Hepatitis A and California’s lack of public toilets

Infographic released by the Orange County Poverty Alleviation Center

Infographic from Orange County Poverty Alleviation Coalition

The reluctance of Southern California’s local governments to provide public restrooms has resulted in a public health crisis.  (For updates, see comments at end) San Diego County reports Hepatitis A is the cause of death of 16 people, 14 of which were unhoused citizens living in the city’s East Village. Today 444 San Diegans are infected, more than the 2015 total for the states of California, New York and Texas combined. Los Angeles County, many of whose 57,000 homeless residents live downtown in tents and temporary shelters, is struggling to contain their own outbreak. Between San Diego and Los Angeles lies Orange County, where portable toilets were removed from along the Santa Ana river in a counter-productive attempt to encourage people camping nearby to move on. In response to the open letter that PHLUSH sent to the Board of Supervisors, the County tweeted that they had “extended the hours of a restroom along the flood control channel at Katella to make them available for 24/7 use.” Later we learned that this facility is two miles from where most homeless people live. Activists engage and victims are blamed. On September 20, Mohammed Aly , the young lawyer who heads the Orange County Poverty Alleviation Coalition was arrested while taking measures to improve hygiene in a homeless community.  After supporters helped pay his $20,000 bail, he released this statement. “I was arrested yesterday and charged with a felony for using bleach and a hand pump to disinfect and drain a fetid swamp inside of the Santa Ana Riverbed homeless encampment. That polluted water accumulated because the largest homeless encampment in the county still lacks regular access to hygiene and basic sanitation.” In San Diego, Father Joe’s, a human services nonprofit under contract with the city to provide toilets for the homeless has faced criticism for their lack of cleanliness. Executive Director Jim Vargas says that portapotties have long been cleaned every two hours but that following closures elsewhere there are simply not enough toilets downtown. Meanwhile a Fox News headline screams. “San Diego begins ‘sanitary street washing’ of downtown after pooping homeless people cause deadly hepatitis outbreak.”  That the homeless victims of this outbreak are perceived as the “other” is echoed in Hep A avoidance guidelines from San Diego County Public Health’s Dr. Wilma Wooten, who “recommends people remove their shoes before entering their homes.” Officials scramble with handwashing stations, street bleaching and vaccination campaigns. The US Centers for Disease Control state unequivocally that Hep A “is spread from person to person through contact with the feces (stool) of people who are infected, which can easily happen if someone does not wash his or her hands properly.” As hand sanitizer is not considered effective against Hepatitis A, the city of San Diego has quickly deployed 40 portable handwashing stations.  On the website of LA County Public Health, however, basic fecal-oral transmission is hardly mentioned and handwashing with soap is almost an afterthought. Instead the focus is on illicit drugs needle sharing, sex, and eating contaminated food. Los Angeles’ deployment of multi unit restroom facilities is constrained by a lack of appropriate public space, causing the LA Times Editorial Board to recommend that “Anyone who has a parking lot to offer should call the city.”  While San Diego restroom availability has expanded considerably thanks to longer hours, the placement of portable units and better signage, the East Village remains underserved. All three Southern California counties are undertaking  vaccination campaigns among vulnerable communities. San Diego clinics and health outreach workers have administered more than 22,000 vaccinations so far. Public restrooms and the lessons of too little too late. Writing in the San Diego Union-Tribune, investigative reporter James DeHaven shows that local officials had been warned of the public health consequences of two few available public restrooms.  Since the year 2000, the City of San Diego’s 19-member civic watchdog panel has released four grand jury reports. “Each of the reports called on the city to either add more all-hours, publicly available restrooms or bolster its street cleaning regimen to ensure the public would not be exposed to human waste,” writes DeHaven. (Note the irony of clearing the right-of-way of poop rather than providing restrooms that would send it directly to the sewer. ) The City’s response to the grand jury reports?  New restrooms attract crime and cost too much. As for help from private developers, city officials note that they, too, are not eager to be associated with restrooms.            


  1. Carol on September 22, 2017 at 6:27 am

    There’s a new Hepatitis A outbreak in southeast Michigan. 319 cases and 14 deaths between Aug 1 and Sept 15 alone! https://tinyurl.com/yb2gfx3w Reporter @kbouffard has failed to stress fecal-oral transmission routes, noting instead sex and intervenous drugs although Hep A is not blood borne like Hep B.

