As the COVID-19 public health crisis spreads across American cities, housing advocates and providers have noted the difficulty — at times the impossibility — of adhering to public health edicts while homeless. Many (myself included) have pointed out the futility of directing people without shelter to “shelter in place,” or those who sleep head-to-toe in congregate shelters to stay six feet away from other people. Equally difficult, but less discussed, is the mandate to wash your hands frequently if you have no regular access to running water.
The consequences of the coronavirus outbreak for people experiencing homelessness have been devastating. But even as these consequences become better understood, the process of redirecting scarce resources is often slow. Leaders in the field have moved swiftly and safely to relocate residents of congregate shelters to hotel rooms. But many cities and states have struggled to match housing with need, placing homeless populations and service providers in peril. Despite the fact that thousands of people experiencing homelessness remain without shelter, relatively little attention has focused on the particular vulnerabilities created by a lack of restroom access. Managing the current public health crisis among unsheltered homeless populations requires a critical rethinking of how to provide public hygiene and sanitation resources.
In the United States, hygiene is a private practice: By and large, we brush our teeth, shower, and do laundry at home. Public health guidance thus relies on the notion that people visiting grocery stores, pharmacies, or even food pantries will be able to wash their hands after they return. But people without shelter are also people without bathrooms. In most cities, the few places that function as public sanitation hubs, from Starbucks to public libraries, have closed. Shortages of hygiene supplies from hand sanitizer to toilet paper are now a punchline. But for people experiencing homelessness and for society more broadly, the need for proper hygiene has never been more critical. We need concerted local efforts to provide access to sanitation for these vulnerable individuals to prevent the spread of deadly infection that is overwhelming hospitals and destroying our economy.
Some cities, like San Francisco and Philadelphia, have begun to address the twin public health crises of unsheltered homelessness and COVID-19 by increasing the availability of public toilets and handwashing stations in areas of greatest need. But in other places, mass closures of public buildings have suddenly, and perhaps inadvertently, done away with the only resources some people can access to wash their hands and faces.
Until these spaces can be reopened safely, it is urgent to replace the hygiene resources they provided to bring the basic sanitation we take for granted to homeless communities. Luckily, innovation and opportunities abound that can be adapted for this crisis, and more will undoubtedly come. In San Francisco, nonprofit Lava Mae operates showers and distributes hygiene supplies from retrofitted buses. In Los Angeles, portable handwashing stations service encampments and a “Laundry Truck” offers free laundry services.
Thousands of traditional Port-a-Potties now sit in storage as concerts, festivals and other large events are stalled by the pandemic. These should be brought back into service. Because these resources are mobile, they can be accessed without traveling long distances or through multiple public spaces. These services can also be cleaned easily and frequently; can be used without congregating large groups of people; and are inexpensive to operate, relative to full brick-and-mortar restrooms.
People experiencing homelessness and their service providers should also receive high priority for the distribution of hand sanitizer and other scarce sanitation supplies. To be sure, meeting the needs of healthcare and frontline workers is a crucial first step. But beyond the frontlines, there are few places where the impact of directed sanitation resources could be greater than among homeless populations with limited access to running water and soap. We cannot successfully flatten the curve while a huge portion of the population remains totally unprotected.
The COVID-19 crisis also forces a broader reckoning with the fact that we have let so many go without such basic necessities for so long. Even after the crisis has subsided, cities must address the fact that large-scale unsheltered homelessness has cut off a swath of society from activities that preserve not only health but human dignity: handwashing, clean clothes, hot showers. That state of affairs has never been compatible with public health. The current pandemic makes the stakes of proper hygiene both clearer and higher. It’s time to extend access to the hygiene and sanitation we now rely on to protect us to the most vulnerable in our midst.
Sophie House is a lawyer and researcher at the NYU Furman Center for Real Estate and Urban Policy.