San Diego’s nearly year-old Hepatitis outbreak is getting worse, forcing the Southern California port city to take extreme measures, including sanitary street washing in the downtown area, according to Mayor Kevin Faulconer’s office on Friday.

The sanitary street washing will start next week, and is only the latest effort to combat the deadly outbreak of the highly contagious liver disease that has infected over 400 people in the past year, killing 15. The drastic measure by the city is in response to a letter from the county—who declared the situation a public health emergency last Wednesday—giving the city 5 days to respond with a plan to address the crisis.

According to the San Jose Mercury News,

The situation is grave: since November 2016, the outbreak has infected hundreds of people and left 15 dead; the crisis appears to be hitting the city’s homeless the hardest. According to the San Diego Health & Human Services Agency (HHSA), as of Sept. 5, 2017, the current outbreak has infected 398 people and caused 279 hospitalizations. The San Diego HHSA noted that most of the people infected with the disease are either homeless or drug users, and that the outbreak is being spread between people through contact with a “fecally contaminated environment.” That essentially means that the new victim is usually an unvaccinated person who ingests food or water, touches an object, or uses drugs contaminated with fecal matter from an infected person.

The outbreak has worsened in part because of a dramatic increase in the population of those homeless and living on streets who lack access to restrooms or showers.

Mercury News reports that “San Diego’s homeless population has been skyrocketing: while the number of homeless people across the county increased 5 percent in the past year, according to the Regional Task Force on the Homeless, those living on the streets of downtown San Diego spiked 27 percent.”

The San Diego Tribune notes that:

In addition to regularly pressure-washing dirty city right-of-ways with chlorinated water, the county also asked the city to “immediately expand access to public restrooms and wash stations within the city limits that are adjacent to at-risk populations.” The mayor’s office provided no additional information on public restroom access except a three-page list of existing facilities, some of which are open 24 hours a day.

Homeless advocates like Anne Rios, the director of Think Dignity, which provides mobile showers and other services for the homeless at six locations in the county doesn’t think it’s enough. “Unless they’re going to power wash them every day, this isn’t going to solve the problem,” she told the Tribune.

What’s needed, Rios says, is proper maintenance at the public facilities that already exist, and more need to be provided. The county already installed 40 more hand-washing stations in areas where the homeless camp and a city spokesman says they plan to do even more in the coming weeks.

County officials are not satisfied with the progress, and the pressure to do more will likely continue until the outbreaks show signs of abating.

“In hindsight you can always say, ‘Could we do more?’” said Greg Cox, a San Diego County supervisor, [according to the New York Times]. “I’m not happy that it took so long to get the hand-washing stations out there. But the real key — the best prevention — is going to be the vaccinations.”

Tim Donnelly is a former California State Assemblyman and Author, currently on a book tour for his new book: Patriot Not Politician: Win or Go Homeless. He also ran for governor in 2014.

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