San Diego death toll from hepatitis A outbreak rises to 16

Since San Diego officials declared a public health emergency following a hepatitis A outbreak on September 1, two more people have died bringing the total for the current outbreak to 16 fatalities. The city has taken a slow response to contain the infectious disease, only in the last month installing 40 portable hand-washing stations downtown and vaccinating about 28,000 people.

The outbreak is the deadliest in the United States in decades and has wreaked havoc on the city’s homeless population. According to the Centers for Disease Control (CDC), San Diego’s mortality rate for the disease is 4 percent, four times the national average of 1 percent.

The city has begun power-washing the streets with bleach, a practice borrowed from Los Angeles which has reported an outbreak of hepatitis A as well.

The disease, which affects the liver, is extremely contagious especially given the conditions in downtown San Diego, where human waste and trash exist alongside homeless encampments of men, women, and children. More than half the hepatitis A cases in San Diego are homeless people.

Experts have cautioned San Diegans to practice good hygiene, but given the lack of public toilets and washing facilities this has proven especially difficult for homeless people.

Officials in San Diego first identified the outbreak in March but were aware of the first case last November. Only after 14 people had died and the outbreak became international news did the city offer any plans to combat the spread of the disease. So far, city officials have only offered cosmetic policy changes while doing nothing to address the root cause of the problem: the lack of affordable housing combined with the criminalization of the homeless population.

An “Emergency Operations Center” was opened on Friday in coordination with the Office of Homeland Security in City Hall which will oversee the city’s response to the crisis.

As of last week, there have been 444 recorded cases of hepatitis A, including 305 hospitalizations, compared to just 22 cases in all of 2015. Santa Cruz County in Northern California has reported 69 cases since April. Los Angeles has reported 10 cases this year, citing the deplorable housing conditions in Los Angeles, health officials have warned that the disease may easily spread there as well.

The San Diego Police Department has continued its daily sweeps of the homeless encampments in the downtown area, pushing the population away from the tourist areas. In the last year, arrest of homeless people under Republican Mayor Kevin Faulconer have increased by 68 percent.

The disease has now spread to the jails, where the homeless are routinely locked up for anti-vagrancy tickets. Already, 21 cases of hepatitis A have been reported in jails throughout San Diego County. Of the 5,800 inmates across the county, more than 2,300 have received vaccinations.

Health officials have stated that because the disease has an incubation period of 15 to 50 days, the outbreak may continue for another six months. Although the cases in San Diego have affected homeless individuals and intravenous drug users, over one third of the number do not fall into either category.

San Diego County's chief medical officer, Dr. Nick Yphantides told NBC 7, “Based on history, prior to the availability of the vaccine in the late 1990s, we expect this outbreak will last longer, and will likely have an additional number of further cases.”

Officials have known that a public health crisis was brewing years before the current outbreak. According to the San Diego Union-Tribune, the public records of four grand jury reports since 2000 revealed that officials were warned of the potential risks of human waste on the city streets and the lack of toilets as the city’s homeless population exploded.

The official response to these reports was that additional bathrooms would be too costly, require more security, and that the suggestions themselves deserved more study.

In 2013, the San Diego Sheriff’s office and the County’s Chief Administrative Officer rejected one such grand jury report which recommend vaccinating inmates in the jails in compliance with federal guidelines. Needless to say, the guidelines were not implemented.

The outbreak has already threatened the city’s much celebrated tourism industry, with a cookie convention being called off at the San Diego Convention Center last weekend. It for this reason, bad publicity for “America’s finest city”, that Mayor Faulconer and the political establishment have shown more interest in solving the hepatitis A outbreak, or at least paying lip service to it.

The Mayor’s office has promised three shelters which can accommodate 100 beds with restrooms and showers. Officials said the first one or two shelters might open by the end of the year. However this does not even begin to solve the problem as there are more than 9,000 homeless individuals in San Diego County according to the latest homeless survey.

Moreover, the shelters promised had already been announced last January by the Faulconer and private donators had announced two months ago they would pay for the program. The mayor’s staff had looked at the proposed sites for the shelters previously and gave many reasons why they would not work, but now that the hep A outbreak has occurred the sites were now deemed acceptable.