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The COVID-19 pandemic has brought renewed attention to unhoused people’s lack of access to sanitary living conditions. The extreme dearth of shelter beds and public restrooms across the country means that unhoused people, despite being particularly vulnerable to the effects of the outbreak, have little means by which to protect themselves. These gaps in our system will have devastating consequences. Four shelter residents in New York have already died from the virus, and a recently released report predicted as many as 3,454 deaths among the national homeless population.

Government officials have taken action to protect unhoused people from COVID-19; California Governor Gavin Newsom, for example, authorized $150 million for housing Californians experiencing homelessness. Local governments can use this funding for measures such as creating hand-washing stations near homeless encampments and renting space in hotels and motels, especially as shelters reduce capacity to meet social distancing guidelines. While such steps are commendable, the need for drastic action long precedes the current pandemic. The COVID-19 crisis only magnifies the already shameful lack of sanitation available to people experiencing homelessness. Unhoused people’s lack of access to public bathrooms is an illustrative example of this problem.

The ratio of public bathrooms to unhoused individuals ranges from 1:27 (San Diego) to 1:126 (Los Angeles) in the ten cities with the largest homeless populations, according to data compiled by Ron Hochbaum, a clinical teaching fellow at Loyola University Chicago’s Health Justice Project. In comparison, the Occupational Safety and Health Administration requires most workplaces to provide approximately one toilet per fifteen to twenty-five employees. Furthermore, many of the restrooms deemed “public” by municipalities are not entirely accessible — Hochbaum notes that most of Boston’s bathrooms are not in buildings open twenty-four hours a day, and others require fees to use.

Aside from denying unhoused people the dignity of basic hygiene, the low supply of public bathrooms poses health risks beyond the spread of coronavirus. In 2017 and 2018, San Diego was the site of a hepatitis A outbreak that killed 20 people and made nearly 600 sick. A grand jury report identified lack of access to public toilets and handwashing stations as a primary cause of the outbreak, criticizing the government for failing to heed previous grand jury reports in 2005, 2010 and 2015 that recommended increased access to public toilets for the homeless.

Additionally, the issue of bathroom access is tied to the widespread criminalization of homelessness. Laws that make public urination a crime make the shortage of public toilets especially unjust, resulting in people experiencing homelessness being further marginalized by the criminal justice system.

Installing public toilets can be expensive and a headache for municipalities to maintain. The mayor of Los Angeles, where there are more than 36,000 unhoused people, has blamed the city’s shortage of toilets on lack of funds. Nonetheless, disasters such as San Diego’s hepatitis outbreak and the ongoing pandemic make it clear that municipalities must install more public bathrooms. After Starbucks implemented an open-bathroom policy in 2018 in which bathroom-users would no longer be required to purchase anything, researchers found a decrease in citations for public urination in areas near Starbucks locations. In addition to showing that more available restrooms can make a measurable difference, this research also highlights the futility of relying on private industry to solve this problem; because of COVID-19, many Starbucks stores are now closed throughout most of the country.

Of course, installing more public restrooms and handwashing stations is only a small part of current efforts to protect homeless people during this ongoing emergency. As the outbreak continues, governments must work quickly to move as many people as possible from streets and overcrowded shelters to housing where they can safely self-isolate. Lawmakers also need to issue guidance to shelters on how to safely stay open in light of the need for social distancing. Still, the lack of accessible toilets is emblematic of how unhoused people are made even more vulnerable by social systems that exclude them.