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As San Diego’s hepatitis A outbreak continues, so do the questions and worries. One of the biggest is whether our waterways – our rivers, which are often barren, but also our coastal waters, which draw people from around the world – are part of the problem.
There’s been a lot of dancing around the question. We’ve, for instance, reported that the sewage spilling across the border through the Tijuana River is likely not a source of the outbreak. But the San Diego River and local beaches can be a bacterial mess, laced with sewage from a variety of sources. Hepatitis A can be found in sewage.
On the one hand, San Diego County and its health department have sent a strong signal: The hepatitis A outbreak is being transmitted person to person “via the fecal-oral route” and “epidemiological data” indicate “waterbodies (such as rivers) have not been a source in the initial infection or continued transmission.”
County officials also note, based on information from the U.S. Centers for Disease Control, that water-related outbreaks usually involve people intentionally gulping water they do not know is contaminated with hepatitis. The CDC cited four academic papers looking at outbreaks over the past several decades, each of which involved people drinking water from a well or spring that had been contaminated by sewage.
On the other hand, there are other ways to get the virus from water than by intentionally drinking it. In 1969, members of a Boy Scout troop in South Carolina fell ill after “inadvertently” consuming contaminated water at a lake where they were camping.
It’s also unclear if officials know how the San Diego outbreak started. Officials seem to have lost track of the homeless man from around El Cajon who may have been the outbreak’s “patient zero,” as the Union-Tribune reported, though it’s also not clear whether he had the same strain of hepatitis that has since infected over 500 and killed 19.
That means there’s a little daylight between the county’s supposedly ironclad “epidemiological data” that show waterways are not the source of the infection – data the public has not seen – and the questions about our waterways.
As questions from politicians and the press mounted, the county asked the CDC to confirm in writing what federal officials had apparently told the county privately: That it’s a waste of time to focus on waterways.
The CDC responded in kind. The agency said it would be an act of “futility” to test San Diego’s waters for the virus. Further, the agency warned, testing the waters now could “unnecessarily divert resources that are needed to contain the outbreak in proven and effective ways (vaccination, education, restrooms, and hand hygiene practices).”
To figure out if this makes sense, I talked to Richard Gersberg, a professor of environmental health at San Diego State University who has studied hepatitis A in area waterways.
His take was nuanced. Yes, he said, the CDC’s guidance make sense. There’s no reason to rush to test for hepatitis A in the water. Gersberg also agrees the outbreak doesn’t seem to be spreading through waterways.
But – and this is a big “but” – that doesn’t mean government agencies shouldn’t be regularly testing waterways for hepatitis A. Generally, the county Department of Environmental Health monitors beaches for water quality problems, but individual cities also have obligations to keep pollution out of waterways that flow toward the coast.
Indeed, one of the reasons it doesn’t make sense to test for hepatitis A in response to the outbreak is because agencies haven’t been testing for hepatitis A in the past. So, even if agencies found hepatitis A right now, officials would have no context for whether there’s more or less than before, because they haven’t been testing.
If officials did find hepatitis in a waterway, it may not mean much. It wouldn’t answer, for example, whether the hepatitis is causing the outbreak, or if the outbreak is causing it to be there.
Still, this doesn’t add up to an argument for never testing local waterways for hepatitis, which is a leap some officials seem to be making.
A city spokesman recently said in an email that “We aren’t aware of a Hep A max concentration level that would be considered or expressed as dangerous or not dangerous.” In other words, even if tested, we wouldn’t know much about what the results meant.
Gersberg said that is a bureaucratic response. If there’s no virus, that would be one thing; if there was a little bit of it, that would be another; and if there was a lot, well, that would be something else.
“It’s a piece of information,” Gersberg said, “It wouldn’t tell you the exact level of risk, but it would tell you there is risk, if they found it.”
Right now, agencies only monitor for what are known as “indicator bacteria.” Those are bacteria – like hepatitis – that can travel in human fecal matter. The bacteria happen to be cheaper and faster to test for than the hepatitis A virus. But it’s an imperfect way to look for hepatitis. Just because there’s bacteria doesn’t mean there’s hepatitis, and there can also be hepatitis even if there isn’t bacteria.
In Other News
• Speaking of risk, the New York Times has a great story about internal debates at the Environmental Protection Agency. The takeaway is that the agency is “more aligned with the industry’s wishes” when it comes to allowing Americans to be exposed to potentially dangerous chemicals. But it’s not the typical story about some regulation or another being loosened or tightened. The reporter, Eric Lipton, delves into the biographies of the two EPA officials who feuded over the agency’s regulatory approach. The result is a rich story about how two people reach different conclusions about how to regulate hazardous chemicals. Indeed, there’s an unusually empathetic portrayal of the official who is now trying to loosen restrictions. Unfortunately, an EPA spokeswoman chose not to engage and called the story “elitist clickbait.”
• The Union-Tribune takes a look at how carbon credits may allow urban sprawl, an unexpected ramification of the carbon market. If you’re looking for a great primer on that market, check out this Los Angeles Times story from March.
• As Northern Californians begin to pick up the pieces after the Wine Country fires, it’s become clear how close we are to one another, even in a big state like California. Union-Tribune reporter Joshua Emerson Smith wrote about how his family lost their house up there in a fire.
• There have also been some good perspective pieces on the fire, like a Los Angeles Time story about how, across the state, power lines and electrical equipment have been linked to fires, including our own here in San Diego. The Sacramento Bee editorial board, though, has a different take: Don’t just blame Pacific Gas & Electric, which some believe may have contributed to the Northern Californian fires, blame yourselves. “Almost 40 million people inhabit California,” the board writes, “and their presence alone is a fire hazard in a widening share of this state.”
From the Actual Environment
There’s another thing that had me thinking about risk this weekend. Strangely, going into the desert seemed like a decent way to beat the San Diego heat, so I went out to Joshua Tree, where it’s slightly cooler now than San Diego, especially at night.
That’s also why it’s peak season there, and there wasn’t a spot at the established campgrounds. This isn’t always a problem, though. I went at New Year’s with a group of people, and we easily found someone willing to share their spot with us. But I ran into a couple this weekend who told me they’d already cased several campgrounds and found no one willing to share. I’d just driven two hours and was ready to do something, so my first thought was that social decay has taken over after a long, tumultuous year. So without trying to see for myself if they were right, I just got a backcountry permit, hiked a few miles in and set up my tent out of sight of anyone but probably within shouting distance of someone.
I’m sure some people reading this have camped alone and that it is old hat, but this was only my second time trying it. I once saw a movie about someone running over two people with a truck while they slept. I thought of that for a while. But then I got a text from the couple, who said they found a spot and invited me to share it with them. I didn’t, because it was already late, but I slept easier – except for a dream where a bear nearly ate me, but I woke up before it did and realized there aren’t bears in the desert.
Everything was fine, I saw a great shooting star and cleared my head – exactly the point of the trip. Then I got back to town and read this Press-Enterprise story about how missing hikers had been found dead in Joshua Tree, both shot – the theory being that they got lost, and the man shot the women before killing himself – a “sympathetic murder-suicide,” in the words of one family member. That’s the sort of thing that doesn’t ease one’s mind about risk.