On a cold, sunny day not too long ago, I went to see the city’s new Tenderloin Center for drug addicts on Market Street. It’s downtown, an open-air chain-link enclosure in what used to be a public plaza. On the sidewalks all around it, people are lying on the ground, twitching. There’s a free mobile shower, laundry, and bathroom station emblazoned with the words dignity on wheels. A young man is lying next to it, stoned, his shirt riding up, his face puffy and sunburned. Inside the enclosure, services are doled out: food, medical care, clean syringes, referrals for housing. It’s basically a safe space to shoot up. The city government says it’s trying to help. But from the outside, what it looks like is young people being eased into death on the sidewalk, surrounded by half-eaten boxed lunches.

A couple of years ago, this was an intersection full of tourists and office workers who coexisted, somehow, with the large and ever-present community of the homeless. I’ve walked the corner a thousand times. Now the homeless—and those who care for the homeless—are the only ones left.

During the first part of the pandemic, San Francisco County lost more than one in 20 residents—myself among them. Signs of the city’s pandemic decline are everywhere—the boarded-up stores, the ghostly downtown, the encampments. But walking these streets awakens me to how bad San Francisco had gotten even before the coronavirus hit—to how much suffering and squalor I’d come to think was normal.

Stepping over people’s bodies, blurring my eyes to not see a dull needle jabbing and jabbing again between toes—it coarsened me. I’d gotten used to the idea that some people just want to live like that. I was even a little defensive of it: Hey, it’s America. It’s your choice.