As health officials work to control a hepatitis outbreak in Southern California, Sacramento County and City officials are trying to get ahead of the crisis.
“We can learn from what happened in San Diego and take control measures that they enacted afterward and put them in place before,” said Dr. Runjhun Misra, an internal medicine specialist from Oakland.
After declaring an outbreak in San Diego County in April, health officials started distributing the vaccine to the homeless since they are the most at-risk because of poor hygiene and sanitary conditions. That outbreak has killed 17 and hospitalized 337.
Cases of the liver disease have inched north resulting in outbreaks in Los Angeles and Santa Cruz counties.
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On Sept. 20, Sacramento County health officials announced a prevention plan that included vaccination clinics for the homeless, healthcare providers and food service employees. Clinic dates and locations have yet to be determined, said county spokeswoman Samantha Mott on Thursday.
The California Department of Public Health said it received a request for 1,000 vaccines from Sacramento County, well below the number needed to immunize the 3,665 homeless people that were in Sacramento County as of July.
Hepatitis A is a liver disease that is most commonly spread when people do not wash their hands after using the bathroom and then contaminate food or other objects. To prevent further spread of the virus, San Diego installed portable hand-washing stations and portable restrooms.
Sacramento lacks bathroom access for the homeless in downtown and surrounding areas. The problem has been persistent and drew criticism from a United Nations envoy in 2012, who pointed out the “lack of access to adequate water and sanitation” in a letter to Mayor Kevin Johnson.
The only restroom in downtown is located in Cesar Chavez Plaza, but that facility, now owned by LaCosecha restaurant, was closed to the public because of vandalism and public health concerns. The bathrooms in nearby Old Sacramento are not open at night.
When the Central Library is open, the homeless frequent those restrooms. But when it’s closed, excrement and urine end up on the streets.
Seeking to prevent an outbreak of hepatitis A in Sacramento, Councilman Jeff Harris is exploring whether the city can expand its network of public restrooms and hire attendants tasked with keeping facilities clean and safe.
Harris said he will bring a “fairly evolved proposal” to the City Council in the next few weeks. He is investigating grants and state funding to help pay for restroom attendants. Attendants, possibly former felons, could be assigned to newly installed portable restrooms or in facilities at parks and libraries.
“This hep A outbreak in other parts of the state helps give us a wake-up call that we need public facilities, but we need them to be safe and clean,” Harris said. “And the only way I see that happening is with attendants.”
Harris spearheaded a city program last year that funded a portable “pit stop” bathroom in the industrial River District north of downtown, a neighborhood with a high homeless population. But the bathroom cost $173,000 for the six months it was in use, far exceeding the initial $100,000 budget and the bathroom was removed.
Now Harris is trying to come up with a cheaper alternative. He wants to propose a smaller portable bathroom that could fit in a parking space. Harris is not proposing a specific site, but said it makes sense to place the facilities “where there’s an aggregation of homeless.”
“The bottom line is I want to be able to walk from City Hall to Golden 1 Center and not smell feces and urine,” Harris said. “If people come downtown, they need a place to go to the restroom and not everybody can duck into a business place.”
Other West Coast cities have experimented with small restrooms in urban areas. The Portland Loo is a fixed restroom with a flush toilet that is open 24 hours a day. San Francisco has a network of restrooms on trailers that are monitored by paid attendants and include sinks and receptacles for used needles.
Councilman Steve Hansen, who represents downtown, recently asked city staff to conduct an analysis of the city’s stock of public restrooms.
“I think we’re trying to thoughtfully go through this,” Hansen said. “The biggest challenge we have is when we do open restrooms, they get destroyed. How do we design them in a way that they don’t get damaged? How do we maintain them? Where do we site them?”