San Francisco quick to fight COVID-19, slow to help homeless

Reviewed by James Ives, M.Psych. (Editor)Apr 21 2020

San Francisco Mayor London Breed has won nationwide praise for taking drastic early measures against COVID-19 that seem to have spared San Francisco the catastrophic fate of New York and other cities.

But she hesitated over what to do with the city's estimated 8,000 homeless people during the pandemic — until the issue came back to bite her.

A COVID-19 outbreak at the city's largest homeless shelter had sickened at least 105 people by Friday, about a tenth of the entire San Francisco caseload. It led the city — which had planned to pack the homeless into the Moscone Center, the city's gigantic convention hall, and other big venues — to suddenly switch directions.

While only 123 homeless people had been housed in six hotels as of April 3, last week the city said it had moved 447 people from shelters into some of the 2,082 rooms it had rented. That included all 340 residents of Multi-Service Center South, the shelter run by the St. Vincent de Paul Society where the outbreak happened.

"It’s really a massive undertaking that has the city’s entire focus now," said Abigail Stewart-Kahn, the city's director of the department of homelessness and assistive housing.

Meanwhile, the Board of Supervisors — San Francisco's city council — on Tuesday unanimously passed an emergency ordinance requiring the city to rent 8,250 hotel rooms by April 26 for homeless people, discharged COVID-19 patients and exposed front-line workers.

The board, as well as advocates for the poor and health care workers in San Francisco, had for weeks lashed out at Breed for her approach to the homeless, saying it epitomized the city's disgraceful handling of its most vulnerable population.

The pandemic has exposed San Francisco's "deep disregard for the humanity of our unhoused people," said Dr. Rupa Marya, an internist at UC-San Francisco Medical Center. "COVID-19 is exposing the fracture lines of our society and bringing to the forefront who we don't care about."

While negotiating room rates with hotel and motel owners for more rooms, San Francisco opted first to put only homeless people with confirmed COVID-19 infections into hotels, while preparing mass shelters for others living on the streets.

Breed declared a state of emergency on Feb. 25, nine days before the city reported its first confirmed case of COVID-19, and took center stage as six Bay Area counties issued stay-at-home orders for all residents on March 16.

But the mayor resisted using her authority to provide hotel rooms for the homeless, citing logistical difficulties. Staff and resources were needed to ensure "chaos" didn't overtake the hotels, she said.

"I know that people are asking: Why don't we just open the doors and let everyone who is homeless have access to a hotel room? I wish it were that easy," Breed said at a news briefing.

Some progressives took matters into their own hands, moving people out of shelters and into hotels despite the city government's reluctance. City Supervisor Dean Preston put up $10,000 of his own money to help reserve at least 30 rooms at the Oasis Inn near City Hall.

On April 4, another supervisor, Matt Haney, led a guerrilla action with six staff members and about 25 guests from Hospitality House, one of the city's oldest shelters. The residents put their belongings on moving carts and pushed them to a nearby vacant hotel.

Hospitality House prioritized those age 60 or older or those suffering from underlying health conditions. They made sure those people could care for themselves in a hotel room, said its executive director, Joe Wilson.

"People are loving having their own bed, their own private bathroom," Wilson said a few days later. "We're urging the city to really step up and accelerate its actions."

"Our position all along has been to get people into private rooms," said Jennifer Friedenbach, executive director of the Coalition on Homelessness in San Francisco. "Why not do it early? The city is paying for the rooms."

City officials estimate that renting 8,250 rooms will cost $58.6 million a month, including food and security. Up to $40 million of that could be reimbursed by the state.

On April 3, Gov. Gavin Newsom announced Project Roomkey, a statewide initiative that aimed to open up 15,000 hotel rooms to the state's homeless population, with a 75% reimbursement rate from the federal government.

Around that time, Los Angeles — home to the state's largest concentration of homeless, about 58,000 people — began moving people into hotel rooms, pulling them out of shelters, hospitals and access centers, or off the streets. But Los Angeles has also moved slowly.

The goal was to house homeless people in 15,000 hotel rooms, said Heidi Marston, interim executive director of Los Angeles' Homeless Services Authority, but as of Friday only 629 had moved in.

"It gives them an opportunity to rest and recover," Marston said. "It's a good opportunity for us to engage with folks without the stress of having to live on the streets. We're committed to not going back to where we were."

Unlike San Francisco, Los Angeles hasn't had a large outbreak at a homeless shelter, though authorities reported last Monday that four people staying in shelters in L.A. County have tested positive for the virus.

In San Francisco, the city originally looked into large venues that could be used to "thin out" the shelters. A plan to house 400 people at the Moscone Center was scrapped after a publication for the homeless, Street Sheet, showed the plans involved putting mats on concrete floors divided by masking tape.

The city has repeatedly cited logistical concerns in moving people into hotels, while saying that many living on the street preferred to stay there.

"We don’t want to be renting 3,000 rooms that sit empty for a couple weeks, but we want to be flexible enough to be able to manage the medical surge, as well as manage the need for our vulnerable populations, both in our shelters and on our streets, as well as in our single-room occupancy hotels," said Trent Rohr, director of San Francisco's Human Services Agency.

Advocates for the homeless said the Multi-Service Center South outbreak could be repeated unless hotel rooms are quickly made available.

"It's very scary to think about what's going to happen with them and very painful to know this could have been prevented," Dr. Juliana Morris, a primary care physician at UCSF who works with patients at shelters, said at a virtual news conference.

"While Mayor Breed should be commended for her acting so rapidly to protect so many people in San Francisco, who got left behind were our unhoused," Marya said.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.