How helping the homeless with COVID helps all of San Francisco

54% of people experiencing homelessness in The City are fully vaccinated

Nearly two years since the reports of COVID-19 cases in San Francisco, The City continues to have some of the lowest infection rates, hospitalizations and deaths of any major metro area in the country.

Part of that is due to The City’s robust efforts to provide healthcare and increased support to people experiencing homelessness. Protecting people who are more likely to transmit the virus due to their inability to quarantine benefits all residents by reducing community spread.

“How we serve people experiencing homelessness in San Francisco has helped every single person,” said Deb Borne, who oversees health policy for people experiencing homelessness at the Department of Public Health (DPH).

When the coronavirus struck, Borne helped design a host of programs: the shelter-in-place hotels to move people off the streets and into private rooms; the safe sleeping sites to ensure people living in tents could socially distance; and the community health model that partnered with neighborhood organizations to bring resources directly to vulnerable people.

She spearheaded The City’s mobile vaccination strategy to help put shots in arms of people living on the streets or shelter by meeting them close to where they live. Homeless individuals are more likely to experience the co-morbidities that can make COVID-19 fatal and less likely to have a trusted relationship with a healthcare provider. They’re also at risk of spreading the virus, if contracted, given their inability to self-isolate.

As of December, 54% of people experiencing homelessness are fully vaccinated, and about 60% have received at least one dose, according to data from DPH provided to the Examiner. By comparison, only about 61% of all people nationwide have been vaccinated, despite most facing far fewer obstacles to obtaining the shots.

Just having data on this hard-to-count population is a big deal. It shows how health officials have worked deliberately to ingratiate themselves within this community to track and treat the pandemic. The Department of Public Health created a pandemic tracker to make comprehensive data available to the public, but people experiencing homelessness are “inherently invisible” because they aren’t included in census tracts, according to Borne.

This data collection effort allows The City to gain a clear grasp of which strategies have worked and possibly extend those into treatment of other conditions such as sexually transmitted infections, HIV/AIDS and drug addiction.

“It’s not a judgment of humans who have these diseases, but it’s about getting an understanding of how we’re doing getting services to them,” she said. “We can learn how to keep that momentum going.”

Dr. Borne, left, watches as health worker Shannon Ducharme gets a COVID test at the corner of Clayton and Haight streets. (Craig Lee/The Examiner)

Dr. Borne, left, watches as health worker Shannon Ducharme gets a COVID test at the corner of Clayton and Haight streets. (Craig Lee/The Examiner)

Still, the difference between the 54% vaccination rate among San Franciscans experiencing homelessness and the citywide figure of 80% seems like a lot on paper. But Borne points to the deeply internalized trauma and mistrust that many people experiencing homelessness feel and notes that they are also more prone to mental illness, chronic health conditions and substance use that might complicate their decision-making process.

“I can tell you without question that I couldn’t survive a night on the street, and I have so much respect for the people who do that,” Borne said. “Why is there still a gap? For many people it really requires a deep dive into themselves. It’s not because they don’t want to get well.”

Looking back, Borne says much of her life was spent readying her for this moment.

She’s trained as both a social worker and physician, but she also pulls from the principles of alternative medicine and energy studies in her current line of work.

Borne’s medical career started as a clinician in New York City with a focus on family medicine and addiction. She ran the drug and HIV prevention programs on Rikers Island, a New York jail, before moving to San Francisco in 2006 and eventually taking over the role of medical director at Tom Waddell Health Center in the Tenderloin.

Borne isn’t like other doctors. For one, she asks people not to use that title when addressing her.

“Please call me Deb,” she says. “Having that title takes the information and power away from other people.”

She reads tarot cards and does healing “energy work” with people in the Tenderloin. She helps with needle exchange programs in Haight-Ashbury. She doubles as the medical provider for a local nonprofit, Homeless Youth Alliance. She even adopted her dog from a litter of puppies born in a safe sleeping site during the pandemic.

Borne, a self-proclaimed “maniacal knitter,” threads yarn with a homeless woman who before the pandemic was transient. Now, the woman lives at a safe sleeping site, made contact with her children and sees a dentist.

“There’s not one human who doesn’t care about how they feel,” Borne said. “So how do we create spaces that honor humans and all of their light so we can actually bring them the health they need?”

When describing the pandemic for people living on the streets, Borne says there have been some “amazing and magical” moments, such as those when outreach workers and healthcare providers experience breakthroughs with residents who never before considered entering shelter or engaging with the system.

She says getting over half of people experiencing homelessness vaccinated wouldn’t have been possible without programs such as the shelter-in-place hotels, street clinics and peer ambassadors or the availability of showers and toilets.

“Some of the most reluctant, most traumatized, most disenfranchised people have come inside, felt love and stayed inside or stayed in a tent, and it worked.” she said. “The boundaries about how people live have been broken down and hopefully will never get placed back up.”

Borne isn’t pollyannish about the past two years. Nor is she satisfied with the conditions of the streets that people continue to call home or the speed at which residents are being helped from homelessness into housing.

Basic access to sanitation facilities such as toilets, showers and a place to wash hands or clothes remains limited. From a public health perspective, hygiene as a human right would be an easy way to make sure people can keep themselves and their communities clean and healthy.

There’s also the continued scarcity of resources that makes it challenging to scale up some of the lessons learned from San Francisco’s COVID-19 pandemic and vaccination efforts. Particularly, having to limit the flow of people into services has slowed the rate of progress that Borne believes to be possible.

Human suffering has reached extraordinary levels in the Tenderloin, for example, where open air drug use and severe mental illness, drug dealing and tent sites have become normal. Borne, who has spent much of her professional career working directly on the streets of this neighborhood, wants to see The City double down on investment in the kind of public health interventions that have helped save lives during the COVID-19 pandemic.

Last week, Mayor London Breed introduced an investment of a different kind. She declared a state of emergency in the Tenderloin and rolled out a controversial roster of proposed public safety policies including increasing overtime funding for police presence, ramping up enforcement of drug use, giving SFPD more freedom to use camera surveillance technology and excluding street vending in certain locations.

Many social services providers say these actions demonstrate a grave misunderstanding and misstep of how to treat, and ultimately prevent, substance use and homelessness.

Borne didn’t comment on the plan directly, but the vision she paints for a more public health-oriented future doesn’t include increased law enforcement presence, encampment sweeps or surveillance.

“We should be taking what’s worked and having everyone thinking about our public health, not trying to get people experiencing homelessness off the streets or policing them,” Borne said. “But how do we look at these human beings to help them because they are that – human beings.”

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