By: Marcus J. Hopkins, Blogger
In mid-September 2017, HEAL Blog wrote about the extreme measures taken by San Diego County and city to combat a severe outbreak of Hepatitis A (HAV) among the county’s homeless, indigent, and illicit drug user populations (Hopkins, 2017). At that time, the HAV outbreak consisted of 421 confirmed cases, 292 hospitalizations, and 16 deaths. That initial outbreak, which began in November 2016, has continued to grow with 481 confirmed cases, 337 hospitalizations, and 17 deaths (Sisson, 2017). The outbreak is also spreading.
Both Santa Cruz and Los Angeles Counties have begun seeing outbreaks of HAV related to the initial outbreak in San Diego County, with 68 confirmed cases in Santa Cruz County (Health Services Agency, 2017) and 12 confirmed cases in Los Angeles County, 9 of which required hospitalization (Acute Communicable Disease Control, 2017). These cases do not include all of the reported HAV cases; only those connected to the San Diego outbreak. These cases are primary among the same populations in these counties as they were in San Diego County – homeless, indigent, and illicit drug users.
According to Kaiser Health News writer, Stephanie O’Neill, poor access to restrooms and sinks in homeless encampments is largely to blame for these outbreaks (O’Neill, 2017). San Diego County responded to their outbreak by installing 40 portable hand-washing stations throughout the downtown areas hardest hit by the outbreak, leaving public restrooms open overnight, and power-washing heavily soiled sections of downtown sidewalks and streets with a bleach solution in an effort to stop the spread of the virus (O’Neill).
Southern California’s HAV outbreak is being described as “unprecedented” and “the largest outbreak in the U.S. that is not related to a contaminated food product” since the U.S. first introduced a vaccine for hepatitis A in 1995 (O’Neill). This trend is unlikely to be restricted to Southern California. According to the National Law Center on Homelessness and Poverty (NLCHP), “Despite a lack of affordable housing and shelter space, many cities have chosen to criminally or civilly punish people living on the street for doing what any human being must do to survive” (NLCHP, n.d.). Additionally, the NLCHP notes that, since 2006, bans on camping city-wide have increased by 69%, bans on sleeping in public have increased by 31%, bans on sitting or lying down in public have increased 52%, bans on loitering, loafing, and vagrancy have increased 88%, and bans on living in vehicles have increased 143% (NLCHP). Furthermore, most cities in the U.S. close public restrooms at dusk, leaving homeless people with nowhere to relieve themselves.
While the intention of these bans is to move cities’ homeless populations out of the line of sight and create “safer” public spaces for homed populations, the real-life effect has resulted in creating conditions ripe for the spread of diseases like HAV. People who lack access to restroom and handwashing facilities are forced to relieve themselves in the open, creating biohazardous waste and fostering the spread of HAV to potentially anyone who comes in contact with their refuse.
It is also likely that, as more cities are hit with HAV outbreaks related to homelessness and illicit drug use, responses will vary between highly effective public health responses like those put in place by San Diego County, and highly ineffective criminalization responses that end up creating worse circumstances than they purport to fix.
- Acute Communicable Disease Control. (2017, October 02). Los Angeles County Hepatitis A Outbreak Associated* Cases and Outcomes as of Close of Business: Monday, October 02, 2017. Los Angeles, CA: Los Angeles County Health and Human Services Program: County of Los Angeles Public Health: Acute Communicable Disease Control: Hepatitis A Outbreak. Retrieved from: http://publichealth.lacounty.gov/acd/Diseases/HepA/OB.htm
- Health Services Agency. (2017, September). Reported Hepatitis A Cases in Santa Cruz County by Resolution Status. Santa Cruz, CA: County of Santa Cruz: Health Services Agency: Public Health: Communicable Disease Control: Hepatitis A. Retrieved from: http://www.santacruzhealth.org/Portals/7/Pdfs/Alerts/SantaCruzHepAOutbreakDataTables.pdf
- Hopkins, M.J. (2017, September 18). Hepatitis A: Extreme Sanitation Measures in San Diego. Washington, DC: Community Access National Network: HEAL Blog. Retrieved from: https://communityaccessnationalnetwork.wordpress.com/2017/09/18/hepatitis-a-extreme-sanitation-measures-in-san-diego/
- National Law Center for Homelessness and Poverty. (n.d.). Housing Not Handcuffs – Ending the Criminalization of Homelessness in U.S. Cities. Washington, DC: National Law Center on Homelessness and Poverty. Retrieved from: https://www.nlchp.org/documents/Housing-Not-Handcuffs
- O’Neill, S. (2017, October 01). California scrambles to contain ‘unprecedented’ hepatitis A outbreaks. Scotts Valley, CA: Santa Cruz Sentinel: Lifestyle: Health. Retrieved from: http://www.santacruzsentinel.com/article/NE/20171001/NEWS/171009989
- Sisson, P. (2017, October 04). San Diego hepatitis outbreak continues to grow: 481 cases. Los Angeles, CA: The Los Angeles Times: Local. Retrieved from: http://www.latimes.com/local/lanow/la-me-hepatitis-san-diego-20171004-story.html
Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.