COUNTY TELLS CITY TO ADD RESTROOMS
Officials urged to boost sanitation, vaccination efforts as hepatitis A infections rise among homeless people
On K Street in downtown San Diego on Friday morning, a homeless man named Mike seemed reluctant to speak with passing strangers, huddling with a friend, head down, smoking a cigarette.
But he sat up straight when he heard that the city plans to install 13 portable restrooms downtown, including one on the very block where he and many others are currently living.
People just don’t understand, he said, what it’s like to live in an urban environment with plumbing everywhere but most of it off limits.
“You know, there’s no way you’re going to be able to go inside any kind of restaurant, even like a McDonald’s or a Jack in the Box, so you know, if you have an emergency, me personally, I’ve had to run,” he said.
Adding more restrooms downtown has long been a demand of advocates and those living on city streets, but a recent resurgence of hepatitis A infections among homeless residents forced the issue, with the county health officer, Dr. Wilma Wooten, asking for an increase in street sanitation and vaccination last week.
That ask was quite specific, delineating the exact downtown city blocks where the health department’s research indicates the greatest concentration of unhoused men and women reside.
According to the county, 18 of 28 hepatitis A cases reported to the public health department this year have been people who were unhoused, and 17 of those have lived in downtown San Diego. Thus far, the disease, which can cause deadly liver complications, does not appear to be spreading as quickly in this population as it did in 2017, when more than 500 got sick and 20 died.
Case numbers started ticking up this winter, and the county health department, led by Wooten, began asking for cities throughout the region to get more serious about street sanitation, vaccination and outreach.
A letter sent to the city of San Diego on Feb. 15 asked for increased efforts to “deploy additional handwashing stations and portable rest
rooms to serve the unsheltered as well as analyzing encampments to determine if more frequent cleaning was warranted.”
Hepatitis A is transmitted through fecal contamination, which puts people living on the streets directly in harm’s way, especially in areas where many may end up using a bucket overnight when many public restrooms near encampments are closed.
By March 30, the city responded to that request, indicating that its own analysis found that 10 hand-washing stations should be set up in locations frequented by people at risk of becoming infected.
While this correspondence indicated that the stations were in the process of being set up, that did not appear to be the case for all locations on Friday. Four of eight checked were not yet in place.
In emails last week, city officials said that the county’s new sanitation request will be met, though timelines were not specified.
The city already contracts with the Downtown San Diego Partnership, funding a Clean & Safe Program that pressure-washes 275 blocks in the area. While most get washed monthly, some “high frequency” areas are cleaned weekly.
Spot treatments are also performed within 24 hours when there are reports of unsanitary conditions.
“In response to the county’s direction this week to increase sanitation efforts, the City will be increasing the frequency of cleaning to twice per week at several corridors identified by the county based on their tracing of hepatitis A cases,” Nicole Darling, director of the city’s communications department, said last week.
Regardless of timelines, John Brady, executive director of Lived Experience Advisers and a member of San Diego County’s Regional Task Force on Homelessness, applauded the strong call for more sanitation in addition to vaccination efforts that have recently had teams visiting encampments regularly.
Thirteen more portable restrooms, he said, can only help in the fight to keep hepatitis A from spreading.
“It’s what helped us last time this happened in 2017,” Brady said. “We don’t have enough restrooms downtown for the general population, let alone for people who are homeless.”
Of course, he added, the 2017 outbreak taught everyone that simply putting more portable restrooms on the street is not enough. These resources must be cleaned frequently in order to be useful.
The city did not specify the cleaning frequency for the 13 locations specified by the county.
Mike, who said he has been homeless since losing his job as a forklift mechanic last August, gestured in the general direction of an existing portable bathroom downtown, making it clear that regular maintenance will be the critical factor in whether additional restrooms get used.
“That one doesn’t really seem to get used,” he said. “It seems to be really, like, horrible, disgusting, you know?”
Because the vast majority of hepatitis A cases among homeless residents have occurred in the city of San Diego, similar specific recommendations were not made for the region’s other municipalities. But a letter requesting that each city do more to study encampments and ramp up sanitation efforts was sent by the public health department to all city managers on March 1.
El Cajon officials indicated that they are “in regular communications” with county health officials and are “ensuring that park restrooms throughout the city remain open and clean.”
Imperial Beach officials said they are also monitoring encampments and engaging with homeless residents weekly “to assess needs and opportunities for housing,” and cleaning “highly trafficked areas including public restrooms that are used by both visitors and/or the unsheltered.”
Chula Vista, which recently opened a homeless bridge shelter, is “distributing hygiene kits, clothes, tents and other supplies during weekly outreach visits.” Hepatitis A signage has also been posted in city restrooms, and bleach products are being used to sanitize city streets and sidewalks “as needed.”
Carlsbad said that it already has 13 portable restrooms in areas where unhoused people congregate. They were installed during the COVID-19 pandemic. The city has identified four additional locations where portable restrooms could be deployed “if warranted.” The city also regularly cleans encampment areas.