Mayor Seeks Solutions To Hepatitis A Outbreak, Dismisses Blame

County Medical Chief "Surprised" Outbreak Didn't Happen Sooner

Friday, September 22, 2017
By KPBS News, Maureen Cavanaugh, Michael Lipkin
Photo by Andrew Bowen / KPBS
Above: San Diego Mayor Kevin Faulconer announces a plan to open up industrial tents as temporary shelters for the homeless, Sept. 13, 2017.

As the City of San Diego prepares to install 19 more handwashing stations and eight more public restrooms to tackle a hepatitis A outbreak that has killed 16 people and infected 444 countywide, Mayor Kevin Faulconer is saying the city’s response to the growing crisis has been immediate.

About half of those cases have occurred in the City of San Diego. The San Diego Union-Tribune reported Thursday that multiple grand jury reports have warned the city that more public bathrooms were needed downtown to avoid unsanitary conditions, but officials variously said the projects would be too costly, require additional security or that the suggestions deserved more study.

San Diego Mayor Kevin Faulconer said the city acted immediately when they recently put up handwashing stations and opened up more restrooms. He said he is not thinking about the past.

“It’s all about, we have a situation, we have a crisis. I'm not going to be looking backward,” he said. “We need to solve this and come together as a community, and that’s the message that we've been talking about."

San Diego County medical officials said there are many factors that play into the hepatitis A crisis, and there are other places in the country that are facing a similar challenge.

“I am frankly surprised that we did not have this happen sooner,” said San Diego County Chief Medical Officer Dr. Nick Yphantides. “So, you know, it is part of the reflection of the complexity of the environmental, biological factors that are at play in this situation.”

RELATED: Hundreds Vaccinated For Hepatitis A In Downtown San Diego In Effort To Curb Outbreak

Mayor Kevin Faulconer said the city's focus right now is vaccinating at-risk populations such as the homeless and illicit drug users. More than 250 people received shots against hepatitis A at a clinic in downtown San Diego Thursday. More than 22,000 people have been vaccinated in the county since the outbreak.

Mayor Faulconer and Dr. Yphantides joined KPBS Midday Edition’s Maureen Cavanaugh on Friday to discuss the city's response to the hepatitis A outbreak:

MC: Mr. Mayor, this week, you announced a new vaccination, sanitation and education program targeting the hepatitis A outbreak. What else do you think the city can do to try to stop this outbreak?

Faulconer: It is a partnership, Maureen. To be here with Dr. Nick, it is all about getting that word out, and you hit the nail on the head. Vaccination first and foremost primarily, and particularly and our message today has been very clear. On that at-risk population, which is primarily homeless and illicit drug users and so the more that we are vaccinating that group, which I said is our at-risk population, that has been our sole focus on not only the outreach that we had yesterday at city hall but the work that we are doing. The city and the county with our public health nurses, with our homeless outreach team, going out to the streets, going the canyons to get those people that need the vaccination the most, to get them vaccinated. That is incredibly important. And at the same time, getting the word out. If you are a healthy adult in San Diego, we want you washing your hands. Warm soap and water, as Dr. Nick has said over and over and over. And then taking additional steps obviously, in some of our at-risk areas, sanitation street power washing, hand stations. We just left a SANDAG meeting, Dr. Nick and I. This outbreak that started in El Cajon is in virtually every city in the county — most acute, in part of San Diego. So, it is a collective effort on education, but most importantly stressing that vaccination to that at-risk group: homeless and illicit drug users.

MC: You know Dr. Nick, San Diego City staff said yesterday that more hand washing stations are set to go up today. There are plans for eight more public bathrooms in the city on Monday. What are your estimates for how many more of these need to be installed?

Yphantides: This is an unprecedented situation, so we do not have the reference point of anybody else who has gone through this kind of a thing of being able to say here is the specific X, Y, Z number. What we are doing is a very comprehensive scientific approach of mapping where are the individuals, and as the basis of where those individuals are, then making sure that they have access to the hand washing and toiletry that they need. So, I cannot today, Maureen, give you a specific number. But, I can give you a commitment that that evaluation is ongoing both at the city and county level. And again, to echo Mayor Faulconer’s comments, while so much of the attention is in downtown San Diego, we are dealing with these issues throughout our region.

MC: Now Mayor Faulconer, you announced last week that you will be setting up three large tent shelters in the near future including showers, bathrooms, and security. This was an idea that was pushed by business leaders Peter Seidler and Dan Shea for Months. And they are donating $1.5 million for the project. What is the role of San Diego’s business community in helping address this outbreak?

Faulconer: It has been a great partnership. And I am glad you mentioned Peter Seidler and Dan Shea. And in fact working closely with them. First, looking for an indoor facility, as I said when we announced this, you are never going to find the perfect location. You might have seen in the newspaper today some pushback on the sites we did announce. And I said, we have to do this. We have to get people off the streets into a secure, sanitary environment, where they can get the services they need, the wrap around service, often times, mental health and substance abuse. So, yes we are moving forward on a significant presence with three different locations: one down on 16th and Newton, one at St. Vincent DePaul, one out in the Midway District, primarily focused on our veteran population. But, you know, we are looking right now close to 700 and probably more as we add people who are going to be able to get off the streets in these. And to see, Maureen, to see the commitment from the business community saying, "look the government can do their part, needs to do their part." But, to see local business leaders saying we are going to help too, I am hoping that this is going to grow because the challenge is so big and I cannot say enough about, as I said before, Peter Seidler and Dan Shea, that is the type of leadership that we want in the business community, that I am fostering, that says: We are all in this together. This is our city, these are our neighbors, and let’s take the right action.

