As city officials continue to debate the feasibility and prudence of trying to provide hotel rooms as shelter for San Francisco's approximately 8,000 homeless people, a doctor at UCSF has a personal tale of having to discharge a homeless patient who tested negative for COVID-19 and who therefore doesn't qualify for emergency housing.

The SF Board of Supervisors is voting next week on an emergency measure to compel the city to lease 8,000 hotel rooms for this purpose. But as of now, the city has only secured around 900 rooms and only those homeless individuals who have already tested positive and don't require hospitalization, or those who are over 60 or otherwise vulnerable to having a severe case of COVID-19, will be eligible for a room.

As Mayor London Breed said on Friday, "We are not going to be able to solve our homeless problem in San Francisco with this crisis."

Dr. Abhisake Kole wrote in to SFist to describe the depressing situation he was in last week with a homeless patient who had come to UCSF from one of the city's Navigation Centers with a gastrointestinal infection. The patient's name has been changed, but the following is an op-ed in Kole's own words.

How can we ask someone to shelter in place while simultaneously denying them shelter? It sounds cruel and counterintuitive, but this is exactly what is happening in our liberal bastion of San Francisco. After our shelter-in-place orders were enacted, restaurants and businesses scrambled to restructure their operations. Washington injected over two trillion dollars into the economy to keep corporations afloat. The individual will only get $1200, perhaps months later and only if the IRS has an address or a bank account on file. And the unhoused population is once again an afterthought.
Last week, I took care of Steven (name changed). Steven lived at the Navigation Center, a homeless shelter in San Francisco. Steven caught a stomach bug and due to the potential for infectious spread, he was transferred to the hospital. His symptoms resolved on their own in less than a day, but when he was ready to leave the hospital, he found himself with nowhere to go. Navigation Center had stopped taking new residents due to COVID-19, and his one day in the hospital caused him to lose his previous bed.
San Francisco is using its many empty hotel rooms to house the homeless during this time, but only if the individuals require isolation. The city is essentially telling the homeless “We will provide you shelter, but only if you pose a threat to the rest of us.” But what about Steven? Does he not need protection from strangers too? Is he not at greater risk without access to a bathroom to wash his hands? The rate of new cases among the homeless in Massachusetts is seven times higher than the rest of the state. Where is the reciprocity in our social contract?
I tested Steven for COVID-19, even though he did not have a cough or fever. This was standard procedure for anyone coming from a congregate setting, but in some perverse way, I was hoping he was an asymptomatic carrier, so that his disease could justify a roof over his head. This is an example of biological (or medical) citizenship, in which a person’s disease state offers them additional benefits. We have seen this with HIV/AIDS wherein a positive diagnosis opens up access to new funds and clinics. But what does biological citizenship say about us as a society? That we would rather treat your illness than prevent it. That you are only human during catastrophe. That we will only extend privilege when it is too late.
Governor Newsom has announced Project Roomkey, an initiative to secure 15,000 hotel rooms for those experiencing homelessness, but California has over 150,000 persons needing rooms. Those at highest risk of infection will be prioritized, but figuring out which person without shelter or access to hygiene is not at high risk of contracting an infectious disease is absurd. Mayor London Breed announced a plan last Friday to use the Moscone Center and the Palace of Fine Arts as temporary shelter. While this provides more space than a traditional shelter, it is a far cry from the isolation that the rest of us are privileged enough to have. San Francisco has 8,000 persons experiencing homelessness and over four times as many hotel rooms. We must be able to bridge this mismatch for humanitarian reasons, even if as the mayor's office claims, “it would not be fiscally prudent.”
Steven tested negative for COVID-19. Instead of being relieved, Steven was left no option but to take his discharge papers and walk onto the street.

Dr. Abhisake Kole is an MD/PhD and a fellow in the HEAL Initiative for global health equity at UCSF in the Department of Hospital Medicine.

Top photo: Tomas Castelazo/Wikimedia