On April 5, two people experiencing homelessness tested positive for the coronavirus at San Francisco’s biggest shelter. By Monday, just over a week later, 81 people staying at the Multi-Service Center South shelter — more than half of its 125 residents — and 10 staff are confirmed to have COVID-19. Homeless advocates had been warning of such an outbreak for weeks.

On Monday, advocates and supporters took to the streets in protest — remaining socially distanced in slow-moving cars with signs — to repeat their calls for one solution: Test all 8,000 homeless residents in San Francisco for the virus and move them into vacant hotel rooms.

While homeless people represent about 0.9% of San Francisco County’s total population of 880,000, unhoused people so far make up 8.8% of confirmed COVID-19 cases (at least 84 cases are among homeless people, out of a total 957 cases reported countywide so far).

“For weeks we’ve been raising our voices to demand that unhoused people go into reasonable shelters — which in the context of a highly infectious pandemic are hotel rooms or vacant units,” said Dr. Rupa Marya, an associate professor at University of California San Francisco in hospital medicine, on a call Friday led by the San Francisco Coalition on Homelessness.

“The demand is that they go into hotels — not in a week, not in two weeks, but today,” she added.

The mayor, who otherwise has been lauded for San Francisco’s low numbers of coronavirus cases, has said the city is following public health guidelines and working hard to protect those most vulnerable. City officials have prioritized moving into hotels only homeless people with confirmed COVID-19 and those deemed “vulnerable” for being over 60 years old or with underlying health conditions.

“If I could open up every hotel room in this city and allow every person a place to stay, it’s not even a question,” Mayor London Breed said at a Monday press conference, noting that housing homeless people during the COVID-19 pandemic “continues to be a challenge,” and pointing to difficulties in finding adequate staffing to support homeless residents relocated to hotels.

As of Monday, the city had still only moved 750 homeless people — less than 10% of its total homeless population and just a fraction of the over 5,000 who live “unsheltered” outdoors — into hotels.

San Francisco supervisors called the recent outbreak “tragic” and “entirely avoidable.”

“This is terrible, devastating and preventable,” supervisor Matt Haney tweeted. “We’ve been yelling and screaming for a month to get people out of these crowded shelters.”

BREAKING: Another car protest before @LondonBreed’s press conference demanding the city fill 9000 vacant hotel rooms with houseless people. We will NOT let you leave homeless people out to die. #HotelsNotHospitalBeds pic.twitter.com/561jm25yVR — Coalition on Homelessness (@TheCoalitionSF) April 13, 2020

In California, the recent pandemic has collided with a yearslong housing crisis, in which more than one-quarter of the nation’s 560,000 homeless people live in the Golden State.

However, as the U.S. overall leads the world in the number of reported cases and deaths from COVID-19, San Francisco itself has kept relatively low numbers. After being one of the earliest cities to implement a “shelter-in-place” order, San Francisco only had 957 confirmed COVID-19 cases and 15 dead as of Monday.

But the city also has a particularly acute homelessness problem, with over 8,000 homeless residents as of last year’s count — up 17% since 2017 alone.

Homeless people are particularly vulnerable to the coronavirus, as many sleep in congregate settings like shelters or encampments where it’s virtually impossible to follow recommended social distancing guidelines. And for those living on the streets, taking other preventive measures, like frequently washing hands, is particularly hard. Homeless people also have disproportionately higher rates of health conditions, like respiratory issues, which leave them at higher risk of becoming severely ill from the virus.

San Francisco has taken steps to reduce the population in its homeless shelters, as well as issued a moratorium on sweeps of homeless encampments and other initiatives.

At the shelter where the outbreak occurred, the city tested guests and staff and moved all residents into hotels. The shelter will be cleaned and converted into a recovery center for homeless people who test positive for the virus but don’t need hospitalization, city officials said.

Under the city’s current plan, officials aim to secure about 7,000 hotel rooms, but so far have only 2,800 rooms at 13 hotels. About 880 of the rooms will go to first responders, who may not want to go home and expose their families after working on the front lines. Some 1,200 will be for homeless people, per Trent Rhorer, director of the city’s department of human services.

But advocates say what is needed to prevent another outbreak is widespread testing and moving all 8,000 homeless residents into hotels before they get confirmed cases — and not just those deemed most vulnerable due to age or health conditions.

“This actually isn’t rocket science,” Dr. Colette Auerswald, an associate professor in community health at the University of California, Berkeley, said in a Friday press call of the need for broad testing of homeless people. She noted that wider testing at the MSC South shelter only happened after several cases were confirmed, and said there were “almost certainly” other coronavirus cases now at other shelters going undetected — until more residents get sick.

The mayor’s office did not immediately say whether it would test all homeless shelters and encampment residents.

“COVID-19 is exposing the fracture lines of our society and bringing to the forefront who we don’t care about,” Dr. Marya said on Friday’s call, noting the racial disparities seen in COVID-19 cases in many regions. “While Mayor Breed should be commended for acting so rapidly to protect so many people in San Francisco, who got left behind were our unhoused.”