How San Diego Ignored Lessons from Hepatitis Outbreak & Set Itself Up for a Public Health Disaster.

By Timothy P. Holmberg

If you are looking in the right direction, it is easy to notice a tsunami before it arrives. But, if you are like San Diego’s political leadership, your head will turn just in time to see it hit, but likely too late to do much but run.

For months now, headlines have dominated about an approaching Corona Virus pandemic (let’s not mince technicalities, and call it what it is).

Within the last week, we have received news that despite China’s valiant, if not misguided containment efforts, the Corona Virus (COVID-19) has reached American shores.

As we have all been rushing to local stores to buy whatever face masks and gloves that have not sold out, genuine preparation has been belated and scant.

We now know that due to fumbles and censorship at the Federal level, the virus has likely gotten a six week head start on any efforts we might take to prepare. Apparently, sharpies can redirect the path of a hurricane, but do little to affect the direction of a pandemic (who knew).

Locally, one vulnerable population has gone virtually unnoticed in our preparation efforts – the homeless.

It is hardly news on its face that the homeless have been neglected. As a nation, until recently, our main method of interdicting homelessness has been practiced ignorance. But as homeless populations have blossomed in urban areas and across the country, there at least is attention, if not always effective policy. In part, that is because homelessness is viewed more as a cause than a symptom.

As COVID-19 reveals itself like a runaway “where is Waldo game”, the panic button is only now being pressed on behalf of perhaps the single most vulnerable population. While this blind spot could be somewhat forgivable (not really) in other regions, San Diego is particularly without a valid excuse.

In 2018, the city distinguished itself nationally with the worst hepatitis outbreak in recent history. At its conclusion, 20 people were dead, and nearly 600 infected. The outbreak, unsurprisingly, originated in the large and neglected homeless population that had ballooned since the Great Recession.

Among those factors that contributed to the outbreak, most were easily identifiable (and wholly preventable) circumstances:

Lack of sanitary restrooms. Exposure. Lack of laundry or bathing facility. Inadequate access to healthcare and other resources. Highly concentrated populations in close proximity to each other. Inadequate nutrition.

San Diego’s response at that time could hardly be called swift, nor coordinated. Business districts began steam cleaning sidewalks to remove urine and excrement. Police were deployed to confiscate belongings and cite the homeless for being . . homeless. Expensive tent cities were erected to show “decisive action” that ultimately drained resources from other programs.

They also netted no significant decline in the homeless population. The most recent count showed a barely measurable decline, and only after ramped up police sweeps that likely (and perhaps intentionally) skewed the count.

In total, the response amounted to various groups and agencies making themselves look busy. But as COVID-19 approaches, the reality remains that nearly every circumstance that contributed to the hepatitis outbreak, largely remains an open invitation to a much more deadly threat.

In fact, what little has been done, may actually further enable the spread of the Corona Virus. Group feedings and communal close quarters shelters will allow the virus to tear through the homeless population like no disease has in modern history.

The cruel irony is that San Diego may see its most substantial reduction in homeless population in a century, but not for reasons that anyone will want to take credit or responsibility for.

Awareness of a potential disaster in the making is finally setting in. The San Diego County Regional Taskforce on the Homeless (RTFH) is set to hold an emergency meeting on Wednesday, March 11th. But even this action is demonstrating the organizational challenges that San Diego faces.

The meeting is currently planned to be closed to the public, exactly the opposite of what would appear to be needed.

It also represents the disjointed nature of San Diego’s homeless response. A range of nonprofit and governmental agencies are seated on the task force, many with overlap, and varying levels of effectiveness. Turf wars and internecine squabble remain an obstacle to the kind of genuine coordination that will be needed to mount an effective response. Glaringly underrepresented on the 30 plus member board, are people with lived homeless experience.

So why has so little been achieved since the last major disease outbreak in the homeless community?

The culprits are varied, but easy to guess. Some of it can be chalked up to ineffective leadership, certainly. But underneath that lay a reality common to many regions with large and building homeless populations. A particular brand of public response that varies from NIMBY-istic to paternalistic, and a decidedly arms-length empathy.

In a democracy, political will is the indispensable and key ingredient for governmental policy. While it is easy (and valid) to criticize politicians for failing to lead, many of the best intentioned ones are paralyzed to take action for fear of substantial public uprising.

Where will the shelters and safe parking lots be located? Where will the money come from? Questions like these have stymied an effective response to a gargantuan and growing problem, and likely will similarly inhibit an effective response to the looming Corona Virus threat. What communities often fail to recognize is that neglect and inaction have consequences of their own. Ones only now being considered.

Already crowded emergency rooms will be overwhelmed much as they were in China. More than that, the failure to address the threat of this disease to the homeless will only enable its ability to spread in the broader population.

Much like HIV, this new virus will point up a lesson we should have learned in the 1980’s – ignorance and indifference has its costs. And we likely have little conception of the true scope of where this might go.

As a developed nation, we like to think that we are somewhat immune to the worst outcomes of a pandemic. We have robust technology and research capability, and a well developed hospital system. But we are also a region and indeed a nation that has a host of interconnected and neglected problems.

The coming disease will prey on them.

Diseases feed on inequality and economic deprivation, and we certainly have that in spades.

As politicians debate the nuances of socialism versus capitalism in healthcare, the Corona Virus will provide real life reminders that these discussions are not esoterica. They are real, and the consequences as serious as any public policy we might undertake.

The homeless are among legions of canaries from many of our societies most neglected mines. They have for some time now been trying to send us a message of impending dangers that our own individual comforts have hidden from view.

We are now likely to get the most tragic and unavoidable reminder that despair left untreated has consequences for us all.

Timothy P. Holmberg Owns Taste of Salt Vintage Yacht Excursions

Lead Image via Pixabay

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