San Diego declares public health emergency after death toll from Hepatitis A outbreak rises to 14

By Kevin Martinez
5 September 2017

San Diego County declared a local health emergency on Friday after the death toll from a Hepatitis A outbreak rose to 14, one of the deadliest outbreaks of the disease in the US in decades. The vast majority of the victims, some 70 percent, are homeless and are easily vulnerable to the highly infectious disease.

More than 264 people have been hospitalized since the disease was first reported last November. Between 2012 and 2016, San Diego County tallied an average of 28 acute Hepatitis A cases for each year. In just the last week, there have been 19 new cases and 32 new hospitalizations according to the San Diego Tribune.

The virus weakens liver function, producing jaundice, nausea, fatigue, and in some cases death. It is usually spread through food or water contaminated with feces and has an incubation period of up to 28 days, meaning people can spread the disease before they are aware they have it.

A Centers for Disease Control (CDC) spokesperson said the number of fatalities from this wave of infections was “likely the most deaths in an outbreak [of Hepatitis A] in the US in the past 20 years.” While previous outbreaks were the result of contaminated food being served to the public, the cause of the outbreak in San Diego is still unknown.

Dr. Rohit Loomba, director of hepatology at the University of California at San Diego, told the Guardian, “My gut feeling is it was a common source where somebody might have given food to a group of homeless individuals.”

The unsanitary conditions that the homeless are forced to live under have only exacerbated the problem. “They don’t have a clean water supply to wash their hands, and once they have hepatitis A, then they become a source for another person,” said Loomba.

Homeless individuals who suffer from drug use, alcoholism, and other illnesses are especially at risk of contracting the disease. While public health officials say that washing hands and good hygiene are the best way to prevent the spread of the disease, this has become an increasingly difficult challenge for the homeless in San Diego.

The only 24-hour restroom is miles away from downtown San Diego’s main homeless encampments. Additionally, a pair of public restrooms in a downtown park were kept locked despite the city paying the park’s developers $1.6 million to keep them open and clean. After public outcry over the locked bathrooms, city officials told the developer to keep the bathrooms open from 6am to 9pm.

City officials have been aware of the Hepatitis A outbreak for over two months and have not come up with a real solution besides installing hand-washing stations throughout the city.

Republican Mayor Kevin Faulconer released a worthless statement on Friday saying, “We must continue to work collaboratively to stop this crisis and save lives.” This after the city had already announced a pilot program to put washing stations in areas of San Diego frequented by the homeless two months ago.

Despite this promise, 11 more people died in the following weeks and months. Until last week, the city only had two hand-washing stations, both of which were located miles from the downtown homeless encampments. County workers moved one of the stations downtown last week and reportedly plan to install 30 more.

The county has also deployed workers with vaccines to inoculate more than 7,100 people considered particularly at risk and thousands more considered less at risk.

While city and county officials have plenty of time and resources to expel the homeless and their belongings off the streets twice a week, the hand-washing “solution” has gone at a snail’s pace. The city originally only addressed the crisis with a “pilot program” for the washing stations before it could be implemented on a larger scale.

County officials reported they could not set up hand-washing stations in the neighboring cities of El Cajon and Escondido as well as providing them to nonprofits working with the homeless without separate permits.

More time has been wasted since the washing stations could not be placed on non-county property without proper approvals. The original vendor for the stations could not deliver, and the city only signed a new contract with a vendor on July 6.

So callous were city officials to the crisis that even the bare minimum “solution” of wash stations was considered too much. Metropolitan Transit System enforcement director Manuel Guaderrama wrote in an August 15 email published by the Voice of San Diego, “My only thoughts are that this would probably become a magnet for homeless people to come onto our property just to use the sink (take a bath, brush their teeth, wash their dishes, etc.), especially during non-revenue hours,” adding, “Perhaps the health department can set up locations with just the sanitizer.”

Public health officials warned that hand sanitizers and wipes are not as effective as hand washing in preventing the outbreak from spreading.

The county health department urged authorities late Friday to take “immediate action” to “address the unsanitary living conditions of the at-risk population.” The city responded with a press release stating it would comply with the county’s guidelines but that it may take 10 days because of a lawsuit that requires 72 hours before street washing.

Mayor Faulconer’s office called for an emergency declaration to allow the city to receive federal and state funding that “could go to a variety of programs that could curb the spread of the virus.” (emphasis added)

The response to the outbreak has illustrated quite starkly how even the gravest and most pressing social problems, such as a deadly disease long thought to be eradicated making a comeback, are treated under capitalism. The most vulnerable layers of the population are met with contempt if not outright hostility from the political establishment, if at all.

Meanwhile, the heads of the major banks and corporations who want an extra stadium or want to clear the streets of the homeless before another tourist convention, can easily mobilize city government and cops in a moment’s notice.

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