Medieval Diseases Are Infecting California’s Homeless

Jennifer Millar keeps trash bags and hand sanitizer near her tent, and she regularly pours water mixed with hydrogen peroxide on the sidewalk nearby. Keeping herself and the patch of concrete she calls home clean is a top priority.

But this homeless encampment off a Hollywood freeway ramp is often littered with needles and trash and soaked in urine. Rats occasionally scamper through, and Millar fears the consequences.

“I worry about all those diseases,” said Millar, 43, who has been homeless most of her life.

Infectious diseases—some that ravaged populations in the Middle Ages—are resurging in California and around the country, and are hitting homeless populations especially hard.

Los Angeles recently experienced an outbreak of typhus—a disease spread by infected fleas on rats and other animals—in downtown streets. Officials briefly closed part of City Hall after reporting that rodents had invaded the building.

People in Washington State have been infected with the diarrheal disease shigella, spread through feces, as well as Bartonella quintana, or trench fever, which spreads through body lice.

Hepatitis A, also spread primarily through feces, infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio, and Kentucky, primarily among people who are homeless or use drugs.

Public-health officials and politicians are using terms like disaster and public-health crisis to describe the outbreaks, and they are warning that these diseases can easily jump beyond the homeless population.

The infections are not a surprise, given the lack of attention to housing and health care for the homeless and the dearth of bathrooms and places to wash hands, says Jeffrey Duchin, the health officer for Seattle and King County, Washington, which has seen shigella, trench fever, and skin infections among homeless populations.

“It’s a public-health disaster,” Duchin says.

New York City, where the majority of the homeless population lives in shelters rather than on the streets, has not experienced the same outbreaks of hepatitis A and typhus, says Kelly Duran, an emergency-medicine physician and assistant professor at New York University. But Duran says different infections occur in shelters, including tuberculosis, a disease that spreads through the air and typically infects the lungs.

The diseases sometimes get the “medieval” moniker because people in that era lived in squalid conditions without clean water or sewage treatment, says Jeffrey Klausner, a professor of medicine and public health at UCLA.

People living on the streets or in homeless shelters are vulnerable to such outbreaks because their weakened immune systems are worsened by stress, malnutrition, and sleep deprivation. Many also have mental illness and substance-abuse disorders, which can make it harder for them to stay healthy or get health care.

On one recent February afternoon, the Saban Community Clinic physician assistant Negeen Farmand walked through homeless encampments in Hollywood carrying a backpack with medical supplies. She stopped to talk to a man sweeping the sidewalks. He said he sees “everything and anything” in the gutters and hopes he doesn’t get sick.

She introduced herself to a few others and asked if they had any health issues that needed checking. When she saw Millar, Farmand checked her blood pressure, asked about her asthma, and urged her to come see a doctor for treatment of her hepatitis C, a viral infection spread through contaminated blood that can lead to serious liver damage.

“To get these people to come into a clinic is a big thing,” she said. “A lot of them are distrustful of the health-care system.”

On another day, 53-year-old Karen Mitchell waited to get treated for a persistent cough by St. John’s Well Child & Family Center’s mobile health clinic. She also needed a tuberculosis test, as required by the shelter where she was living in Bellflower, California.

Mitchell, who said she developed alcoholism after a career in pharmaceutical sales, said she has contracted pneumonia from germs from other shelter residents. “Everyone is always sick, no matter what precautions they take.”

During the hepatitis-A outbreak, public-health officials administered widespread vaccinations, cleaned the streets with bleach and water, and installed hand-washing stations and bathrooms near high concentrations of homeless people.

But health officials and homeless advocates said more needs to be done, including helping people access medical and behavioral health care and affordable housing.

“It really is unconscionable,” says Bobby Watts, the CEO of the National Health Care for the Homeless Council, a policy and advocacy organization. “These are all preventable diseases.”


This post appears courtesy of  Kaiser Health News.

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