A new report released by the San Francisco Department of Public Health (SFDPH) shows that between March 17, 2020, and March 17, 2021, more than twice the average number of deaths among residents experiencing homelessness in the city were recorded. But not because of fatal COVID-19 infections, mind you.

Rates of homelessness have exploded across the state during the pandemic. According to a report released by the U.S. Department of Housing and Urban Development (HUD), California saw a 6.8% increase in homelessness between 2019 and 2020, and a 16.2% increase between 2007 and 2020; the increase from 2019 to 2020 was the largest increase observed in the state during that time frame.

In San Francisco, the City's noteworthy accomplishments around supporting unhoused residents were contrasted by astonishing stumbles. (Preventable COVID-19 outbreaks at SF Navigation Centers immediately come to mind, as does the shuttering of various shelter-in-place hotels made possible by the state's Project Room/key Housing Program.) Through these triumphs and face-palms, a new study conducted by UC San Francisco staff in collaboration with SFDPH researchers has shown that the first year of the pandemic saw an over two-fold increase in deaths among the city's unhoused residents — an uptick largely linked to overdose fatalities.

The study, which is also included in the peer-reviewed academic publication JAMA Network Open, looked into the deaths of people characterized as homeless between March 17, 2020, and March 17, 2021, and compared to the deaths each year from 2016 until 2019. Participating researchers in the study then linked to the City’s data, showing demographic characteristics and the services people had used before they died.

What they found was as demoralizing as it’s presently well known: People who are suffering from homelessness face a disproportionately greater risk of death from elemental threats, violent crimes, preventable illnesses, and, as research took notice of, drug overdoses.

“Our findings highlight the severe vulnerabilities faced by individuals who do not have housing,” said Maria Raven, Chief of Emergency Medicine at UCSF and a Vice-Chair in the UCSF Department of Emergency Medicine, in a press release.

Raven also co-leads the program on adults with complex needs at the Benioff Homelessness and Housing Initiative, as well.

“Death from the COVID-19 pandemic may have been avoided, but deaths from other factors known to impact this population disproportionately—drug use and violence—have increased,” she added. “Mitigating death among people experiencing homelessness will require a multi-faceted approach and a willingness to invest significant resources.”

The study found that 80% of those who died from drug overdose were male. A disproportionate number (27%) were Black — never mind the fact that the City’s Black population is just 5.6%, per the most recent census count. And 90% of those who died were known to the City’s public health and social services, meaning the researchers could track their use of services over time; about 66% of the people in the study were able to access care in the 12 months prior to their deaths.

But it was found that contact with substance use services dropped 7% — from 20% in 2019-2020 to 13% from 2020-2021 — after the pandemic's first year, which is considered a direct result of how COVID-19 impacted the ability of health care and social service workers to conduct their jobs.

“The pandemic has significantly impacted our delivery of care and services to people experiencing homelessness,” said Barry Zevin, SFDPH’s Medical Director of Street Medicine, Shelter Health, and the Open Access Clinic, in the press release. “We have been able to provide care and treatment to large numbers of people who were previously hidden. The key is meeting people where they are at.”

Both UCSF and SFDPH researchers involved in the study noted it was key to distinguish between deaths caused by COVID-19 and those caused by other factors suffered from people experiencing homelessness during the pandemic. Per researchers, a collective hope going forward is that linking mortality data with the uses of services can help identify places where services could be increased to prevent future deaths.

At least 46 deaths related to drug overdoses have been confirmed so far in 2022, which follows last year's 650 drug overdose-related fatalities documented in San Francisco.

Related: [Update] Three Identified In Saturday Morning Drug Overdose Deaths In Mission District

Photo: An aerial view of San Francisco's first temporary sanctioned tent encampment for the homeless on May 18, 2020 in San Francisco, California. After public outrage mounted over a surge of homeless people and tents filling the streets of San Francisco during the coronavirus (COVID-19) pandemic, the City opened its first temporary sanctioned tent encampment this week. The camp provides a safe sleeping area in a fenced-off space near City Hall with marked spots for tents that practice social distancing. Toilets, hand washing stations and 24 hours security will also be provided. Other locations throughout the city will be opening soon. (Photo by Justin Sullivan/Getty Images)