Tenderloin tents are now rare. Open-air drug dealing is still all too common.

Heather Knight Sep. 5, 2020 Updated: Sep. 5, 2020 4 a.m.

Mask on. Plastic gloves pulled up. Her San Francisco 49ers cap pulled down over her brow.

Rosa Alvarado, a 58-year-old grandmother of seven, means business. Monday afternoons are the one time she allows herself an escape from her tiny apartment on Leavenworth Street in the Tenderloin to gather the food, toiletries and medicine she needs for the week.

It’s an ever-changing challenge to map the safest route bypassing the tents, open-air drug markets and crowds of maskless people on the sidewalks. Her neighborhood has one of the highest rates of the coronavirus in the city, but she must keep it out of her apartment. Her husband is fighting prostate cancer, and she doesn’t think he’d survive it.

“Getting out of the house is not easy,” she said. “I have to be very careful.”

Twelve weeks after the city settled a lawsuit filed by UC Hastings College of the Law and Tenderloin businesses and residents, Alvarado’s neighborhood has certainly improved. But that only demonstrates just how grim it had gotten.

The tent count has plunged from a shocking high of 448 in late May to just 21 on Friday after the last big encampment — on the 300 block of Ellis Street — was cleared and those living in it moved into the safe sleeping site at 180 Jones St. City data from Aug. 31 show about 600 homeless people living in the Tenderloin have been moved into hotels, safe sleeping sites and shelters.

The city has finally begun addressing the Tenderloin’s unsafe thoroughfares after years of inaction, shutting part of Jones Street for four blocks to give people space to walk and exercise while social distancing. Part of Turk Street will be closed on Saturdays and turned into a children’s play space, and parts of Golden Gate Avenue and Larkin Street will be shuttered four days a week for outdoor dining.

Finally, the often unseen people of the Tenderloin — the families, the children, the immigrants, the business owners, the grandmas like Alvarado — are getting the help they’ve long deserved. But they need so much more.

While the settlement has addressed much of the devastation that struck the already-struggling Tenderloin at the start of the COVID-19 pandemic, it hasn’t even begun to touch the rampant drug dealing.

The block of Hyde Street north of Golden Gate Avenue remains a shameful, obvious open-air drug den with young men hawking heroin and fentanyl, and those who buy the deadly products passed out and sprawled on the concrete. (Won’t it be a miracle if closing Golden Gate Avenue at Hyde Street for outdoor dining is what finally drives dealers away?)

It’s way too easy to buy drugs in the Tenderloin and, sadly, way too easy to die. New statistics from the Department of Public Health show 441 people died last year of drug overdoses in San Francisco — more than one each day. More than half of the deaths were attributed to fentanyl, and city officials expect this year’s death tally to climb far higher.

San Francisco’s inertia in getting a handle on this crisis is terrible for those addicted to drugs, but also for the people who live amid the misery. In a recent Zoom call with mothers who live in the Tenderloin arranged by La Voz Latina, a resource center for Latino neighbors on Ellis Street, the prevalence of drugs in the neighborhood was the top complaint.

Karla Burgos, 31, said she appreciates that the sidewalks are mostly clear of tents now, but the dealers remain a big problem. Her 10-year-old son recognizes the transactions for what they are, and she tries to plan routes to run errands so he doesn’t see the sadness.

“I’m frustrated,” she said in Spanish as an interpreter translated. “It’s really unfair for the children.”

On the weekends, she tries to take her kids outside the neighborhood and notices that just about everywhere else in San Francisco lacks the Tenderloin’s open-air drug dens, piles of trash and maskless crowds who refuse to social-distance.

Norma Carrera, 50, said her 13-year-old daughter is going stir-crazy being stuck at home, and she tries to get her out to “stretch, get some air, see the outside world and then go back indoors.” But it feels like a risk each time, she said.

Dina Mendoza is program director for La Voz Latina, a resource center for Latino neighbors. They say the prevalence of drugs in the Tenderloin is their top complaint.

“Many people aren’t taking the necessary precautions,” she said. “They’re not wearing their masks. They’re hugging each other. They’re not social distancing. It seems like it’s one big party in the Tenderloin, so we stay indoors to stay safe.”

Margarita Mena, 60, lives in the Tenderloin with her husband, two daughters and four grandchildren ranging from an infant to an 11-year-old.

“I want to highlight that in the Tenderloin, there are a lot of families with young, young children,” she said. “I’m happy kids in other neighborhoods can go out and do activities. My wish is kids here could also do the same.”

Mayor London Breed said last week that the encampment resolution team that moved hundreds of homeless people inside “has been absolutely incredible” and has dealt with other camps that have sprung up near the DMV, Ocean Beach and Duboce Park, though she said she knows many more neighborhoods want help, too.

“I know so many people in this city are tired and frustrated, and I also know there sadly is a lot of poverty and a lack of housing and resources for so many folks,” she said. “It is something we are working hard to address.”

She said that while sidewalks in the Tenderloin are now mostly passable, many social ills remain.

“It is still really horrible — I just want to be honest,” she said, adding the city needs to get much more aggressive in combating drug dealing. “We need to clean up this community so people who are walking down the street with a baby stroller don’t have to go into the streets to walk around a bunch of people selling drugs and shooting up. Is that OK for families to have to live like that?”

Of course not. But there’s little consensus about what to do about it.

Tenderloin police continue to arrest dealers, and District Attorney Chesa Boudin said in a written statement those cases represent one of the largest categories of felony cases handled by his office — and the highest rate of felony rebookings, meaning another arrest for the same crime, of any category.

He doesn’t believe that cycling dealers in and out of jail accomplishes anything, however, and wants to create a new specialty court for dealers who are trafficked from Honduras and work for drug cartels. He also wants the city to finally create the long-discussed safe injection site where people can use drugs inside under supervision and build treatment centers where people addicted to drugs can get help immediately. State Sen. Scott Wiener has tried repeatedly to pass legislation giving San Francisco the authority to open a safe injection site, but has failed.

“The situation in the Tenderloin is unacceptable,” Boudin said. “If we want to save the Tenderloin, we need to make it easier to get help than it is to get high.”

As for Alvarado, the grandmother of seven who emerges to run her errands once a week, she darted around men lounging on a couch on a sidewalk corner, around people selling items spread out on blankets and to the other side of the street when she saw a block-long encampment that has since been cleared. She dodged a man screaming and waving his hands violently at nothing.

“I’m kind of scared,” she said, periodically rubbing her gloved hands with sanitizer.

Finally, she made it back to her apartment on Leavenworth, her rolling suitcase full of food and medicine. She said goodbye with a no-contact elbow bump.

“I think I’m all set now,” she said.

She was safe. For one more week.

San Francisco Chronicle columnist Heather Knight appears Sundays and Tuesdays. Email: hknight@sfchronicle.com Twitter: @hknightsf Instagram: @heatherknightsf