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The fallout from San Diego’s 2017 hepatitis A outbreak has led regional leaders to scramble to try to protect homeless San Diegans during the coronavirus pandemic – and to try to better coordinate their overarching response.
More than two years ago, city and county leaders faced an avalanche of criticism for a sluggish, bureaucratic response to a deadly outbreak that ultimately left 20 dead, including more than a dozen homeless people.
Now, facing a global pandemic that also threatens the broader community, county health officials have deployed tacks they first tried during the hepatitis A outbreak, including handwashing stations in areas where homeless people congregate, hygiene kits and county nurses who join homeless service workers and police officers at shelters and homeless camps.
City and county officials – as well as nonprofit leaders and homeless advocates critical of the hepatitis A response – also report swifter, more seamless coordination and between agencies whose cooperation is crucial in staving off the worst outcomes. The improved relations have followed a blistering state audit documenting past finger pointing that dominated as the hepatitis A death toll rose, state legislation clarifying responsibilities and multiple after-action reviews demanding reforms.
“Having been through the health scare that we had, it’s about immediate action, and it’s about doing everything we can with our population in the bridge shelters and on the street – and the county and the city moving in the same direction from day one,” Mayor Kevin Faulconer said. “We’ve ensured that.”
But cracks remain as officials rush to respond. Homeless San Diegans and advocates for them are reporting confusion and fear amid rising coronavirus cases and government directives, including self-isolation and social distancing, not easily followed by those without homes. Many question where – and how soon – a major influx of resources might be available to get homeless San Diegans with health concerns off the street.
Local leaders say they are preparing to take dramatic actions to try to protect homeless San Diegans. In an unprecedented step, county officials are moving some vulnerable San Diegans, including homeless people and others who test positive for or show symptoms of coronavirus but don’t have safe place to stay, into 1,100 motel rooms they have secured.
At a Tuesday press conference, Supervisor Nathan Fletcher said officials could not immediately say how many of those rooms are filled but that homeless shelter staff have been trained on protocols to direct people who are eligible into the county-funded rooms.
The Regional Task Force on the Homeless and state are also seeking additional refuges specifically for homeless people.
Dr. Wilma Wooten, the county’s public health officer, said this week that the hepatitis A outbreak has helped drive this focus. She noted that federal health authorities initially urged health agencies to focus on people who have traveled from countries that have been hardest hit by the virus, showed symptoms of coronavirus or encountered someone who is infected, factors she said were less likely in San Diego’s homeless population.
But Wooten said experience has taught county health officials that the disease could spread quickly in a population that is particularly vulnerable and led them to focus more immediate effort on protecting homeless San Diegans.
“As this becomes communitywide, they will become impacted,” Wooten said.
Both the hepatitis A outbreak and research underscore the medical vulnerability of the homeless population.
An-often cited UC San Francisco study of homeless seniors in Oakland revealed homeless adults in their late 50s often face health issues similar to those in their 70s or 80s. San Diego’s homeless population, like others across the nation, is aging – factors that make them particularly susceptible to health issues.
Then there’s the fact that homeless people often lack easy access to sanitation resources considered crucial defenses during outbreaks, a factor that fueled the spread of hepatitis A among that population.
As the coronavirus threat worsened, Faulconer called homeless service providers to City Hall last Monday to discuss coronavirus responses. Both city and county officials were on hand. The mayor said he also met with Fletcher and county Chief Administrative Officer Helen Robbins-Meyer to discuss how they could collectively act and quickly install handwashing stations in the city and send county nurses to city homeless shelters to screen residents.
“We know this is a vulnerable population,” Faulconer said. “We’ve seen it before and so (there’s) that bias toward immediate action – not worrying about who’s in charge. Let’s just help people.”
Fletcher, who took office after the 2017 outbreak, declined to compare the city and county’s coronavirus response with the hepatitis A outbreak but said local leaders are moving quickly to try to prevent the worst-case scenarios.
“I can tell you what we’re doing now, which is every day, seven days a week, is really diving in: What is everything we can do?” Fletcher said. “And the constant questions are, what else, how soon, how fast, what more?”
Alpha Project CEO Bob McElroy, who attended Faulconer’s meeting last week, said he has been heartened by the more rapid response by the city and the county amid his fears about the threat to homeless San Diegans, including the hundreds staying in the nonprofit’s two city-funded shelters. He praised the city and county’s quick cooperation to place county nurses in shelters and to assist the shelter in procuring needed cleaning supplies in the days after the meeting.
“That’s miles ahead of where we were with hepatitis A,” McElroy said.
Later in the week, Faulconer and Fletcher were among many community leaders who attended a Regional Task Force on the Homeless meeting about the region’s coronavirus response.
Ellis Rose, a Task Force board member who once lived on the streets and has panned the region’s hepatitis A response, said he came away from the meeting feeling cautiously optimistic.
“I am feeling hopeful in terms of the powers that be,” Rose said. “There’s far more compassion.”
Faulconer and county officials acknowledge reforms and policies created since the hepatitis A crisis have helped pave the way for a more efficient, cooperative response.
A state audit and after-action reports called for the city and the county to pursue a formal agreement laying out the roles they should take during future health scares and for the county to set a plan to pull together key leaders during outbreaks, among other recommendations. The county and the city separately reported to the state auditor last year that they had implemented all of its recommendations.
Assemblyman Todd Gloria, who called for the state audit, also wrote legislation aimed at clarifying the need for counties to share certain information during outbreaks and health officers’ authority to issue directives to cities amid outbreaks. During the hepatitis A outbreak, city officials criticized the county for not sharing location data on cases and deaths while county officials were frustrated by the city’s past request that the county get a permit to place handwashing stations in the city.
Wooten, Faulconer and other officials said those challenges haven’t emerged during the coronavirus response.
Gloria, who condemned the past response, said he also noticed a proactive, cooperative tone in a meeting he attended with county and city officials from across the region last week. He also noted the uptick in public updates on their efforts.
“You see a much more robust and public-facing response to this,” Gloria said.
But 60-year-old Marie, a homeless woman who declined to provide her last name to Voice of San Diego, said she is still waiting to see if the improvements translate into aid for homeless San Diegans. She’s hoping for the best, but her faith is fading after multiple calls to the 2-1-1 information line.
Marie, who suffers from congestive heart failure and high blood pressure, said she has repeatedly called in hopes of being connected with a motel voucher or another housing resource to no avail. She fears contracting coronavirus.
“If there is assistance out there, it is hiding from the poor,” Marie said.