Hepatitis deaths grow by one as cases continue to rise
The death toll in San Diego’s hepatitis A outbreak increased by one Tuesday, and the region’s top public health official said she has not seen any signs yet of a slowdown in the public health emergency that has now killed 17 people.

The death toll in San Diego’s hepatitis A outbreak increased by one Tuesday, and the region’s top public health official said she has not seen any signs yet of a slowdown in the public health emergency that has now killed 17 people.

Dr. Wilma Wooten said there are currently 49 suspected hepatitis cases and one death still under investigation. That number sat at 44 one week ago and has bounced around from roughly 30 to 50 cases under investigation at any given time for several months, public health officials have said.

“Until the numbers start dropping, we won’t have a clear indication of whether we have turned the corner or not,” Wooten said after making a presentation to the county Board of Supervisors.

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She said the total case count in the current outbreak jumped to 461 Tuesday with 315 hospitalizations since November and 17 deaths. That’s one more death, 17 more cases and 10 more hospitalizations than a week ago.

Labs at the U.S. Centers for Disease Control and Prevention in Atlanta have confirmed current case counts, and Wooten said her office is still waiting for word from the CDC that an 18th death was caused by one of the 1B hepatitis strains responsible for outbreak cases in San Diego and several other California communities.

The CDC sent two of its workers to San Diego for a three-week period after the health department requested assistance in May. Dr. Nick Yphantides, the health department’s medical director, said the CDC will send representatives to San Diego next week for a planning meeting with local public health staffers.

San Diego County saw a major uptick in hepatitis A vaccinations since Yphantides led a group of local government and health care workers who stood together one week ago to announce a public education campaign, encouraging vaccinations for at-risk groups, frequent hand-washing and other hygiene and sanitation efforts.

In less than one week the number of vaccinations provided throughout the region jumped from nearly 23,000 to more than 42,000, Wooten said Tuesday.

Given that the county’s homeless population was estimated to be about 9,100 in the annual January count, some might think that the vaccination work is finished. But Wooten said there is more to do. She said that the number estimated to have “unstable” living circumstances is about 25,000.

“They might be living on somebody’s couch today, but they’re on the streets tomorrow,” Wooten said.

Illicit drug users are another major cohort of the hepatitis A cases confirmed so far. Wooten said that this population, across all types of drugs, is estimated to be 400,000 countywide. If half of those are already immune, that would leave about 200,000 who could benefit from immunization. So, while 42,000 vaccinations looks like a lot, that number, Wooten said, is probably far from what’s necessary to reach a large percentage of those who are most at risk.

During Tuesday’s meeting, Supervisor Kristin Gaspar wondered about the roughly 25 percent of cases who are not homeless and don’t use illicit drugs.

While these folks may not be in one or both of these high-risk groups themselves, the county has said that many have links to people who are in those high-risk categories. Gaspar asked for more information on precisely how many of the 461 cases occurred among the general population with no link to a high-risk group.

She said knowing that number could go a long way toward easing the fears of the larger community, especially businesses.

“I know that there is a heightened level of concern which trickled down and has impacts on our small business community, our local restaurants, for example, people that might be considering traveling to San Diego,” Gaspar said. “We want people to be informed, but we don’t want people walking around fearful to touch a doorknob.”

Wooten said she did not have a precise breakdown of that 25 percent available Tuesday morning but said the county, with the assistance of the CDC, is working on answering the question.

“We do know that a significant number of that group has had relationships with or worked or had some association with the at-risk groups. But a significant number have not. Staff and the CDC … will be working over the coming weeks to try to characterize any relationships or demographics of that group,” Wooten said.

Meanwhile, the city of San Diego has been busy on the sanitation front. Four portable restrooms went in at Tailgate Park. Located downtown at 14th and L streets, the facilities will be disinfected twice per day and will be monitored by full-time security. The addition brings the total number of downtown restrooms accessible to the homeless to 22, about half of which are open 24 hours a day.

Dozens of hand-washing stations have been installed around San Diego’s urban core and Wooten said work is underway to install more stations in outlying communities.

There were also fresh maneuvers Tuesday on the political front.

In a move to step up pressure on the mayor’s office to address homelessness and the hepatitis A outbreak, four City Council members released a memo Tuesday pushing for a ballot measure focused exclusively on addressing the homeless crisis and the need for affordable housing.

In the meantime, the council members said that Mayor Kevin Faulconer should redirect the $5 million that had previously been allocated in the city budget for a special election to “accelerate the citywide efforts to combat homelessness.”

The statement was signed by Council President Myrtle Cole and members David Alvarez, Barbara Bry and Georgette Gomez, all Democrats.

Their memo comes amid ongoing efforts by a coalition of tourism and civic leaders to get a citizens initiative on the June 2018 ballot that would raise the hotel tax to fund a convention center expansion, expand homeless services and fund road repairs. Some homeless advocates have opposed the effort, arguing that the homeless crisis deserves a ballot measure of its own. So far, no firm measure has been released.

“The position of the four of us is that if we’re going to put anything forward, it should be focused on homelessness and an affordable housing component that keeps people from becoming homeless,” Alvarez said. “The message we’re sending is we’re not interested in holding the homeless hostage to try and pursue other initiatives and another agenda.”

Councilwoman Bry said that, unlike the homeless crisis, expanding the convention center is not an emergency.

“If they were to collect enough signatures for something that focuses on the convention center expansion, my only decision would be what ballot it would go on. And I would vote to put it on the November 2018 ballot,” she said

Craig Gustafson, the mayor’s spokesman, did not address the notion that the homeless issue should be separated from convention center expansion and road repairs, focusing instead on what Faulconer’s proposal would do for the homeless if the council supported it.

“Earlier this year the Mayor proposed a ballot measure to create the first-ever dedicated funding stream for homeless services and affordable housing in the city’s history,” Gustafson said in an email. “It’s unfortunate the Council majority chose to delay the Mayor’s plan for homeless funding until next year, but he remains committed to working with the Council to take meaningful action to reduce homelessness.”

Staff writers Lori Weisberg and David Garrick contributed to this report.

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