Tenderloin residents have long felt dismissed by City Hall. It’s adjacent to the seat of San Francisco power geographically, but it might as well be a world away.

Though city officials would never admit it, they’ve long treated the low-income neighborhood as a containment zone, tolerating everything from blatant drug dealing to open-air injection drug use to filthy sidewalks that wouldn’t stand in wealthier parts of town.

COVID-19 is just the latest example.

While many San Francisco neighborhoods are far quieter than usual as people shelter in place in their homes, the Tenderloin looks more crowded and dirty. A recent visit to the neighborhood showed some sidewalks are clear and clean, but many are packed with tents, garbage and people milling around in proximity.

The Tenderloin Community Benefit District counts 300 tents in the neighborhood, up from 120 before the virus struck. While it’s better that homeless people have a tent than nothing, it also means impassable sidewalks for everybody else.

The dense, low-income neighborhood houses more children per capita than anywhere else in San Francisco. Many families live in tiny rooms in single-room-occupancy hotels, sharing communal kitchens and bathrooms. But to get outside for fresh air or to run essential errands, they’re faced with an impossible choice: push through crowded sidewalks, social distancing be damned, or walk into traffic to get around the throngs.

“The problem is getting worse,” said Simon Bertrang, executive director of the Tenderloin Community Benefit District. “Kids have not been outside for weeks who are living in small apartments in the Tenderloin. As someone who’s sheltering in place with my children, that’s pretty hard to hear.”

Bertrang had to temporarily halt the nonprofit’s cleaning of the neighborhood Wednesday because someone on the cleaning crew developed COVID-19 symptoms and is awaiting test results. He said the city’s few handwashing stations and extra Pit Stop public toilets are appreciated — and the city says more are on the way — but the response doesn’t seem to match the severity of the epidemic.

After all, as the outbreak at the MSC South homeless shelter showed, the virus can quickly rip through a crowd of people living in proximity.

There are some answers. The city should move as many homeless people as possible into vacant hotel rooms. Mayor London Breed is working to move those who are older than 60 or who have chronic illnesses out of shelters and into hotel rooms, but she’s adamant that it’s not realistic to move the entire homeless population inside, saying Wednesday, “If it were that easy we would have done it a long time ago.”

But it’s also not realistic to leave them packed on Tenderloin sidewalks and just hope for the best.

Bertrang would like to see safe camping sites set up out of the way of residential neighborhoods with social distancing required, and handwashing stations, public bathrooms, garbage removal and COVID-19 symptom screening at the ready. He suggested one space: the large parking area between the Asian Art Museum and the Main Library, both of which are closed.

Another commonsense idea is to close some Tenderloin streets to private cars so pedestrians can safely walk around the neighborhood, and children cooped up inside SRO hotel rooms can get outside for exercise.

Supervisor Matt Haney is preparing a letter, along with Tenderloin advocates, to send to the mayor and her department heads asking for these measures, along with more police foot patrols for the neighborhood to combat crime and drug dealing, and more masks and hand sanitizer for neighborhood residents.

Abigail Stewart-Kahn, director of the Department of Homelessness and Supportive Housing, said she is “extremely concerned” about the crowding in the Tenderloin. She said outreach workers are educating people about the pandemic and telling them to spread their tents 6 feet apart, but new tents keep popping up in the gaps.

“When people are anxious, which many of us are, we seek connection,” she said, explaining people huddled together in the Tenderloin. “This is a natural human instinct, and that connection is putting everybody in danger.”

She said a “very small pilot” program is beginning to move people older than 60 or who have chronic health problems off the sidewalks and into hotels, in addition to the larger effort already under way to get the same population out of shelters.

But these desperate times call for big answers, not small tests.

Jose Ramirez, executive director of St. Anthony’s, said City Hall talks a good game about helping the long-neglected neighborhood, but he hasn’t seen much proof.

“We’ve heard a lot of talk about serving our most vulnerable, but we haven’t seen a lot of action around it,” he said.

His winter shelter, for example, was supposed to shut March 31. The shelter space was used during the day to pack 3,500 meals — up from the pre-virus average of 2,000 — and he was concerned about shelter residents leaving during the day and potentially bringing the virus back at night.

But he wasn’t about to release its 22 residents to sleep on the streets in the middle of a pandemic, so he sought help from City Hall. Officials told him the 22 people could move to Moscone Center’s shelter — but 90 minutes later, that offer was off the table as plans for a shelter there were nixed.

Ramirez and his staff raised money to pay for rooms at a nearby hotel for a month, walking the residents there with boxes of their meager belongings. What happens after the month is up? He still doesn’t know.

“We’re hoping 30 nights is enough time for the city to get its act together,” he said.

Meanwhile, St. Anthony’s was charged $3,660.55 by Public Works for a permit to offer its meals, clothing and other services curbside rather than requiring people to come into the building. Ramirez asked for a refund and received an email from a Public Works staffer reading, “Our fees are codified,” which might be the most bureaucratic response ever.

After I called Public Works, a spokeswoman said the fee would be waived retroactively.

Ramirez has also asked for a handwashing station outside St. Anthony’s — or at least for financial help to pay for one. The nonprofit is paying $3,500 a month for a rental, and has received no reimbursement.

Rachel and Michael Haynes were sleeping at St. Anthony’s before scoring a new hotel room on Rachel’s 64th birthday.

“I was so ecstatic, I almost chewed my fingernails off!” she said.

They said they’re sleeping better and are more relaxed.

“All we do is stay inside and watch TV — that’s it,” Michael said. “There are a lot of tents out there. We don’t go outside at all hardly.”

And after their reservation is up, what then?

“I don’t have the slightest idea,” Michael said.

Neither, it seems, does anybody else in the Tenderloin.

San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf Instagram: @heatherknightsf