  2. Carol on September 24, 2017 at 9:42 am

    Today’s San Diego Union Tribune looks at the medical challenges of the Hep A out break. First, fighting the disease has focused on prevention and there is limited data on effective treatment. Second, people with compromised livers and other health vulnerabilities are most at risk of death. Third, there are cases where the disease rebounds after physicians have sent patients home. https://tinyurl.com/y9uylaog

    San Diego County authorities have issued a useful 2-page Hep A disinfection guide here: https://tinyurl.com/y95vwekx

  3. Admin on September 27, 2017 at 5:34 pm

    Southern California Radio 89.3 KPCC reports that nine public restrooms serve 1,700 people who live there “without a roof over their heads– or indoor plumbing to call their own.” According to Ricky Bluthenthal, a professor of preventive medicine at the University of California, lock of hygiene facilities can lead not only to Hepatitis A but to wound botulism, sepsis, abscesses, skin and soft tissue infections. Interview is here: https://tinyurl.com/y9mb7a3h

    Meanwhile Michigan cities are facing their own Hep A epidemic. State Health authorities have documented 319 cases with 89% hospitalized andw 14 deaths. About 51 percent of the cases have a history of substance abuse, 28 percent also have hepatitis C, 15 percent are homeless or in transient housing situations, and 19 cases, of 6.4 percent, have a history of recent incarceration. More here: https://tinyurl.com/ybtn44og

  4. Admin on October 6, 2017 at 7:20 am

    Writing for the Voice of San Diego, Lisa Halverstadt explains that San Diego County is not releasing data on places most impacted by Hep A. To the north in Santa Cruz County, however, cases are listed by zip code. SD County officials attribute their inability to share info to privacy laws, the diseases long incubation period and the difficulty of tracking the movements of homeless San Diegans.

    Dr. Eric McDonald leads the county’s epidemiology efforts and the program that has now vaccinated 54,000 individuals. According to McDonald “The problem is this disease, because it has a two- to seven-week incubation period, what you’d have to do is put a big blob on the map of where somebody’s been for the last seven weeks and it’s not helpful. If somebody really and truly was in one spot for seven weeks, then maybe you can say that’s where they got infected.” Read the whole story here: https://tinyurl.com/y87ww4xs

    Meanwhile the San Diego Union-Tribune reports the average rent in San Diego County is now at a record high – $1,875. This represents an increase of 7.59 percent in the past year, which follows an increase of 8.4 percent in the previous year. At the lower end of the rental market, rents on studios have risen 11.4 percent. https://tinyurl.com/ybjycn58

  5. Admin on October 17, 2017 at 4:47 pm

    By the end of the second week of October, California Gov. Jerry Brown had declared two separate emergencies. By proclaiming the unprecedented Hepatitis A outbreak an emergency, Brown authorized state health authorities to purchase quantities of vaccines directly from manufacturers and distribute them free of charge to people at risk. Next the Governor declared a shelter crisis and authorized local governments”to suspend state and local building standards for three years.”

    http://www.mercurynews.com/2017/10/14/gov-brown-declares-state-of-emergency-amid-deadly-hepatitis-a-outbreak/ Gov. Brown declares state of emergency amid deadly hepatitis A outbreak By Stephanie K. Baer. October 14, 2017.

    https://www.gov.ca.gov/docs/AB_932_Signing_Message_2017.pdf Letter from Jerry Brown to California Legislators upon signing Assembly Bill 932.

  6. Carol McCreary on November 1, 2017 at 6:19 am

    A 67-year old man is the 20th Hepatitis A death in this year’s outbreak in San Diego. The victim had been treated and his symptoms had largely disappeared when he became ill again. “Relapse is a known occurrence with hepatitis A. Medical literature indicates that the virus comes back after appearing to be vanquished in between 3 percent and 20 percent of cases.” reports the San Diego Times-Union of Nov 1. The number of confirmed cases is now 536. While the rates of fatal and non-fatal infections have slowed, the outbreak is still not under control. Meanwhile, other parts of the US face their own Hep A crises. http://www.sandiegouniontribune.com/news/health/sd-me-hepatitis-update-20171031-story.html

  7. Admin on November 4, 2017 at 6:57 am

    At an October 12th press conference, State Senator Ben Hueso claimed “The county of San Diego is holding over $100 million in unspent Mental Health Services Act funds.” A fact check by Voice of San Diego investigative reporter Lisa Halverstadt has determined this is true. The revelation comes at a time when Democrats and labor leaders are asking San Diego County officials to spend more on services to the homeless. https://www.voiceofsandiego.org/topics/government/fact-check-100m-mental-health-sitting-bank/?utm_source=Voice+of+San+Diego+Master+List&utm_campaign=7564bb0f5b-Morning_Report&utm_medium=email&utm_term=0_c2357fd0a3-7564bb0f5b-84167109&goal=0_c2357fd0a3-7564bb0f5b-84167109

  8. Admin on November 27, 2017 at 8:37 am

    The City of San Diego is “walking a legal tight rope With its Hep A and homelessness strategies,” writes Lisa Halverstadt. Says attorney Scott Dreher, “They’re now using the (hepatitis A public health) ‘emergency’ to run roughshod over the constitutional rights of the homeless.” Halverstadt lists the settlements and cases and alleges city violations of basic rights.

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