Homeless People Dying of Hepatitis A

The homelessness crisis in several major cities across the United States is a national embarrassment. And the news keeps getting worse.

Beginning in November 2016, the homeless population in San Diego underwent an outbreak of hepatitis A that just now ended, according to the San Diego Union-Tribune. During that two-year-long nightmare, more than 600 people got sick and 20 died.

Such deaths, of course, are entirely preventable. Hepatitis A is spread by the fecal-oral route, meaning the unsanitary conditions often found in homeless encampments likely played a large role in the spread of the disease. Additionally, hepatitis A is transmitted through intravenous drug use, a problem that also plagues many homeless people.

If we can't stop people from shooting up drugs, we can stop them from living in their own filth on the sidewalk. But we choose not to. Every action has a consequence, and the consequence of our collective negligence was entirely predictable: More hepatitis A outbreaks occurred elsewhere in the country.

Hepatitis A Outbreaks Hit Four U.S. States, Killing 41

In its latest edition of MMWR, the CDC reports that four states in 2017 (California, Michigan, Utah, and Kentucky) experienced outbreaks of hepatitis A, mostly among homeless people and/or intravenous drug users. Overall, 1,521 people got sick and 41 died. (All of the deaths occurred in California and Michigan, and this figure includes those from the San Diego outbreak.)

There are solutions to the problem, but few if any politicians or public health departments want to implement them. Involuntarily removing a homeless person from the street is considered cruel, and mandatory vaccinations are similarly rejected. (I've been called a Nazi, once by a Seattle City Councilmember and once by the Twitter mob, over both policy proposals.)

So, instead, we as a society have decided, in the name of compassion, to let people who are unable or unwilling to care for themselves die like animals on the street.

Will Compassion or Common Sense Ever Prevail?

Every life is precious. Hopefully, some city council will finally understand that and do whatever is necessary to prevent these tragic deaths. Until then, not only hepatitis A, but diseases that most people have never seen before -- like trench fever and typhus -- are making a comeback, perhaps in a downtown near you.

Source: Foster M, Ramachandran S, Myatt K, et al. "Hepatitis A Virus Outbreaks Associated with Drug Use and Homelessness — California, Kentucky, Michigan, and Utah, 2017." MMWR 67 (43):1208-1210. Published: 2-Nov-2018. DOI: 10.15585/mmwr.mm6743a3.