Part I of an occasional series on the public health implications of California’s homeless crisis
As coronavirus continues to spread and approach its apex in the United States, homeless people will be among the hardest hit. They live with numerous risk factors including poor sanitation, close contact, substance abuse, preexisting conditions, and compromised immune systems. California, home to nearly half the country’s unhoused population, faces particular perils. Health experts are reporting they are at twice the risk of contracting the virus as compared to the general population. A recent study by researchers at UCLA, Boston University, and the University of Pennsylvania estimates that as many as 1,200 homeless people could die of the virus in Los Angeles before the current outbreak recedes. Homeless victims alone could quickly overwhelm the county’s stretched medical resources. And while the state’s official response to the outbreak overall has received good marks, and rightly so, it’s a different story with the homeless.
The dynamics of homelessness these days also potentially endanger the broader population. A decade ago chronic homelessness, for better or worse, was concentrated in a few neighborhoods like San Francisco’s Tenderloin, Skid Row in Los Angeles, and north Bakersfield. The situation was at crisis levels and constituted a humanitarian disaster, but at the time it still appeared manageable, with the state and individual cities spending billions of dollars to bring people indoors and provide them with services.
In contrast, these days California’s homeless population is diffused throughout the state, a translucent parallel population superimposed upon cities and towns. Individual camps have social orders and some have developed rudimentary economies and self-government. Still, the twin demons of addiction and mental illness leave few unhaunted and the camps are places of endless suffering. That translucent civilization is corrupted by criminality, exploitation, disease, and death. Last October a man lwho called himself Hippie, who was living in front of the U.S. Post Office in Mar Vista told The All Aspect Report, “It’s f***g Hell, man. I wouldn’t wish this on anybody.”
At the same time, as reported by City Journal‘s Chris Rufo and others, previously autonomous encampments are becoming interconnected and even interdependent. In particular the profusion of scooters, e-bikes, and bike share programs provide ample opportunity for people to move among camps. Bike and scooter chopshops are commonplace in encampments. As a man in a homeless camp in Lake Balboa who identified himself as Roberto told The All Aspect Report last summer, everyone knows where to go to get which drugs and where to barter for electronics, bicycles, clothing, food, even sexual favors.
Disease already spreads easily through homeless encampments. San Diego, Los Angeles, Oakland, and other cities have experienced outbreaks of hepatitis, typhus, influenza, and tuberculosis in camps. Last year L.A. was sued by, ironically, a City Attorney who alleges she contracted typhus from flea-infested rats at City Hall. Also last year City Council President Herb Wesson ordered the rugs in his office replaced after his staff found fleas and reported hearing “rustling” in the ceiling. Of course, homeless people don’t have the luxury of litigation or fumigation.
Given that disease and sickness already were prevalent in the homeless population, their new mobility virtually guarantees that infectious agents are spreading among different camps – and that means spreading through neighborhoods. Homeless people often find shelter in the doorways and courtyards of apartment complexes where hundreds of people live, or the parks where families play and recreate. They traverse neighborhoods, entering backyards and even breaking into homes. They are ideal vectors for aggressive pathogens as proved by those experiences at City Hall last year. With coronavirus the crisis now threatens the health and welfare of all Californians.
City emergency resources were at the breaking point before coronavirus
As these issues coalesce, the state’s emergency response infrastructure already is at a breaking point. LAFD Station 9 in downtown L.A. got 35,518 calls for service last year, making it the busiest station in the country. A huge portion of which were homeless-related. The San Francisco Fire Department fields enough homeless calls every day to reduce service capacity to Level Zero, meaning no available resources are left for additional emergencies. While it sometimes only lasts a few minutes, those minutes can make a life or death difference. The city’s widely respected new fire chief told the board of supervisors last autumn, “It’s been a huge challenge for us. We run at level zero on a daily basis and level zero is when there are no ambulances available to respond to an incident. That speaks volumes to me.”
The All Aspect Report has spoken with dozens of emergency officials off the record and on background about the crisis. The rank and file use words like “overwhelmed,” “exhausted,” and most of all “frustrated.” When asked how many of his station’s fire calls are homeless-related he replied unhesitatingly, “All of them.” Speaking on an otherwise quiet Sunday afternoon he and his crew said they had responded to eight calls to fires just that day. “Toss in the emergency and non-emergency calls the homeless make, sometimes just because they need a ride to the doctor to fill a prescription, and we’re toast,” he said.
Overwhelmed first responders and Level Zero resource capacity are bad enough during normal times. These are not normal times. It is well past time for officials like Governor Gavin Newsom and mayors like London Breed in San Francisco and Eric Garcetti in Los Angeles to admit the state no longer can go it alone.
Only the military and organizations like the Red Cross are equipped to handle the crisis
Within 24 hours of the devastating 2004 tsunami in southeast Asia the United States dispatched C-17 Globemaster, C-5 Galaxy, and C-130 Hercules heavy lift aircraft to the region. Military personnel and private and nonprofit contractors provided shelter, clean water, food, medicine, sanitation, and search and rescue operations from Indonesia to Madigascar. Operation Unified Assistance became the largest relief effort since the Berlin Airlift. It involved some 15,000 personnel, two aircraft carrier task forces, a Marine expeditionary unit, a U.S. Navy hospital ship, and countless vehicles and rotary and fixed wing aircraft. At the peak of the operation the U.S. and a dozen other countries were delivering more than 100,000 pounds of supplies every 24 hours. Less than a year later, some of those same personnel and resources were on the ground in cities and towns throughout the southeastern U.S. providing relief to survivors of Hurricane Katrina.
That is the kind of response California’s homeless crisis demands in the context of the coronavirus. The state’s responses to date have proved woefully inadequate, as a walk down the street proves. It would require a fraction of the effort and resources of Unified Response to aid every homeless person in California in a matter of weeks and prevent a possible mass outbreak of coronavirus in that population. The coronavirus emergency should be a starting point in terms of a long-term solution to homelessness, a solution that recognizes the urgency of the situation. No more “Ten Year Plans” to solve homelessness, no more $700,000 apartments built by plugged-in developers. Californians don’t have the luxury to indulge official corruption and incompetence anymore.
If it wasn’t apparent to the political class before it is now: This is an emergency. It’s time to bring in the resources with the knowledge and experience to tackle it. The military has an extraordinary record of service in the context of natural and man made disasters going back to at least the 1906 San Francisco Earthquake. General Fredrick Funston’s Presidio Battalion established relief camps, provided food, water, and medical attention to survivors, conducted search-and-rescue operations, and tapped out looting and civil unrest. If they could do it 115 years ago they can do it today.
Mr. Governor, this is no longer a drill. Look to the history of the city in which you began your political career, learn from it, and do right by the people of this state. Call up the National Guard.