The Unique Challenges That Coronavirus Presents to the Homeless

And to the people who provide them with services.

Responding to COVID-19’s aggressive spread has posed great challenges for many city politicians and service providers. From the beginning, it was apparent that the homeless faced unique risks and required special accommodations. The homeless live in dense, often unsanitary conditions and have poor health. One group of researchers estimated that 40 percent of the homeless could catch coronavirus, leading to potentially thousands of deaths.

As is the case with the COVID-19 pandemic more broadly, homelessness policymakers have had to base their decisions on sketchy information and conjecture. Nightmarish scenarios have not yet come to pass. But it’s not too early to begin to assess what’s working, early signs of strain, and the general state of “known unknowns” with respect to coronavirus and homelessness.

New York City and Boston combined, as of early this week, probably had about 500 confirmed cases among their homeless populations. Los Angeles and San Francisco, about 20, despite being internationally notorious for their homelessness crisis. This could be because those cities’ mayors and Gov. Gavin Newsom enacted protective measures.

Another factor, though, might be that the homeless of New York and Boston live mostly in shelters, and most of the homeless of San Francisco and Los Angeles live on the streets. The percentage of “unsheltered” homelessness in New York and Boston is 5 percent and 2 percent, respectively, in contrast to San Francisco’s 64 percent and Los Angeles’ 75 percent

Normally, in homeless services, a low unsheltered rate is seen as a good thing. Shelters can provide a range of services to help someone get their life back in order. Last year, officials in California debated imposing a “right to shelter,” similar to what exists in New York and to some extent Boston, to move more people off the streets. But however unhygienic conditions may be in encampments, many of the street homeless are very isolated. Shelters can resemble nursing homes, which have been host to several coronavirus outbreaks

The CDC and other federal agencies have directed cities to thin out their homeless shelter systems, meaning not necessarily create more beds but more facilities and less dense living conditions. To boost capacity, officials have been exploring juvenile detention centers, RVs, tennis clubs, top-shelf hotels, college dormitories, trailers, youth campsseminary buildings, state fairgrounds, county fairgrounds, church halls, parochial schools, public schools, convention centers, and civic auditoriums. Hotels have been an especially attractive option, since that way shelter clients can watch TV by themselves instead of in common areas and have their own bathrooms. Many of the jerry-rigged shelter expansions will be billed to the federal government; the CARES Act allocated $4 billion for homelessness assistance grants. 

The good news is that, just when the homeless service system needs to ramp up fast, many other systems, in the private and public sectors, have excess capacity on their hands. Relative to cities’ normal pace (ordinarily, it can take years to build more housing for the homeless), shelter systems have been expanding at light speed.

But the bad news is that COVID-19 has its own timeline. Despite the flurry of planning that went on throughout March, only in early April have we seen cities move large numbers of homeless out of packed shelters. If the average American started sheltering in place in mid-to-late March, most among the homeless population are at least a month behind. Not optimal. Some shelters have had to either close or impose new restrictions on access to minimize exposure risk among their clients. Homeless shelters are often full in ordinary times but the pandemic has created artificial supply shortages as shelters previously regarded as adequate no longer suffice if they pack too many people in the same room.

As for demand, it’s unclear whether homelessness has been going up during the pandemic. New York City’s daily shelter census actually registered a slight decline over the course of March 2020. Though unemployment is surging and homelessness had been increasing for years in many major cities, cities have been working to manage demand for homeless services. Reducing the burden on homeless services systems has been a central motivation behind the many eviction moratoria recently put in place across the country. Cities have also eased off on encampment sweeps, a move supported by the CDC. 

Some cities have seen more of an increase in demand for homeless services during the daytime than the nighttime. The lives of the single adult homeless, who live on the street, or cycle between the streets and shelter, were profoundly disrupted by the pandemic. Eateries that distributed leftover food at the end of the day are now closed. Panhandling opportunities have shriveled up. So much for relying on Starbucks and public libraries to charge one’s phone, use the bathroom, and avoid the elements. Usage levels at New York’s daytime drop-in centers has been on an upswing.

Charitable organizations have been severely tested, particularly those that rely on volunteer labor. For who, in America, is especially likely to have time enough to volunteer at a soup kitchen? Seniors, a cohort we’re especially eager to protect from exposure to COVID-19. Some service providers have prohibited volunteers from entering their facilities. Over the centuries, America’s social welfare state has shifted from a private charity-led system to one in which government has the lead. This shift was driven by crises, most notably the Great Depression, during which private charity was simply overwhelmed. Perhaps only minor harm has been done from groups having to shift from shared meals to a grab-and-go brown bag system. But the varying responses of public and private homeless service providers to the COVID-19 crisis is something we’ll have to evaluate more closely, someday. 

We have also learned that service providers have very little appetite for enforcing quarantine orders. One New London, Conn.-based shelter operator surely spoke for many when she said “Now we’re not a prison, so if people who have fevers choose to say, ‘No I’m not going to stay in that room,’ they’ll be free to leave and we’ll notify the appropriate city resources. … That could be somebody who’s contagious who just left our site.” One homeless man in King County, Washington, left the isolation hotel he’d been placed in while awaiting his test results (which turned out to be negative). In New Haven, Conn., a homeless man hospitalized with COVID-19 ignored his quarantine order and made his way to a nearby city. 

Of course, enforcing quarantine has been a challenge across the nation and for all manner of populations. Social pressure has been our chief enforcement mechanism. It is unclear whether the same degree of social pressure exists among the homeless population. Many press reports have raised questions about how well the homeless grasp the current urgency, especially the more isolated among them.

There has plainly been inadequate attention given to the supply needs of homeless services organizations. A survey of homeless service providers in Ohio, published last week, found that “[o]nly 29 percent report having sufficient sanitation and hygiene supplies on hand to prevent transmission of COVID-19.” The pervasive supply shortage in homeless services has been driven by the intense priority now placed on supplying the healthcare workforce. But without adequate protective equipment, staffing in homeless services will suffer. Staffing needs are growing with the current expansion of space for shelter and isolation. You could provide the homeless with access to the choicest hotel rooms in town, but without also providing at least basic supervision and security, the consequences could be dire. Cities have been vague about how they plan to secure enough trained and motivated workers to service the new facilities they’re opening

We should not discount the possibility that efforts to expand shelter capacity and so forth will, in fact, save lives. Worldwide, the impact of COVID-19 has been heterogenous. Here in America, some cities’ homeless populations are likely to be harder hit by COVID-19 than others. But the main point for now should be that, while the mood over COVID-19 this week as been relatively optimistic, homeless service providers remain extremely on edge.

Stephen Eide is a senior fellow at the Manhattan Institute and contributing editor of City Journal.

Photograph by Karen Ducey/Getty Images.