear the streets, the focus on encampment sweeps has been criticised by advocacy groups like the Coalition on Homelessness, who argue that HSOC are tackling the wrong issue, with policies “inherently built to clear visible homelessness”, says a spokesperson.

* Athlyn Cathcart-Keays is a research and communications associate with the Centre for Homelessness Impact

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