“It’s hard to find any place where I can use the restroom,” said Williams, speaking outside a ­library in Seattle’s Ballard neighborhood that has reopened its ­restrooms to the public.

The library is one of five citywide to have opened their doors, and other parts of the city have almost no options for those who need to relieve themselves or wash their hands.

“I understand why some people downtown will duck into an alleyway,” he said. “There’s nowhere else to go, and I’m not going to do it in my pants.”

The lack of restrooms has become an issue for delivery workers, taxi and ride-hailing drivers and others who make their living outside of a fixed office building. For the city’s homeless, it’s part of an ongoing problem that preceded covid-19.

“It’s gone from bad to worse,” said Eric, who lives in an encampment near Interstate 5. (Eric asked to be identified by only his first name.) “It’s definitely much, much harder.”

A nearby pet supply store used to let homeless people use the restroom, but that changed during the pandemic. Conditions improved markedly when the city placed a portable restroom and handwashing station near the camp, but Eric said many more parts of town still lack similar amenities.

“It doesn’t smell like urine out here anymore,” he said. “Forty to 50 people having to [urinate] and [defecate] every day, what do you expect? I’m surprised we don’t see these [portable stations] all over the place.”

Seattle officials say the city has set up 32 portable toilets during the pandemic, bringing the total to 114 citywide. Another 107 restrooms are available at city parks. At the five reopened library restrooms, nearly 6,000 patrons have taken advantage of the facilities, according to the library system, which has been tracking usage.

But advocates for the homeless say the city has come nowhere close to meeting the need.

“All the public libraries, all the public buildings, all the coffee shops — we’re probably down thousands of restrooms,” said Alison Eisinger, executive director of the Seattle/King County Coalition on Homelessness. “There’s no way to make up for that with handwashing stations and a few port-a-potties.”

Eisinger’s group has asked throughout the pandemic for Seattle to reopen all public buildings for restroom use. Sabrina Register, spokeswoman for Seattle Public Utilities, did not answer emailed questions about reopening public buildings, or whether the city thinks its restroom supply is adequate.

She did note that Seattle has erected nearly 100 new shelter spaces in tiny house villages for the homeless, but added that “the need outweighs our available resources” during the pandemic.

Eisinger said some homeless people in the city have resorted to wearing adult diapers or using five-gallon buckets filled with cat litter. She pointed to the city’s recent hepatitis A outbreak — as well as that covid-19 can live in feces — as evidence that the city’s restroom shortage is a public health failure.

“This is a government responsibility, an obligation to the public to protect people’s health and safety,” she said. “This is a rich city in a rich county, and we still haven’t made available to people regular, dignified simple basics. It is better to meet folks’ needs on a regular basis than to wait until there is a public health crisis.”

The public restroom crisis is not limited to Seattle, nor did it begin during the pandemic. Those who study the issue say American cities have spent decades divesting from such facilities, leaving private businesses such as Starbucks and McDonald’s to pick up the slack.

“The government has basically given up on installing public toilets,” said Steven Soifer, a social work professor at the University of Mississippi who leads the American Restroom Association, which advocates for better public infrastructure. “It took something like the coronavirus to bring it out in the open.”

Private companies might require guests to buy something before using the restroom, advocates said, creating a barrier for homeless or otherwise marginalized people. In places where public urination laws are enforced, those who can’t pay may face repercussions.

“You’re criminalizing having a bladder,” said Taunya Lovell Banks, a professor at the University of Maryland School of Law who recently wrote a law review article about the lack of public toilets. “If you’re caught by the police and ticketed, you have to register as a sex offender. It’s beyond the pale.”

Banks noted that businesses may be less likely to allow homeless people to use their facilities, and people of color also are less assured of gaining access. For female-bodied people, urinating discreetly in the absence of restrooms is not always possible.

“It’s a class issue, it’s a race issue, it’s a gender issue,” she said. “[During the pandemic,] middle-class white people who normally have greater access to toilets in public spaces are all of a sudden being denied access. Now they’re woke to it.”

Covid-19 has made things much worse. Market reports show that sales of urine funnels, external catheters and other restroom substitutes have skyrocketed during the pandemic.

Public urination is on the rise in New York City, and leaders in Montpelier, Vt., fear that closures have left the city without an adequate restroom supply. In Chicago, delivery drivers can’t use the restrooms at restaurants when they pick up food, leaving some to resort to urinating in alleys.

Governments and businesses alike are justifiably concerned about the risk of covid-19 transmission in restrooms. Research has found that flushing creates “toilet plumes” that can spread particles carrying the coronavirus.

Places that do have open restrooms often need to limit occupancy and clean them frequently. Soifer said some restrooms have blocked off every other urinal.

But closing restrooms is its own public health risk. If delivery drivers, for instance, don’t have a place to safely relieve themselves and wash their hands, they risk spreading infection via the food and packages they drop off. Waste that ends up in the streets also could contribute to the spread of covid-19 or other diseases.

Ben Valdez, a Los Angeles-based ride-hailing driver and an organizer with Rideshare Drivers United, said he carries an empty bottle in the car in case of emergency — along with lots of disinfectant wipes and hand sanitizer.

“I literally have to plan my evening around being near a restroom,” he said “If I know I have no restroom available to me, I can’t drink anything or eat anything. I’ve had numerous occasions where I’ve had to decline a ride because I’ve been in that situation.”

Valdez said many gas stations now have “out of order” signs on their restrooms — likely an effort to limit transmission risk rather than an actual plumbing issue. Some hotels have limited access to lobby restrooms as well. With a driving radius that often reaches 100 miles, Valdez has found no institutions he can consistently count on to find a facility.

In San Francisco, officials have expanded the city’s Pit Stop program, which they think is a leading model for providing restroom access. The city set up 37 toilets to bolster the 24 already in place before the pandemic. The toilets are staffed by nonprofit partners, who clean them between each use and monitor for drug use and overdoses.

Since the city began staffing toilets, said Beth Rubenstein, spokeswoman for the San Francisco Public Works Department, the number of flushes per day went up “exponentially.” In neighborhoods where the Pit Stop toilets have been installed, the city has seen fewer calls for waste cleanup on the streets.

“It ensures cleanliness and safety,” Rubenstein said. “I know that the increased number of toilets [during the pandemic] has been very much used. Our essential workers use them as well, including our Public Works staff.”

Stateline is an initiative of the Pew Charitable Trusts.