MC: Mayor Faulconer, what about the critique from councilman David Alvarez and others that three months until December, that is when the first tent is going to open, is too long to wait to get these tents up? And some other sanitary shelter options should be found?

Faulconer: Well you know I am not spending my time listening to critique’s, Maureen. Especially from some folks like that, who have not been very helpful when it comes to homeless issues. And you read some of that today. We are looking forward on what do we need to do now, to get people off the street now.

MC:< Right, so now, not in December. What are you looking at?

Faulconer: So part of one of the things we are looking at is safe zones. Where we are going to encourage folks to get off the street, you know, in addition to the shelters we have. But, also, it is important to note, St. Vincent DePaul’s, Alpha Projects, we are driving folks into some of those beds now because they do have some capacity. And part of our message is we have some spots, we want to use them. But, we also need and why we are moving forward on the tents in the sprung structures the need is so much greater. And so as you will hear more, we are going to move forward on some of these safer zones that I think is going to be a big help, but again, the determination, the commitment, I should say, not the determination, is we need to get people off the street in bigger numbers.

MC: Mayor do you think this outbreak was either preventable or foreseeable? Four grand jury reports warned city leaders that more public restrooms were needed downtown. One report explicitly warned that an outbreak of illness caused by such unsanitary conditions could resort in liability to this city.

Faulconer: I will tell you this. Anytime we are doing homeless services, you are always going to get pushback from people. And the fact that we have said: no, we are acting immediately on the hand washing stations, the restrooms that we have put in, opening up the restrooms that we have had. Like I said, some that are now 24/7. It is all about, we have a situation, a crisis, I am not going to be looking backward. We need to solve this and come together as a community and that is the message that we have been talking about. I will leave it to Dr. Nick as to the genesis and the origins.

Yphantides: Yeah, you know, based on the long incubation period and so forth, I will just answer tightly that there is an unprecedented challenge that we are facing here, and there are biological reasons that it took several months for us to be able to track when this started, and so on and so forth. With confidence that we were on top of it in monitoring things as we always do. Hepatitis A constantly occurs, but most of the cases historically were from people coming from outside of the country. Whether or not this could have been prevented, again in hindsight I think there are so many factors that go into this and so many places in our country that are facing similar challenges that we have had. To be honest with you Maureen and some other outlets and contexts that I have had this question asked, I am frankly surprised that we didn't have this happen sooner. So, you know, it is part of the reflection of the complexity of the environmental, biological factors that are at play in this situation.

MC: Mr. Mayor I know you are in the heart of this right now and your concern is to stop this outbreak. But I wonder if some conversations have been going down in city hall about what liability the city might have for the people who contracted this disease and the people’s families who died?

Faulconer: I can say unequivocally, our conversations are all about how we can get people the help that they need right now. Not looking backward. Bringing everybody together in an unprecedented fashion. The city, the county, our medical professionals at the county, and from our standpoint, our team. We had AMR, our fire rescue out there yesterday on vaccinations. The whole team was doing it on sanitation. This is an all hands on deck effort, Maureen, and rightfully so. Because as I mentioned at the beginning, this is our community, this is our county, these are our people, and we need to take care of each other and make sure we are getting people the support and the services that they need. And as mayor, that is my sole focus, one hundred percent sole focus right now.

MC: Mayor Faulconer, I know that you do not want to look back and that you are in the middle of this crisis right now, but just humor me for a moment if you would. Homeless advocate said at the time that San Diego’s decision to close emergency tent shelters would not work because there weren’t enough permanent beds for the homeless. When those emergency tents were permanently closed, we began to see a dramatic increase in the number of people living on the streets. Homeless advocates were screaming about this. Do you see that now as one of the reasons for this hepatitis A outbreak?

Faulconer: And we are not looking back, Maureen. You know, when we went to the permanent indoor shelter, was that a better idea than the six-month winter shelter? Absolutely. Because the idea was let’s get more people the beds and the services, not just for a couple of months during the winter, but year round. What we have clearly seen is that as that need grows, we need to do more. And as you and I have talked about absolutely, when you look at long-term, we need permanent supportive housing. I mean, that cuts across all of this and so on the backend of that, we could talk a lot on obviously the things we are trying to do to get that and have those permanent income streams. That is incredibly important, and so the shelters that we are going to move forward because we need to. That is incredibly going to be helpful. But, ultimately, we need permanent supportive housing to get people not just off the street for a few months, but to transition. But I will tell you, talking with good folks like Bob McElroy of Alpha Project, who has done this, and once you get people into the shelter environment, then you are able to transition them. And that is what we want. We want you to be safe; we want you to be healthy. We want you to get back into the work environment and give them the support that they need. That is what San Diego is all about and that is why this is all hands on deck. To not only just tackle this for the foreseeable next months, but longer term as well. And one of the reasons, for example, why I felt so strongly, as you know, we have talked before, the measure to not only expand our convention center, but to raise those dollars for a permanent supportive, for homeless funds that we don’t have at the city. We don’t have a dedicated fund. The city council chose to put that off. I think that was the wrong decision. But, we will get it on because we need dedicated homeless funding and that is something that I feel very, very passionately about.

MC: I have been speaking with San Diego Mayor Kevin Faulconer and with San Diego County Chief Medical Officer Dr. Nick Yphantides. Thank you Gentleman.

Faulconer: Thank you, Maureen.

Yphantides: Thank you.