Two homeless residences beneath the Hollywood Freeway during a winter rainstorm. (Matt Tinoco/LAist)

Minimizing the spread of COVID-19 is now the top public health concern, but it hasn't done anything to change the longstanding public health crisis on the street resulting from mass homelessness.

The potential combination of a coronavirus outbreak amid a population of highly vulnerable people has authorities scrambling to come up with precautions.

ARE HOMELESS PEOPLE MORE VULNERABLE TO THE VIRUS?

Every individual is different, but the expert consensus is: Yes, homeless people are particularly vulnerable to the virus. Speaking earlier this month, L.A. County's Public Health director Barbara Ferrer underscored her concerns:

"I'm not worried about homeless people spreading the disease to non-homeless people. I'm worried about homeless people being infected and spreading the disease amongst themselves as they live in these very close, sort of challenging conditions," said Ferrer.

There are multiple parts to this.

Access to clean water

The first is that sanitary conditions for people who live outside are paltry. Access to clean water and the ability to wash up is extremely limited. That greatly complicates following the prevailing advice to regularly wash your hands with soap and warm water for 20 seconds.

Little personal space

Likewise, homeless shelters typically crowd a large number of people into a large room on cots sometimes just inches apart. There is virtually no personal space in most of L.A.'s shelter system.

"We have some challenges in terms of isolating people if we need to. But we do have some contingency plans, and we do have the ability to separate people who may be sick from others so that we can contain any spread of illness," said Steve Lytle, director of the Bell Shelter, one of the largest in L.A. County with nearly 500 beds.

Significantly sicker

Experiencing homelessness also adversely affects an individual's personal health. The result is that people who are homeless, especially those who are unsheltered and on the street, are already a significantly sicker group of people than the general public.

Part of this has to do with minimal access to medical care (and sanitary resources), but also the physiological stress caused by living outside, which erodes a body's ability to fight off illness.

"This could be that extra tipping point to folks who have multiple illnesses, multiple difficulties, and have suffered stressful, traumatic incidents over the years," said Dr. Coley King, a physician with the Venice Family Clinic who treats homeless patients. "They are physically unprepared for one extra stress. A good share of them are very high risk."

WHAT ARE LOCAL AUTHORITIES DOING ABOUT IT?

As it became apparent COVID-19 was spreading in Southern California, L.A. County health officials ordered health inspectors to visit each homeless shelter around the county, to make sure basic precautions and best practices were being followed. They also doublechecked that shelters had the ability to isolate anyone who is sick.

However, for homeless people living on the streets, space to be quarantined is near impossible to find. In a press conference on Thursday, Ferrer said officials were actively looking for places that could be used for that purpose.

Meanwhile, other cities on the West Coast, like Seattle and San Francisco, have publicized renting trailers and hotel rooms. (Jenna Chandler, the editor-in-chief of Curbed LA, pointed out several potential locations on Twitter.)

Handwashing stations

The city of Los Angeles is working to place at least 165 hand washing stations at locations near large camps around the city. However, the stations are not the result of a centralized city policy. Rather, individual departments and elected members of the city council have moved to do this on their own, through their own budgets.

Westside Councilmember Mike Bonin paid for about 40 handwashing stations in his district using his office budget.

As the novel #coronavirus spreads, we are stepping up hygiene services at many homeless encampments in my district, taking steps to protect the public health and safety of the unhoused and the housed alike. pic.twitter.com/FEcJoAeIax — Mike Bonin-Official (@MikeBoninLA) March 11, 2020

"If nothing else, I want to be able to seize the opportunity of this acute public health crisis to address some of the problems caused by the more long term and pervasive public health crisis," said Bonin by phone to LAist.

Encampment sweeps

This week, officials in San Jose ordered a temporary halt on encampment cleanups, which can result in the loss of personal property crucial for survival outside.

City officials in Los Angeles, however, have not indicated they plan to stop for the time being (though sweeps don't generally occur during rainy weather).

Asked about whether he would halt encampment cleanups in his district, Bonin demurred:

"I want to hear from the public health professionals. What does the best science and the best medical advice dictate? Should we completely stop? Are there things we should stop and other things we should continue? Are there things that we should stop, and other things we should start? I think we've got to let the science and the public health dictate the response to a public health crisis."

On Friday, Bonin sent a letter to both the county and state departments of public health. In it, he asks for guidance on how to address the public health challenges posed by encampments, particularly in context of coronavirus.

Advocates for the homeless are also pressuring the government to rapidly address the crisis:

Elected Officials: If you want to help houseless people survive a potential coronavirus outbreak in LA, you would:



1. Immediately open vacant city, state, and county-owned buildings and provide items needed to slow/stop the spread. — LA CAN (@LACANetwork) March 11, 2020

WHAT ABOUT SOCIAL WORKERS AND OTHER SERVICE WORKERS?

Thousands of social service workers are employed in the region to help people experiencing homelessness. On a typical day, these workers interact with several people, traveling from one individual to another.

Speaking confidentially to LAist for fear of losing their jobs, multiple people employed by government and nonprofit organizations expressed concerns about their potential for spreading the virus among a vulnerable population.

While office staff are working at home, many outreach workers and case managers are still interacting with people on the street.

They're torn. On one hand, they know social distancing is a crucial element of beating the virus. On the other, the immediate needs of homeless people remain as dire as ever. Shutting down shelters, drop-in centers, food banks and other resources would leave homeless people with even fewer resources than they currently have.

The L.A. Homeless Services Authority, which sets guidelines and recommendations for serving homeless people L.A. County, has not yet responded to a request for more information. Its website offers some guidelines for service providers.