San Diego a haven for the homeless — and deadly hepatitis A

The rampant hepatitis A outbreak in San Diego is highlighting the city’s significant homeless problem.

More than half of the 444 people with confirmed cases as of Sept. 14 are homeless, county health officials reported earlier this month. The officials say the highly contagious liver infection was spread through person-to-person contact.

While hepatitis A usually is not fatal, the San Diego outbreak has resulted in 17 deaths to date.

San Diego has more than 9,100 homeless people, which amounts to the fourth largest homeless population in the country. The first three are New York, Los Angeles and Seattle.

“There seems to be no plan, no strategy, no leadership on this issue.” — Michael McConnell

To combat the virus, San Diego officials are concentrating their efforts downtown, where many homeless congregate. Police recently cleared hundreds of tents and tarps from homeless encampments in the area. Officials are power-washing the streets with chlorine bleach and adding public restrooms. Public health workers are offering free hepatitis A vaccinations, including visiting homeless on the street to give on-the-spot shots.

Most of those who died had complicating, underlying health conditions and were homeless and/or intravenous drug users, county officials said.

Michael McConnell, a homeless advocate and La Jolla coin shop dealer, said he’s disappointed in government officials’ response so far to deal with the problem “They’re inching along as this crisis ravages the homeless population,” he said.

He criticized the removal of the homeless tents, saying that amounts to moving the homeless from one part of the city to another. He said government officials should open more spaces immediately where the homeless can go out of the public right of way- maybe even empty parking lots.

“There seems to be no plan, no strategy, no leadership on this issue,” he said.

But Deacon Jim Vargas, president and chief executive officer of Father Joe’s Villages, the region’s largest homeless services provider, approved of the city’s response so far. “I’m encouraged by what I’ve been seeing,” he said. “A lot more needs to be done obviously.”

“Hepatitis A infection is not deadly in the vast majority of otherwise healthy adults.” — Nick Yphantides,

He said the real problem is getting homeless people off the streets and the biggest challenge is the lack of affordable housing in the city.  He pointed out that on average, a one-bedroom apartment in San Diego rents for $1,800.

Hepatitis means inflammation of the liver. Hepatitis A results from infection with the hepatitis A virus and can cause an illness lasting from a few weeks to several months. Symptoms include fever, fatigue, nausea, vomiting, abdominal pain and loss of appetite. Hepatitis A does not become chronic and usually improves without treatment.

“Hepatitis A infection is not deadly in the vast majority of otherwise healthy adults,” said Nick Yphantides, San Diego County’s chief medical officer at a videotaped press conference earlier this month.

The virus is spread when a person has contact with objects contaminated by feces or stool from an infected person, according to the U.S. Centers for Disease Control website.  It can easily be stopped by hand washing with warm water and soap.

Of the 444 confirmed cases in the San Diego outbreak, 34 percent are both homeless and IV drug users, 17 percent are homeless only, 13 percent are IV drug users only, 24 percent didn’t fall into those categories but are in relation with someone who is and 12 percent had no medical records.

Due to the unprecedented situation in San Diego, the county has also recommended that people in certain occupations should also get vaccinated.

Nationwide, rates of hepatitis A are the lowest they have been in 40 years thanks largely to the introduction of the vaccine in 1995, according to the website.

As of the middle of this month, San Diego County has given the hepatitis A vaccine to nearly 23,000 people at health centers, clinics, jails, pharmacies and outreach events, county health officials said.

Yphantides said that the county’s goal is to vaccinate everyone who is most at risk for contracting hepatitis A. Those are the homeless, IV or illicit drug users, men who have sex with men, people who have sex with someone infected with the virus, people with chronic liver disease and people with a clotting factor disease.

Due to the unprecedented situation in San Diego, the county has also recommended that people in certain occupations should also get vaccinated: fire and emergency personnel, law enforcement, food handlers, health care professionals, service workers who interact with homeless and substance abusers and public transit workers.

Yphantides said he believes the outbreak could last another six months.

It is too soon to tell if there will be any impact on the city’s important tourism business.

McConnell, the homeless advocate, said the outbreak has caused a lot of fear in San Diego and worry about how it will affect the city’s future.

Candice Eley, communications director for the San Diego Tourism Authority, said it is too soon to tell if there will be any impact on the city’s important tourism business.

“Our staff have spoken with meeting attendees and general visitors that wanted to get more information about the current state of travel to San Diego given the outbreak, but it will be some time before we see any data that would indicate whether or not there was a loss in visitors,” she said in an email.

Mayor Kevin Faulconer remained hopeful in a Sept. 22 statement about the crisis.

“We are a resilient city and have proven time and again that we are ready to handle anything that comes our way,” he said.