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# Hepatitis A and the Homeless - A Crisis in the Making?
October 02 2017
Written by Tim Deegan.
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DEEGAN ON LA-Several times daily you feel the splash of hot water and inhale the scent of soap as you routinely wash your hands after any number of tasks. The homeless do not have this experience, but they should, for all the usual reasons, and now with more urgency than ever since the County Department of Public Health has announced an outbreak of Hepatitis A, a potentially serious liver disease nurtured and transmitted by poor hygiene. The homeless are especially vulnerable because they do not have a ready supply of hot water and soap, something most of us take for granted but which is an unreachable luxury for them.
Why is this suddenly becoming an issue? The alarm was sounded two weeks ago by Barbara Ferrer, PhD, County Public Health Director, who told the County Board of Supervisors that Los Angeles was officially experiencing a Hepatitis A outbreak, and that homeless populations in San Diego and Santa Cruz had already felt the impact of the virus.
So, what exactly is Hepatitis A, and why is it a public health concern and possibly a hazard to all of us, not just the homeless?
The World Health Organization (WHO) provides these key [Hepatitis A facts:](http://www.who.int/mediacentre/factsheets/fs328/en/)
- Hepatitis A is a viral liver disease that can cause mild to severe illness.
- The Hepatitis A virus is transmitted primarily by the fecal-oral route; that is when an uninfected person ingests food or water that has been contaminated with the feces of an infected person.
- The risk of Hepatitis A infection is associated with a lack of safe water, and poor sanitation and hygiene (such as dirty hands).
- The Hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.
- Safe water supply, food safety, improved sanitation, handwashing and the Hepatitis A vaccine are the most effective ways to combat the disease.
- A safe and effective vaccine is available to prevent Hepatitis A.
- Epidemics can be explosive and cause substantial economic loss.
“The current situation is neither tolerable nor humane, and it is a risk to public health”, declared Councilmembers Mike Bonin (CD11) and Jose Huizar (CD14), who offered a [motion](https://cityclerk.lacity.org/lacityclerkconnect/index.cfm?fa=ccfi.viewrecord&cfnumber=17-1092) stating, “Twenty-five thousand unsheltered people in Los Angeles lack access to restrooms facilities. This lack of access has created a risky situation for both the homeless population and the public. (Our) conditions do not even meet the standards the United Nations sets for refugee camps.”
What do they suggest? “Vaccinating homeless individuals and their service providers is critical to preventing the outbreak from spreading. In addition to vaccinations, the availability of public restroom facilities is a vital component of preventing the further spread of Hepatitis A.”
Councilmember Huizar (CD14), whose district includes Skid Row, already has a role in a program of portable toilets for Skid Row that needs scaling up, and the city’s allocation of funds to make that happen quickly. The Hepatitis A outbreak may be just the incentive to do that.
Speaking about the City of Los Angeles Coordinated Street Furniture Program, managed by the LA Bureau of Street Services, Co-Managing Director for Outfront/Decaux J Francois Nion said, “we have six portable automated toilets in downtown Los Angeles. Five are at Skid Row and one is around Pershing Square.”
“We have a coalition of good people wanting to do good things -- Bureau of Street Services, City Sanitation, County Public Health, the local Council Office (CD14-Jose Huizar), the LAPD, and County Social Services. We have a concrete example in the [San Francisco Pit Stop](http://sfpublicworks.org/pitstop) model, for how to make it better for the public that desperately needs free and safe access to clean toilets. The current conditions desperately call for a physical presence of attendants to monitor activity to enhance accessibility and make a positive difference.
“What we need is momentum, and the danger of the Hepatitis A outbreak may be just the trigger to enhance and expand the city’s current program with a pilot attendant program for three or four months to start with.”
What are other agencies and programs doing to help contain the outbreak of Hepatitis A?
Corri Planck, Project Manager of the City of [West Hollywood’s Homeless Initiative](http://www.weho.org/services/social-services/homeless-services), told *CityWatch,* “We are assisting our homeless community members that are vulnerable to acquiring Hepatitis A. Our outreach teams have been sharing information about Hepatitis A, including vaccinations are available and information on general hygiene. Our teams, even prior to this outbreak, distribute hygiene kits as part of their outreach. We certainly want people to know how to prevent the spread of Hepatitis A, and have stepped up our efforts on this front in light of the recent county public health announcements.”
For shower services, West Hollywood homeless community members can go to the [Saban Community Clinic](http://www.sabancommunityclinic.org/Support-Us/Ways-to-Give/Shower-Program.aspx) and homeless youth can also access services at the [Los Angeles LGBT Center’s Youth Center](https://lalgbtcenter.org/social-service-and-housing/youth/homelessness)**.**
Heather Carmichael, Executive Director of a homeless teen program in Hollywood says [My Friend's Place](http://myfriendsplace.org/) is committed to helping young people experiencing homelessness stay as healthy as possible. We have the Department of Public Health here today offering free vaccines to youth, staff and volunteers. We provide nearly 30 showers daily, this is a great service, but not enough for the average 85 visitors a day. We are working hard to build our capacity to meet the growing needs of the youth.”
What do you think: are we on the right track for finding solutions for the Hepatitis A outbreak for people with homelessness? Should the City immediately accelerate efforts and spending on this issue?
Please take a moment and share your opinion on this issue by taking the brief poll below and then press “view” to see how your responses compare with others.
Pop poll questions
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*(Tim Deegan is a long-time resident and community leader in the Miracle Mile, who has served as board chair at the Mid City West Community Council and on the board of the Miracle Mile Civic Coalition. Tim can be reached at* *.) Edited for CityWatch by Linda Abrams.*
*-cw*
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