Deaths of Homeless People Spike in San Francisco

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Tents line Fulton Street near City Hall on May 5, 2020. (Beth LaBerge/KQED)

San Francisco public health officials are reporting an alarming increase in the number of homeless people who died this spring but said the increase is not directly caused by COVID-19.

Instead, they said the deaths are more likely due to overdoses from fentanyl and indirect impacts from the coronavirus pandemic.

The San Francisco Department of Public Health reported Tuesday that 48 people experiencing homelessness died between March 30 and May 24. That’s up from 14 during the same time period in 2019.

In a May 26 statement, officials noted that while at least two people tested positive for COVID-19 near the time of their death, the virus was not the likely reason, and it will take several months to confirm the actual cause.

Dr. Barry Zevin, medical director of street medicine and shelter health for the Department of Public Health, told KQED that it’s more likely the deaths reflect a trend of increasing fatal drug overdoses.

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“We've had fentanyl in San Francisco for the last year or two and month by month increasing numbers of overdose related to fentanyl in the drug supply,” Zevin said. “It's not surprising. Every city in the United States that has seen increases in fentanyl has seen increases in deaths.”

Zevin speculated that the aggressive actions San Francisco took to fight the spread of the coronavirus among homeless people may have indirectly contributed to the increase in deaths by disrupting people’s routines and services they receive.

The covered entrance to the Embarcadero navigation center. All guests have to be brought in by the Homeless Outreach Team — walk-ins aren't allowed. (Beth LaBerge/KQED)

To meet social distancing measures, San Francisco shelters and service providers were forced to drastically reduce capacity. Many shelters have also stopped accepting new clients. The city’s largest shelter, MSC-South, was evacuated last month after more than 100 residents and staff tested positive for COVID-19.

“We’re all operating at a very diminished capacity,” said Kyriell Noon, chief impact officer at the Glide Foundation, a homeless and low-income service provider in the Tenderloin neighborhood.

Noon said the pandemic has only highlighted the risks of living on the streets. And with shelters and organizations paring down services, he said, “The data is sobering, but not surprising.”

San Francisco health officials think the disruption may have resulted in fewer people seeking medical care and more dying out of sight of others, who might have called for help.

“It just confirms our worst fears,” said Jennifer Friedenbach, executive director of the Coalition on Homelessness.

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With coffee shops, gyms and libraries closed due to the city’s shelter-in-place measures, Friedenbach said homeless people have been cut off from resources they depend on for survival. Just having a place to charge your phone safely could be a lifesaver during a medical emergency.

Friedenbach believes the numbers of homeless deaths are still an undercount. She wants the city to provide more COVID-19 testing to unsheltered people and act faster to house them in available hotel rooms.

“The fact that we have thousands of hotel rooms empty and people are dying on the streets is a travesty,” Friedenbach said.

So far, San Francisco has moved more than 1,200 homeless people into hotel rooms during the pandemic, but only people who have tested positive, are older or have underlying health conditions.

Meanwhile, more tent encampments have sprung up, especially in the city’s Tenderloin neighborhood, which saw a 285% increase during the pandemic. Earlier this month, a group of residents and businesses, including UC Hastings College of the Law, filed a federal lawsuit demanding the city address worsening conditions in the neighborhood. Soon after, the city unveiled a plan that included moving people to sanctioned camping sites.

Public health data showed most of the deaths this spring were of unsheltered people living on the streets. Five occurred in shelter-in-place hotels, and at least three of those were likely from drug overdoses. A higher concentration of deaths were centered in the Tenderloin.

“It’s tragic,” said San Francisco Supervisor Matt Haney, whose district includes the Tenderloin. “I believe many of these deaths were preventable. This pandemic creates dangerous, even deadly, conditions for people who cannot shelter in place.”

Because of the outbreak at MSC-South, two of the people who died recently were tested for COVID-19 and were found to be positive. But officials say the two seem to have died from other causes.

“It's certainly not what I was expecting,” Zevin said. “I was expecting a tidal wave. I had every reason to think that we would be mourning many, many people experiencing homelessness who died of COVID-19, but we've had very few get sick and vanishingly few, if any, who died.”