COVID-19 Hasn’t Been a Catastrophe for the Homeless

A man wearing a face mask directs homeless people for food donations outside the Glide Memorial Methodist Church in the Tenderloin district of San Francisco, Calif., March 20, 2020. (Shannon Stapleton/Reuters)
The death toll (thankfully) is far lower than predicted, and the vast majority of cases are asymptomatic. Let’s adjust policies accordingly.

NRPLUS MEMBER ARTICLE T he COVID-19 pandemic has not been nearly as harmful to the nation’s homeless population as initially feared. This is good news that has gone underreported. Some shelters experienced outbreaks, but many of the cases were asymptomatic. COVID’s impact on the street homeless as well as the number of deaths have been far less serious than the conventional wisdom asserted back in early March.

COVID-19 remains a concern for homeless-service systems. But reckoning honestly with the risks associated with the virus will require a response less dominated by ideology and advocacy than the current approach.

The pandemic began amid an already-raging homelessness crisis. The 2010s witnessed the perverse coincidence, in major metro areas, of growing economies and surging levels of homelessness. Healthy budgets allowed Los Angeles, Seattle, San Francisco, and New York to spend lavishly on homeless services, but nothing ever seemed to get much better.

COVID-19 posed the greatest threat to single adults who are homeless, because they suffer from many underlying health problems, and they dwell in dense, unsanitary conditions on the street and in shelters. Good luck social distancing with ten to 15 men to a room all sharing the same bathrooms and eating and recreation areas.

Our best-quality source of information on COVID-19 and the homeless comes from big testing pushes done in several shelter systems across the nation. In some cases, such as in San FranciscoBostonWorcester, Mass., and Salt Lake City, the results did show high rates of infection, but also high were the rates of asymptomatic cases.

High rates of asymptomatic infections in homeless shelters are worse than no infections whatsoever. But that’s a far better scenario than overwhelming numbers of severely symptomatic cases requiring hospitalization.

Back in mid-March, the Los Angeles Times warned that “coronavirus hitting California’s homeless population could be what finally breaks hospitals,” as one headline put it. Fears of such strain on the health-care system have long since receded. The hospital overflow system that Washington State’s King County built to accommodate the homeless, which was highly touted by the federal government, never came close to using its full capacity.

A late-March report by a group of leading homeless researchers predicted about 3,500 COVID-caused deaths among America’s homeless. Their analysis relied, in part, on the work of the Imperial College researchers whose model has since come under enormous scrutiny and criticism for its hugely inflated predictions of the numbers of deaths and hospitalizations. As of late May, one website (Homeless Death Counts) tallied 125 COVID-related deaths among the homeless nationwide. Though far from comprehensive, its survey included all the nation’s major homeless hotspots, including Los Angeles, Seattle, San Francisco, and New York. Fatality rates seem to have run especially low in cities with very large street populations. The street populations are generally considered the worst-off among the homeless, and they’re regularly hit by infectious disease outbreaks. But perhaps because the virus doesn’t spread as easily in outdoor conditions, numbers are very low.

In a recent article about homelessness in San Francisco, whose street crisis is one of the most notorious in America, the New Yorker noted, four-fifths into a 9,500-word account, that there had been only one death from the coronavirus. Anyone predicting that outcome back in early March would have been excoriated for his ignorance and cold-heartedness.

Could it be that the models were sound but the policy response was overwhelmingly effective? Doubtful. Even the most competent local homeless-service systems didn’t implement widespread social distancing until early April, weeks after it went into effect among the non-homeless population. The high rates of infection in some shelters suggest that the social distancing did, in fact, come too late, but, again, the vast majority of the cases were asymptomatic. If the policy response was not perfect, and yet the impact not as catastrophic as predicted, then the predictions were likely somehow flawed.  

Advocates for the homeless worry that diminished urgency will mean less money for the homeless. So, despite the good news that the virus has proven less deadly than feared, they remain emphatic that COVID threatens doom for the homeless. Well into May, progressive leaders in New York and San Francisco were demanding private hotel rooms for every homeless adult in their cities for the duration of the pandemic. Some acknowledged that the harm had not been as great as projected, but they warned that the reopening would pose new risks of spreading the virus through the homeless population. Have these same officials expressed concern that the recent protests, and the attendant disregard of social distancing, will prompt a surge in COVID infections, hospitalizations, and death among the homeless? If so, they’ve kept quiet about it.

It is reasonable to fear, in terms of homelessness, a potential “second wave” this fall, the economic consequences of the lockdown, and even what the status quo rate of infection poses for elderly homeless people. But we need to find a middle ground somewhere between “mission accomplished” and the outlook dominant in March. Advocates continue to insist that encampments be left alone and even be allowed to expand, because dispersing the street homeless risks spreading the virus. But does the unchecked growth of encampments build public confidence in the reopening? There’s also the budget to think about. State and local governments have yet to truly reckon with the fiscal consequences of the shutdown, and homeless services are not the only claim on revenues.

If one’s position is that governments’ obligation to the homeless is infinite, regardless of whether we’re in the middle of a historic pandemic, then, fair enough. But many in progressive policy circles pride themselves not just on their compassion for the homeless, but on their commitment to “evidence-based” policymaking. In a pandemic, three months of experience is a lifetime’s worth. It’s past time that the narrative caught up with the evidence.

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

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