San Diego hepatitis A outbreak could and should have been prevented

In 2003, Chi Chi’s restaurant in Beaver County, Pennsylvania was the source of one of the biggest hepatitis A outbreaks, when over 900 people were infected after eating green onions.

Hepatitis A outbreaks may be rare in the United States, but when it is known that hepatitis can easily spread through homeless communities, San Diego, with the fourth highest homeless population of the U.S., should have known an epidemic was coming. In September 2017, a public health emergency was declared in San Diego because of the hepatitis A outbreak sweeping through the homeless community, and although the city is taking steps to stop the hepatitis, preventative measures should have been implemented far before the epidemic became an issue.

Hepatitis A is a highly contagious liver virus, often transmitted through the consumption of food or water contaminated with fecal matter, and a safe and effective vaccine exists. The disease tends to thrive in areas lacking clean water and sanitation, and although hepatitis itself isn’t usually fatal, it can lead to liver failure, which typically is fatal.

In San Diego, about 577 people have been diagnosed with hepatitis A, and approximately 20 have died from it, according to the San Diego County Health and Human Services Agency. In response to the outbreak, the city of San Diego has installed hand-washing stations around the county and has been washing the streets with water and bleach. About 57,000 people, composed of homeless people, drug users and others closely associated with either of them, have been vaccinated for hepatitis, according to the Los Angeles Times.

The problem is not that San Diego is not doing enough to combat the epidemic, it is that this outbreak should have been foreseen and prevented.

In fact, it was not so much a matter of foresight, since the city was warned repeatedly of its declining sanitation standards. According to the Los Angeles Times, four grand jury reports since 2000 have pointed out a lack of public bathrooms in San Diego, and one such report from 2010 explicitly mentioned that the unhygienic conditions could lead to the outbreak of an illness that could prove to be a liability to the city of San Diego. Public bathrooms were not added because in 2005, the city responded to a grand jury report stating that there were financial restrictions to pursue a project like that, and city manager Ronne Froman said that corporate sponsorships did not want their brands to be associated with restrooms.

Rather than add restrooms, which were clearly identified and emphasized as a problem, San Diego began to close public bathrooms downtown in an effort to curb crime rates, particularly surrounding drugs and prostitution. A valiant objective, but the wrong course of action. With a virus as contagious and easily-spread through feces as hepatitis A, removing public bathrooms, especially when the number of restrooms is lacking to begin with, is asking for trouble.

The San Diego outbreak would not have been as much a problem if the city’s homeless population had not been rising. According to Forbes, in 2016, San Diego had a homeless population of 8,669, the fourth highest in the United States. In 2007, San Diego was ranked 12th in the country for homelessness, and this rise is likely due to the housing crisis.

California’s housing prices have risen dramatically, and low-income housing is increasingly difficult to find, resulting in California being the state with the nation’s highest poverty rate at 20.6 percent, according to Forbes. In 2011, during the state budget crisis, Governor Jerry Brown rerouted money normally used for low-income housing to debt relief and schools, which has resulted in a loss of about $200 million for affordable housing. Without that, low-income individuals have been forced to the streets.

However, steps have been taken to rectify the problems that have been building for years. Portable bathrooms have been provided, 57,000 of the most vulnerable people have been inoculated against the disease and security has been set up. In September, Brown signed off on spending about $4 billion to construct low-income housing in California in 2018, and programs like Housing Our Heroes have worked to get veterans off the streets and into permanent housing.

But the fact still stands that the city should have prevented the outbreak. With a rising homeless population to the point of national recognition, and decreasing sanitation levels that warranted reports for years, the city of San Diego should not have been surprised to see hepatitis A sweep through its homeless community. It would not have been possible to completely prevent hepatitis, but had preventative measures been taken in response to the various factors that are known to result in epidemics like this, this outbreak would not have been ranked the second largest hepatitis A outbreak in the history of the United States, just behind the 2003 Pennsylvania epidemic. This was a man-made disaster, and due to the nature of hepatitis A, it is one that will likely hang around San Diego for a few more years despite the disaster control San Diego is implementing.

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