The Ballard branch of the Seattle Public Library reopened its restrooms to the public, one of the few places in the city where the facilities are still available.(Alex Brown/MCT)Seattle — When delivery man Brent Williams makes his daily deliveries around town, he runs into a nagging problem: There's hardly anywhere he can use the bathroom.Most public buildings are closed under the pandemic, and restaurants and cafes that have switched to takeout are not allowing you to use their facilities."It's hard to find a place where he can use the bathroom," Williams said, speaking outside a library in Seattle's Ballard neighborhood that has reopened its bathrooms to the public.The library is one of five in the city that have opened its 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 walk into an alley," he said."There's nowhere else to go, and I'm not going to get in my pants."The lack of restrooms has become a problem for delivery men, taxi drivers, rideshare drivers, and others who make a living out of an office.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 a campground off Interstate 5. (Eric asked to be identified only by his first name.) "It's definitely a lot harder."A nearby pet store used to allow homeless people to use the bathroom, but that changed during the pandemic.Conditions improved markedly when the city placed a portable toilet and hand-washing station near the camp, but Eric said many other parts of the city still lack similar services."It doesn't smell like urine out here anymore," he commented."Forty or fifty people have to (urinate) and (poop) every day, what do you expect? I'm surprised we don't see these (portable stations) everywhere."Seattle officials say the city has installed 32 portable toilets during the pandemic, bringing the total to 114 citywide.Another 107 restrooms are available in city parks.In the restrooms of the five reopened libraries, 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 hasn't come close to meeting the need."All the libraries and public buildings, all the coffee shops -- we're missing thousands of bathrooms," 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 portable toilets."Eisinger's group has called throughout the pandemic for Seattle to reopen all public buildings for restroom use.Sabrina Register, a spokeswoman for Seattle Public Utilities, did not respond to emailed questions about the reopening of public buildings, or whether the city believes the restroom supply is adequate.She did point out that Seattle has erected nearly 100 new shelter spaces in small housing villages, but she added that "the need outstrips our available resources" during the pandemic.According to Eisinger, some homeless people in the city have resorted to using adult diapers or using five-gallon buckets filled with kitty litter.She pointed to the city's recent outbreak of hepatitis A (as well as the fact that COVID-19 can live in feces) as evidence that the city's toilet 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 wealthy city in a wealthy county, and we still haven't made the basics regular, dignified, and simple available to people. It's better to meet people's needs on a regular basis than to wait for a public health crisis." ".The public restroom crisis is not limited to Seattle, nor did it start during the pandemic.Those who study the issue point out that American cities have spent decades getting rid of such facilities, leaving private businesses like Starbucks and McDonald's to pick up the slack."The government has basically given up on installing public restrooms," said Steven Soifer, a University of Mississippi social work professor who heads the American Restroom Association, which advocates for better public infrastructure."It took something like the coronavirus to bring it out."Private companies could require users to buy something before using the bathroom, advocates say, creating a barrier for people who are homeless or otherwise marginalized.In places where public urination laws are enforced, those who cannot pay may face repercussions."Having a bladder is being criminalized," said Taunya Lovell Banks, a professor at the University of Maryland School of Law who recently wrote an article about the lack of public restrooms."If you get caught by the police and you get a ticket, you have to register as a sex offender. It's off limits."Banks noted that businesses are less likely to allow homeless people to use their facilities and that people of color also have fewer guarantees of access.For women, discreet urination is not always possible in the absence of toilets."It's a class issue, it's a race issue, it's a gender issue," she said."(During the pandemic), middle-class whites who normally have greater access to restrooms in public spaces are suddenly being denied access. Now they're realizing it."COVID-19 has made things much worse.Market reports show that sales of urinary funnels, external catheters and other substitutes for a toilet have skyrocketed during the pandemic.Public urination is on the rise in New York City, and leaders in Montpelier, Vermont, fear the closures have left the city without an adequate supply of toilets.In Chicago, delivery men are barred from using restaurant bathrooms when picking up food, leaving some to resort to urinating in alleyways.Governments and businesses alike are justifiably concerned about the risk of COVID-19 transmission in restrooms.Research has found that flushing creates "toilet clouds" that can spread particles carrying the coronavirus.Places that have open restrooms often need to limit occupancy and clean them frequently.Soifer said some restrooms have blocked one in two urinals, a tactic known as "peeing social distancing."But closing the restrooms is a public health risk.If delivery people, for example, don't have a place to relieve themselves and wash their hands, they risk spreading infection through the food and packages they deliver.Waste that ends up on the streets could also contribute to the spread of COVID-19 or other illnesses."You're doomed whether you do it or not," Soifer said.Ben Valdez, a Los Angeles carpooler and organizer with Rideshare Drivers United, said he keeps an empty bottle in the car in case of an emergency, along with plenty of disinfectant wipes and hand sanitizer."I literally have to plan my night around being near a bathroom," he said."If I know I don't have a bathroom available, I can't drink or eat anything. There have been numerous times where I've had to turn down a ride because I've been in that situation."Valdez said many gas stations now have "out of service" signs in their restrooms, likely an effort to limit the risk of transmission rather than an actual plumbing problem.Some hotels have limited access to the bathrooms in the lobby as well.With a driving radius that often reaches 100 miles, Valdez has found no institution that he can consistently count on to find a bathroom.In San Francisco, officials have expanded the city's Pit Stop program, which they believe is a leading model for providing bathroom access.The city installed 37 bathrooms to reinforce the 24 that already existed before the pandemic.Restrooms are staffed by nonprofit partners, who clean them between uses and monitor for drug use and overdoses.Since the city began staffing toilets, said Beth Rubenstein, a spokeswoman for the San Francisco Department of Public Works, the number of flushes per day has increased "exponentially."In neighborhoods where Pit Stop toilets have been installed, the city has seen fewer calls for street cleanup."It ensures cleanliness and safety," Rubenstein said."I know that the increased number of toilets (during the pandemic) have been heavily used. Our essential workers use them as well, including our Public Works staff."The pandemic has brought restrooms into the spotlight for many people: landscapers, utility workers, runners, walkers, and cyclists.But for some, restroom equity will remain an issue even when COVID-19 is no longer a threat.“Even before this pandemic, I could barely go anywhere to use a restroom without making a purchase,” said Williams, the Seattle delivery man."Unless you buy a coffee, they won't let you use their bathroom."