Friday September 01, 2017

15 dead in San Diego as hepatitis A outbreak sweeps through city's homeless community

Hepatitis A has killed 15 people in San Diego since it began last November.

Hepatitis A has killed 15 people in San Diego since it began last November. (Homelessness San Diego News/Facebook )

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San Diego is experiencing the worst outbreak in decades of hepatitis A, and the homeless population has been hit the hardest. 

This is in part because the city hasn't equipped homeless people with the necessary tools to fight the disease, says the former Vice Chair of the Regional Task Force on the Homeless in San Diego. 

"The city does a poor job of providing basic need sanitation, rest rooms, hand washing, places to throw garbage. So I'm not overly surprised that this is continuing to be a huge outbreak," Michael McConnell told As It Happens guest host Susan Bonner. 

Since November of last year, 15 people have died from the disease and 263 people have been hospitalised. 

Local health officials are reporting that around 70 per cent of the people affected are homeless. 

McConnell spoke with Bonner about why homeless people in San Diego are vulnerable to hepatitis A. Here is part of their conversation. 

'We can't just cycle people through our emergency rooms and our jails and just send them right back into the horror that is the streets of San Diego.'    - Michael McConnell

Mr. McConnell, local health officials are saying that as many as 70% of the people who've been hospitalised with hep A are homeless. Can you tell us about the homeless population and what living conditions they face in the city?

We have a large unsheltered population of people experiencing homelessness in San Diego county.

The city does a poor job of providing basic need sanitation, rest rooms, hand washing, places to throw garbage. So I'm not overly surprised that this is continuing to be a huge outbreak.

San Diego Encampments

The Centers for Disease Control and Prevention states that "person-to-person transmission through close contact is the primary way people get hepatitis A." (Homelessness News San Diego/ Facebook)

What kind of living conditions are they facing?

We have large encampments here in San Diego and it literally is people with a tent on the sidewalks and in some cases flowing into the streets themselves to where it makes some of the lanes impassable to cars even. Folks over the years have been pushed to the outskirts of downtown, where there's neighbourhoods that are poorer, that haven't been developed as much.

So the city has crowded them into these very small areas, these streets and underpasses. And it creates a very problematic environment for everybody. 

Michael McConnell

"The city and the county have not provided for just the very basic needs for people who are living on the streets," says Michael McConnell, the former Vice Chair of the Regional Task Force on the Homeless in San Diego. (Michael McConnell )

What do we know about how this specific outbreak started?  

Well the county health officials are saying they don't know exactly where it came from. So my understanding is that typically it originates in food contamination.  

One medical expert has been quoted as saying that he believes it's food contamination and the food might have come from some of the community groups who were attempting to feed the homeless.

Well that's another issue that we have here. Because the city and the county have not provided for just the very basic needs for people who are living on the streets, community groups are picking up the slack and have been for a long time. So they go out on the streets and try to take care of the needs of these folks who are living in this horrible situation. And so I don't know if we can really fault them for doing so when the city and the county won't provide.

I'm just thinking back to what you said about the encampments. People trying to help feed them. What kinds of public sanitation facilities do they have access to?

Well there are some facilities in downtown, and then also in public parks.

One of the problems is also that we have a park right near the epicentre of street homelessness in downtown that has public restrooms that have been closed for quite a while now, and recently were just reopened actually because of media pressure and advocates putting pressure on the city. Because one of the best ways to slow down the spread of this disease is just washing your hands. But yet the city and the folks running this public restroom were making it harder to access one of the primary ways to cut down on the spread of the disease.

Embed from Getty Images

So what has the city done in response?  

They are finally ramping up and getting clinicians out on the streets to do the vaccines, which is the number one way to stop the spread — to actually vaccinate a large percentage of the at-risk population. I think they're a long way from the percentages they need.

Secondly, you have to provide sanitation and they've been stressing that. But then nothing is being done about the increased sanitation, other than going out and giving out packs of sanitation supplies to people on the street. We need a lot of places for people to be washing their hands, going to the restrooms. We really need an all hands on deck effort here and we're just not seeing it yet.

Homeless Killings

A woman keeps her belongings in shopping carts near an underpass where homeless people sleep in San Diego. (Lenny Ignelzi/The Associated Press)

And in the meantime so many people are suffering under this outbreak. Can you tell us any stories about people you may have come across personally and how they've been affected by this outbreak?

Well, you know, it's a whole variety. Some people have just disappeared from the streets and we don't even know what happened to them. But there's been quite a few people that I've seen and known go to the hospital. Some of them have ended up in intensive care and seem to have ongoing issues from this. Other folks are getting released from the hospital and seemed to be no worse for wear.

But when you're basically coming right back to the street, something else is going to happen. You're not going to be able to take care of your physical and mental health very easily and we have to have a better plan, not just for folks impacted by this horrible outbreak, but for people experiencing homelessness in general. We can't just cycle people through our emergency rooms and our jails and just send them right back into the horror that is the streets of San Diego.   

This interview has been edited for length and clarity. For more, listen to our coversation with Michael McConnell: