A uniquely vulnerable population could be hit very hard.

Last weekend brought sobering headlines for inhabitants of West Coast cities, who have so far fared relatively well during the coronavirus epidemic, thanks to the prompt adoption of social-distancing measures. The San Francisco Chronicle reported an outbreak of coronavirus among homeless people in the city’s largest homeless shelter, with 70 of them testing positive. It may herald an expansion of the outbreak into a part of the population almost uniquely vulnerable to the virus’s effects.

Ever since the start of the outbreak in the United States, policymakers and advocates had been warning of the risk that coronavirus could spread rapidly among the country’s large homeless population, many of whom are concentrated in urban centers, especially in the West. Many factors place the homeless at far more risk than the rest of America. Living entirely or partly on the streets means that physiologically, homeless persons’ bodies age faster than others. Large segments of the homeless population regularly abuse drugs and alcohol, weakening their immune systems and increasing the prevalence of conditions that make the virus worse, such as lung disease. Homeless shelters that are spacious enough for effective social distancing are exceedingly rare, and on the West Coast, a high percentage of homeless people live on the street, often in crowded and dirty tent encampments. In these conditions, with this uniquely vulnerable population, the circulation of coronavirus could have dire consequences.

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The danger certainly hasn’t gone unnoticed by local and state officials. Stephen Eide, a policy analyst at the Manhattan Institute, says that the general expectation has been that “every place that has a lot of homeless people will be hit very hard.” Governors and mayors have announced plans to “thin out” shelters, making them more amenable to the requirements of social distancing by moving many of their clientele into vacant buildings or hotel rooms. The construction of sanitation facilities, such as handwashing stations, in homeless encampments has been a stated priority. But moving people out of encampments is “not a major focus right now,” according to Eide, as governments are already overburdened with thinning out shelters.

Of course, large and extremely unsanitary tent encampments are far from safe. Nan Roonan, the president and CEO of the Alliance to End Homelessness, a nonpartisan policy organization, stressed in an interview that the health risks were still very serious for those living on the street, and noted that while the CDC has not directed governments to clear encampments, “they certainly haven’t indicated that people should stay on the street.”

But sleeping bags and tents still dot the sidewalks, and there is even anecdotal reporting of encampments growing larger and more out-of-control than before, along with open-air drug dealing and the flouting of social-distancing rules. Many of the street population, affected by drug use and mental-health issues, “live in their own world,” Eide noted. Roonan advocated outreach and education to increase compliance with social distancing, but ongoing attempts have had mixed results at best, endangering not only those who refuse to comply, but those homeless who do follow the rules, and all governmental and nonprofit workers who come into contact with them.

However, there has not yet been the predicted catastrophe among shelters and encampments, aside from a few well-publicized cases. This could be the result of poor testing as much as anything else, especially among the street population, who certainly remain vulnerable while the virus continues to circulate.

But homelessness policymakers may soon be dealing with problems that go far beyond immediate health concerns. While Eide and Roonan both confirmed that there does not seem to be an immediate rise in homelessness, due mostly to governments banning rent evictions, they also both agreed that this pause is temporary. The recession caused by the outbreak threatens to be the worst since the Great Depression, and while homelessness has a myriad of causes, from crime to mental illness to drug addiction, missing rent checks or losing jobs due to recession will inevitably lead to the loss of housing for some.

Urban homelessness was a crisis for years before the pandemic, and the spread of coronavirus threatens to make it even more widespread and even less safe. There is still so much we don’t know about what the coming years will bring for cities: How much will homeless populations grow? Will they be spread throughout the country or will they congregate, as they do now, in cities where services are clustered? What toll will the disease take from the homeless? How much will aid providers, already stretched by a lack of supplies and volunteers, be overwhelmed by demand and inevitable budget cuts? As Roonan put it, even if we safely house the entire existing homeless population, we risk “replacing one [homeless] population with another.”

But there is much we have known for years: that homelessness is a human disaster and a public-health crisis, that it is an intolerable way to allow people to live and a blight on urban life and public order. The inhabitants of these cities, faced with this self-acknowledged humanitarian crisis in the heart of some of the most purportedly progressive places in America, have for years tolerated and even enabled the conditions that allowed it to rise.

Labyrinthine regulations and staunch NIMBYism that has made housing prices prohibitive, opposition to enforcing quality-of-life laws that might preserve order on the streets, persistent activism against attempts to commit mentally ill people living on the street to institutions, and an attitude toward public services that amounts to throwing more money at the problem every election year and trying to ignore the people huddled in subway stations and in doorways: The status quo has been intolerable, but tolerated, for a long time. It remains to be seen whether the current pandemic will test that.