Californians have been living under shelter-in-place orders since March 19, but for the more than 150,000 people experiencing homelessness (PDF) in the state, complying is all but impossible. Medical experts are deeply concerned about people who are homeless contracting COVID-19 because they lack access to stable housing, sanitation, and health care. How do you practice social distancing when you live on the streets or in a crowded shelter?

“What you are seeing is two crises — homelessness and the virus — collide,” Margot Kushel, director of the Center for Vulnerable Populations at UCSF, told Fran Kritz of the California Health Report.

“Being unhoused is a dangerous health condition,” Michelle Schneidermann, MD, director of CHCF’s High-Value Care team, told Essential Coverage. “People living on the streets have death rates between 2.5 and 10 times higher than the general public, and they die an average of 20 years younger.”

People staying in shelters may not fare better during this outbreak. Early studies of the coronavirus show that it is easily transmitted within households, and homeless shelters can be considered giant households, Robert Schooley, MD, head of the Division of Infectious Diseases at the UC San Diego School of Medicine, told Thomas Fuller in the New York Times.

At the end of March, President Donald Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which included federal funding for desperately needed health, housing, and homelessness supports. The National Health Care for the Homeless Council has information on this bill (PDF). So does the National Alliance to End Homelessness.

To mitigate the spread of COVID-19 among Californians who are homeless, Governor Gavin Newsom undertook a series of emergency actions on March 18. Let’s break down those actions and the complementary steps taken by counties and local governments.

Half a Billion Dollars in Emergency Funding

Of the $500 million in emergency funding authorized by the California legislature for activities related to COVID-19, Newsom allocated $150 million for emergency homelessness actions. Of that sum, $100 million will go to local governments to protect the health and safety of homeless populations. In an executive order (PDF), Newsom provided flexibility to local governments to spend the money on “emergency protective measures to bring unsheltered Californians safely indoors, expand shelter capacity, maintain health and sanitation standards, and institute medically indicated interventions.” The remaining $50 million will be used to purchase trailers and lease rooms in hotels, motels, and other facilities to house people experiencing homelessness.

As of April 3, the state had identified over 7,000 hotel rooms potentially available for lease to counties. Ali Sutton, Newsom’s deputy secretary of homelessness, said the state will help counties contract with hotels and negotiate leases if needed. For instance, the state helped secure leases for two hotels in Oakland before transferring control to Alameda County. “A lot of this is actually happening at the county level with state support at this point,” Sutton told Matt Levin in CalMatters.

California is the first state to secure Federal Emergency Management Agency (FEMA) approval for up to 75% federal cost-share reimbursement for hotel and motel rooms. The state aims to secure 15,000 rooms to “help the most vulnerable homeless individuals off the street and into isolation,” said Newsom in a press release. The so-called “Project Roomkey” will include meals, security, and custodial services.

The state procured more than 1,300 trailers from FEMA and private vendors to house individuals who are homeless who need to be quarantined. Orange County will receive 78 trailers, Theresa Walker reported in the OC Register, with most going to help the county’s two largest homeless populations in Anaheim and Santa Ana.

Finding Room at the Inn

Local governments are working around the clock to secure rooms and to open emergency shelters.

Marisa Kendall reported in the East Bay Times that San Francisco officials reached out to local hotels for help and received responses from over 30 of them. Supervisors are negotiating with the hotels to obtain up to 8,500 rooms. The city also leased 30 RVs to house homeless individuals who test positive for COVID-19 and need to self-quarantine. More beds will be available at the Moscone West Center and the Bay Club San Francisco Tennis, which will be converted into temporary homeless shelters.

Santa Clara County is further along in its shelter plans. It secured 172 local rooms and has filled 68 of them, Kendall reported in the Mercury News. The county and the city of San Jose also are “working on opening two new homeless shelters, moving people into new tiny homes, and setting up 109 state-owned trailers.”

In Los Angeles County, local officials have identified about 5,000 hotel and motel rooms that could be leased, Benjamin Oreskes, Anita Chabria, and Doug Smith reported in the Los Angeles Times. The state is negotiating with the owners on behalf of the county. In the meantime, the county is relying heavily on new emergency shelters, with plans to convert city-owned recreation centers into additional shelters.

San Diego is concentrating its efforts on moving people off the streets and into emergency shelters staged at the Golden Hall arena and San Diego Convention Center, according to NBC San Diego. Also, about 1,900 hotel rooms have been secured by the state in San Diego County.

Resources for People Experiencing Homelessness

To assist homeless service providers, the California Business, Consumer Services and Housing Agency issued public health guidance on preventing the spread of disease in shelters, sheltering individuals at risk of infection, and more. Bookmark the agency’s COVID-19 resource page for up-to-date information.

Meanwhile, cities and counties are racing to provide homeless encampments with hygiene supplies and stations. Oakland installed hand-washing stations and portable toilets at 19 encampments and increased garbage pickup, according to KQED. Outreach teams are distributing hygiene supplies. San Jose set up hand-washing stations and portable toilets at 14 encampments and partnered with the nonprofit WeHOPE to operate a mobile medical trailer.

But homeless service providers face a significant challenge: “Amid declining ranks of volunteers — who are sheltering in place or fearful for their own health — and dwindling medical supplies, outreach teams are struggling to get resources to people experiencing homelessness,” Levin reported in CalMatters. A shortage of personal protective equipment like face masks and gloves has made it difficult for outreach workers to protect themselves from the coronavirus. Panic buying at grocery and big box stores has depleted the supply of goods like hand sanitizer and bottled water, which homeless service providers would like to distribute to people experiencing homelessness.

If you want to volunteer your time or donate items to organizations that serve people experiencing homelessness, visit the San Francisco Chronicle’s directory of nonprofits to find one near you.

A Silver Lining for a Vulnerable Community?

The COVID-19 crisis is unexpectedly allowing significant and long-sought advances in California policies on homelessness, Levin reported. “The state is pursuing or considering some of the actions that advocates for the homeless have long called for: purchasing motels, waiving environmental and regulatory hurdles for emergency shelters, expanded federal funding,” Levin wrote.

“In the midst of the emergency, really trying to build systems that potentially allow for transitioning into permanent housing at the end of this is a real opportunity,” Sutton told Levin.

As the crisis progresses, refer to these COVID-19 resource pages for information and guidance on helping people experiencing homelessness:

• National Health Care for the Homeless Council — includes information to join upcoming town halls on April 10 and 17
• Los Angeles Homeless Services Authority
• City and County of San Francisco
• City of San Jose

“This pandemic necessitates a fast, coordinated, and collaborative response within and across sectors,” said Schneidermann. “Perhaps it’s an inflection point for how we come together to address the health and housing needs of people experiencing homelessness. Maybe that’s the silver lining in all of this.”

How is your community responding to the converging crises of homelessness and COVID-19? Tweet at me with #EssentialCoverage or email me.

Xenia Shih Bion

Xenia Shih Bion is a communications officer at CHCF, where she helps to lead communications around the foundation’s work to create health equity. She is the founding author of the “Essential Coverage” column in The CHCF Blog. Read More

More by this Author:

‘You Want Your Immune System Protecting You and Your Baby’, Envisioning a More Just and Inclusive Health Care System, Spreading the Stories of Joyful Black Births