Vaccinating San Francisco’s homeless: Lessons learned

Inoculating those without shelter presented a serious challenge

San Francisco boasts one of the highest vaccination rates of any city in the nation, but the challenge posed by the COVID-19 virus is far from over for its most vulnerable residents.

There have been 1,610 confirmed cases of COVID among residents of single-room occupancy hotels and 39 deaths since the pandemic began, according to DataSF, a public portal for The City. This year has been deadlier than last in SROs, with eight people dying in 2020 and 31 to date in 2021.

In addition, at least 963 homeless people have contracted COVID with the number of cases surging in July and August 2021, even after the vaccine was available. Seven people died as a result.

While nearly 80% of San Franciscans are fully vaccinated, it’s been harder to reach the same levels among the homeless population. As of August, roughly 39% of people experiencing homelessness were vaccinated, according to city data reported in the Public Press.

Though the Department of Public Health couldn’t provide updated estimates, services providers say they’ve seen significant progress in recent weeks.

“We have really trickled down to those folks who have a belief system that challenges them from getting the vaccine,” said Kenneth Kim, director of strategic initiatives at Glide, a social justice and service organization in San Francisco. “I can’t say that’s where we are purely, but I do think we have made gains around the variety of hesitancy.”

As The City sets its eyes on life beyond the pandemic, the difficulty becomes less about mitigating the acute emergency and more about how to ensure these communities are kept safe from a virus that’s likely here for the long haul.

Part of that work, experts say, must include continuing to reduce barriers to health care access.

When the vaccine was approved, city agencies acted quickly to get shots in the arms of vulnerable populations, ranging from those living on the streets or other forms of shelter to essential workers and low-income earners who don’t have much time, energy or money to spare to make an appointment.

The City launched partnerships with services providers, set up pop-up events at shelters and encampments and sent roving vaccination teams to neighborhoods such as the Tenderloin, Bayview and the Mission, for example. It brought vaccines to shelter-in-place hotels and had information sessions with patients in emergency rooms and urgent care facilities.

Such initiatives were designed to make it as easy as possible for someone who didn’t have a consistent schedule, a stable housing situation or could be experiencing a mental health crisis to get the vaccine. They also were intended to work through familiar faces to the community, people who could help mitigate some of the mistrust of outreach programs and build confidence in the information provided.

Ensuring such interventions become permanent fixtures will be essential to protecting all residents against the likely ebb and flow of COVID or its variants in the coming years.

“A lot of what we’ve been asking for came to be because of the pandemic,” Kim said. “Let’s try to build on those instead of going back to normal.”

A proactive vaccination rollout marked a stark contrast from the way The City handled the early days of the virus among those who were homeless.

Communicable disease has always been a threat in shelters, and COVID exacerbated that risk. Knowing that, advocates urged officials to move people into isolated spaces as soon as the virus struck. But they saw little movement from city officials until 70 people contracted the virus at San Francisco’s largest shelter, Multi-Service Center South, in April 2020.

The City added 200 shelter beds over the last four months to its total supply — but it appears shelters will look different moving forward.

This includes maintaining strategies to prevent COVID, such as social distancing, masking, increased hygiene and following federal guidance around bed spacing, according to San Francisco’s Department of Homelessness and Supportive Housing. But it could also include rethinking how facilities are configured, according to advocates.

“That could mean we use our existing spaces and create private units inside those congregate spaces, it might mean having private room options,” said Jennifer Friedenbach, the executive director of the advocacy group Coalition on Homelessness.

Kim said this process wouldn’t happen overnight, but providers like Glide can continue to implement the pandemic-era vaccination and outreach methods that have proven effective in the interim, such as outdoor health hubs and mobile centers.

“We will have a lot of work to do to get ready for modernization based on the pandemic,” he said.

Advocates also hope to see the expansion of something like the shelter-in-place hotel program in which The City rented vacant rooms to provide temporary housing for many facing homelessness.

Not only did private hotel rooms give people coming from shelters or dangerous street conditions a way to socially distance, they enabled The City to more easily deliver services and support to a traditionally difficult to reach population.

“The folks who got into the shelter-in-place hotels saw a huge transformation in their lives, but the folks who were left outside saw a massive decrease in their quality of life,” Friendenbach said.

Since the hotels opened in April 2020, they have housed 3,709 people. Just 729 of them have been permanently housed since. Yet seven of the 25 hotels used for the temporary program have closed over the past year with two more slated to shut their doors by the end of 2021.

Homelessness and Supportive Housing announced on Wednesday it would keep the remaining hotels being used for the temporary program through September 2022. About 1,200 people are staying in these units and will need to be rehoused.

Finally, homelessness advocates and services providers say if there’s any silver lining to the pandemic, it’s that there’s been a spotlight on the dangers faced by people facing severe poverty and homelessness.

Though they’re quick to say the task ahead is daunting, they expressed optimism that perhaps the public’s advocacy for change can outlast the pandemic headlines.

“We’re all reminded that the health of one person affects the health of another person,” Friedenbach said. “That created an urgency around the homelessness issue that did not exist previously, and it opened up a lot of doors to do things differently and better.”

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