How San Diego’s Homelessness Crisis Helped Create A Deadly Outbreak – HuffPost

 In Health
An outbreak of hepatitis A, a dangerous but preventable disease that is spread through fecal contamination and attacks the liver, has gotten so out of hand in San Diego that the county government is handing out plastic poop bags and washing the streets with bleach.

The outbreak has killed 16 people and infected 421 since November, ravaging San Diego’s large homeless and illicit drug-using population. It could eventually cost the county health department up to a million dollars, a local health official estimated.

But San Diego could have avoided its hepatitis A crisis — or at least ensured it didn’t get this bad — if its homeless residents had better access to housing and the city provided the services they need to stay healthy, activists and public health experts say.  

The problem isn’t limited to San Diego County, which has the fourth-largest homeless population in the U.S. Detroit, Salt Lake City, Santa Cruz, California, and areas of Colorado are also dealing with hepatitis A outbreaks. The Los Angeles Acute Communicable Disease Control team told HuffPost that, while L.A. doesn’t currently have an outbreak, officials are on the lookout. And because of the way the disease spreads — all it takes is touching a door handle after a contagious person who hasn’t washed their hands and then eating lunch, for example — these outbreaks could spiral into an even larger public health crisis.

Hepatitis A had long been on the retreat. Thanks to a vaccine approved for use in the U.S. in 1995, there were just 1,390 cases in 2015 — the lowest rate in 40 years and down from 35,000 in 1989, according to the U.S. Centers for Disease Control and Prevention. That means the current outbreaks stand out. From August 2016 to this June, Detroit had recorded 10 deaths and 190 cases of hepatitis A in the city and surrounding counties, 10 times the usual rate of infection. Santa Cruz, California, recorded 69 cases as of Sept. 12, when the city usually has just one or two cases a year. As of May, Colorado reported 26 hepatitis A cases, more than the state typically sees in a year. And the Salt Lake County Health Department reported about 20 cases, when it would normally see about two by this time of year.

The CDC did not respond to requests for comment on the trend nationally. But the factors that contributed to the outbreak in San Diego are similar to those that could aggravate the problem in other cities: a dearth of affordable housing, problems with placing people in shelters — either because there isn’t space or rules keep them out — and the lack of enough free, 24/7 bathrooms and showers. 

“We set up the environment for something like this to happen,” said Michael McConnell, a San Diego resident and small-business owner who is an advocate for homeless residents.

The San Diego outbreak is particularly troubling because most hepatitis A outbreaks are stopped by finding the source, such as a tainted food item, and eliminating it. But a common food source in San Diego hasn’t been identified. And as people continue to come into contact with contaminated human feces, the disease continues to spread — meaning the crisis is far from over. Hepatitis A is also spread through sexual contact and sharing of needles.

Dr. Wilma Wooten, director of public health services for San Diego County’s Health and Human Services Agency, said the current hepatitis A outbreak is the largest public health challenge the county has seen in the 16 years that she has worked there. “We certainly will see more cases and more deaths.”

Here’s how and why this has happened.

Finding public bathrooms can be a challenge

For most people, when they need to shower or use the toilet, there’s a bathroom nearby that’s clean, open and free. But that isn’t always true for homeless people, especially those in San Diego, where many are forced to defecate outside, including in encampments.

In 2015, San Diego had just three city restroom facilities open round the clock, the San Diego County grand jury that investigates government operations reported. San Francisco had 25. San Diego had spent more than a decade trying to solve the problem, but funding difficulties, lack of support from businesses and concerns that additional facilities would attract more homeless people downtown have stood in the way, the grand jury noted.

Last week, as the crisis expanded, the city was making 14 public bathrooms accessible 24/7, and the mayor’s office said the city is hoping to install more. City officials plan to open three new temporary tented shelters with restroom facilities and other services, they announced Wednesday. At least 30 hand-washing stations have also been installed around the city, with the option to add more.

Jonathan Herrera, the San Diego mayor’s senior adviser on homeless coordination, declined to comment on whether the lack of public facilities contributed to the hepatitis A outbreak.

San Diego doesn’t have nearly enough affordable housing

Homelessness in San Diego — and nationwide — stems in part from a lack of affordable housing. Californians have the highest poverty rates in the country, with one in five Californians unable to adequately support themselves or their families because of high housing costs. And the lack of affordable housing in San Diego has been exacerbated by the elimination of 10,000 “affordable dwellings,” or low-income units, since 2010.

As of January, there were 9,116 people in San Diego County living on the streets or in shelters. An annual report earlier this year by the Regional Task Force on the Homeless said the number of tents and hand-built structures downtown had increased 104 percent from 2016. The city has a “housing first” initiative based on a national model to provide permanent housing for homeless people as quickly as possible. The San Diego Housing Commission has committed more than 3,400 federal rental housing vouchers to address homelessness to date. But San Diego County still needs an additional 142,052 affordable residences, one nonprofit estimated.

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