COUNTY MUST HANDLE HEPATITIS A BETTER NOW

Three years before San Diego County public health officials’ smart, transparent and comprehensive response to the start of the COVID-19 pandemic in 2020, their handling of a deadly hepatitis A outbreak based in Downtown San Diego was something else entirely: disastrous. Linked to contact with human feces, the earlier crisis emerged in spring 2017, mostly among homeless people — and grew worse for months. There were five deaths and more than 250 confirmed cases of hepatitis by the end of June. Yet the county didn’t declare a public health emergency until Sept. 1 — after 16 deaths and more than 430 confirmed cases. The problem promptly dwindled when county officials got more aggressive about vaccinating at-risk people, discouraging risky behavior and working with the city on increasing access to bathrooms and hand-washing stations. It seems clear that there would have been far fewer than the final 20 hepatitis deaths and 592 cases if an emergency had been declared earlier.

This backdrop needs to be kept in mind as the county public health department responds to fresh hepatitis A concerns by beginning a vaccination campaign at a local homeless shelter Monday. Five serious hepatitis A infections and one death were reported from Jan. 10 to Feb. 6. Three of the cases, including the death, involved homeless people. Evidence

to date does not suggest the cases were linked by contact between the five people or shared food, drugs or other items.

San Diego Mayor Todd Gloria says the city is working closely with the county to ensure the problem doesn’t escalate. This is good to hear, because while the county may take the lead in responding to public health concerns, the city’s approach to homelessness has long been faulted on health grounds because of its lack of public bathrooms Downtown. This was underscored by the December report from San Diego State University’s Project for Sanitation Justice that there were only two permanent public restroom facilities with nine toilets that are open 24-7. While acknowledging the fact that public bathrooms are really for everyone, that’s one toilet per 215 homeless people, based on the Downtown Partnership’s record monthly count of 1,939 homeless people as of Jan. 31. That shows the failure of the Gloria administration to reach its goal stated in late 2021 of soon having an accessible bathroom within a five-minute walk of everyone in the Downtown area.

City officials say increased bathroom access is a priority and plan to spend a record $173 million on homelessness this fiscal year, so sheltered and unsheltered residents alike are right to expect results. The latest hepatitis A death underscores why.