Gerson Portillo pulled down his beat-up Nike baseball hat, leaned on his cane to shift his weight and wiped away a tear.

The homeless 41-year-old had sat quietly as providers of services to the homeless read aloud the names of 88 homeless people who have died since 2020, including six lost to the novel coronavirus, at a memorial service in Montgomery County on Wednesday. Among those named was Jorge Garcia, Portillo’s former tent mate, who was remembered for his love of music and connecting with community members.

“I’m grateful to be alive, and I’m glad I’m not one of these names,” Portillo said, sighing as he pointed to the program. “I’m still living through the worst of [the pandemic]. It’s difficult. And I’m scared I’m going to live through it again.”

The pandemic has proved especially difficult for people without stable shelter. While millions of Americans return to old routines, many of the homeless remain unvaccinated and face losing access to less-congested sleeping spaces and to support services. During the pandemic, service providers scrambled to keep people sheltered in the face of the additional pandemic protocols, and now they are bracing for a wave of newly homeless people as the end of eviction moratoriums approaches.

Homeless people remain among the most at-risk communities. Many have preexisting health conditions. The pandemic only exacerbated their usual lack of access to transportation and a steady supply of food and safe shelter. The closing of businesses and other public facilities where homeless people seek refuge from harsh weather further contributed to unsafe living conditions

Across the D.C. region, more than 22,000 people have died of covid-19, including 25 who were homeless in the District, according to the city’s department of human services. Additionally, 545 homeless people in D.C. had contracted the coronavirus as of July 20. Comparable reported figures were not available for Maryland and Virginia.

Portillo is one of the 8,309 homeless people in the region, according to the Metropolitan Washington Council of Governments’ 2021 annual report. He said he became homeless more than eight years ago because of drug and substance abuse.

Portillo was afraid of catching the coronavirus, given his preexisting health conditions — HIV and avascular necrosis, a disease that has degraded his bone tissue — and isolated himself for months. Seeking resources with his restricted mobility was already an arduous task, and trying to stay safe from the virus made his search for resources even harder. Last year, he lived in a shelter for a few months but had to leave once he completed the program there. He returned to living on the streets, which he said took a toll on his health. He was in the hospital with pneumonia last month.

Although he never contracted the coronavirus, he said, his depression and alcoholism flared up, sending him back to a life of drugs and into psychiatric wards throughout the year. And his future looks bleaker to him now than it did before the pandemic, he said.

The spread of the coronavirus complicated the work of those providing services to the homeless by cutting the numbers that could stay in shelters with social-distancing rules in effect. Service providers adapted by converting community centers and hotels into additional lodging for the unsheltered. But these temporary spaces may not be available as they reopen to the public — at the same time, the lifting of eviction moratoriums is expected to produce a wave of new people needing homelessness services. The D.C. region has received $300 million of federal rent assistance, but only a fraction of that money has been distributed. Some social service agencies fear that the funding available to support the homeless will not be enough to match the need.

“This is great concern among our providers because we may see that the worst has yet to come for our community as those resources get taken away,” said Katie League, the coronavirus project manager at National Health Care for the Homeless Council, an organization that provides technical assistance and training to health-care workers and hundreds of homeless shelters across the nation.

In D.C., five of the seven hotels that opened to house the homeless during the pandemic remain open, according to D.C. Department of Human Services Director Laura Zeilinger.

Ubi El, a 26-year-old who had been living on the streets in Rockville for seven years, worries that she won’t be able to get help to find housing and transportation, or have just regular access to a place to shower. Without those amenities, she says, it’s hard to get hired.

“I signed up for help, but if you’re not disabled, you get in the back of the line,” said El, who is ineligible for the county’s permanent housing program because it requires that a potential beneficiary have a disability.

Zeilinger said that housing programs in D.C. also prioritize those with disabilities.

The Washington region saw a decline of nearly 1,500 homeless people in 2021 from 2020, according to the Council of Governments’ annual report. D.C. is reported to have made major strides against homelessness in the past year, but Loudoun and Fairfax counties in Virginia, and Frederick and Prince George’s counties in Maryland registered slight increases. Advocates estimate that between 1.15 million and 1.64 million people in the D.C. region are at risk of losing their homes after the July 31 expiry of the moratorium on evictions that the Centers for Disease Control and Prevention imposed during the pandemic.

Although cities and counties across the region are slowly approaching President Biden’s Fourth of July goal of 70 percent of adults receiving at least one vaccine shot, vaccination rates among the homeless remain low, making them susceptible to infection for a longer duration.

Bobby Watts, the chief executive of National Health Care for the Homeless Council (NHCHC), said he estimates the homeless vaccination rate to be roughly 20 to 30 percent.

He attributes the low levels of vaccination to a lack of access to transportation. Some homeless people also are hesitant to be vaccinated because of concern over side effects and not having places to stay if they should need to recover from such effects.

Nationwide, more than 375,000 people at health centers with homelessness programs tested positive for the coronavirus, according to data collected by NHCHC. However, these numbers are based on the database of centers with which the NHCHC collaborates, meaning that the numbers are not comprehensive.

In addition to the challenge of finding space for the homeless as shelters close for the warmer months, outreach providers such as EveryMind, Maryland organization that provides mental health services to the homeless, have had trouble tracking the homeless population because the businesses that many homeless people once visited closed down or maintain restricted hours, leaving the daily routines of the homeless in flux.

The organization also struggled to find volunteers throughout the pandemic, said chief program officer Karishma Sheth, which limited their ability to provide the mental health services, leaving the homeless population with a growing substance abuse problem.

And while coronavirus relief funding was made available, said EveryMind CEO Ann Marie Mazur, it was inadequate for the increased demand.

“We saw demand for our mental health services rise by 30-plus percent. We know the economic crisis is going to last for years to come, and we believe the demand will continue to rise for the foreseeable future,” Mazur said.

In addition to the federal rent relief money, D.C. set aside $19 million for homelessness services, and the D.C. Council appears ready to add $100 million to the city’s revenue by taxing the rich. Some of that revenue would go toward homelessness services and affordable housing. Montgomery County in Maryland added $6 million to its homelessness budget for fiscal 2022 for a totaling $31 million. Similarly, Fairfax County in Virginia increased its spending on homelessness after the U.S. Department of Housing and Urban Development awarded the county $9.5 million.

Zeilinger said D.C. will continue to shelter homeless people in five hotels and will maintain the present level of services and protocols for the foreseeable future. Service providers also are working to create housing plans for those now sheltered under government programs, she added.

In Maryland, health officials will continue to seek out the sheltered and unsheltered homeless to help them get vaccinated, according to public information officer Sara Luell at the state’s Department of Housing and Community Development.

NHCHC officials have been working with partner health centers to identify resources they will need to prepare for a potential wave of newly homeless people.

“This is going to be long-term,” said Bobby Watts, the CEO of NHCHC. “This is a new phenomenon that we need to deal with, and we’re all figuring this out together.”