October 16th, 2017

Hepatitis A outbreak in San Diego: when the excrement hits the pavement

There’s a hepatitis A outbreak in San Diego, and this article was the first one I read about it. It seems to tap-dance around directly stating what has caused the problem, but it’s not all that difficult to figure it out [emphasis mine]:

At least 481 people have been infected and 17 have died of the infection since November in San Diego. Eight-eight other cases have been identified in Santa Cruz and Los Angeles counties, where hepatitis A outbreaks have been declared.

Officials throughout the state are now rushing to vaccinate homeless populations, which are considered the most at risk

Dr. Janet Haas, president-elect of the Association for Professionals in Infection Control and Epidemiology, said the outbreak is unusual for the U.S. because the spread of the liver infection has been blamed on a lack of basic hygiene and sanitation, not contaminated food…

“It’s not like there’s never been a hepatitis A outbreak before. … We know what’s worked in the past. Usually that contains it and the story ends,” Haas said. “But sometimes it doesn’t work, or circumstances are different and you have to ramp it up.”…

In San Diego, where nearly 85 percent of all confirmed cases are located, cleaning crews are hitting the streets, attacking them with high-pressure water mixed with bleach to sanitize any surfaces contaminated with feces, blood or other body fluids.

A private company was hired in September to deliver portable hand-washing stations in places where homeless residents tend to congregate.

Despite those efforts, the disease is spreading and many are asking what could have been done and what will effectively prevent future transmission…

County health officials have been hesitant to release any additional information about where the cases are specifically concentrated, citing state and federal health privacy laws.

In other words, it’s hard to escape the conclusion that this outbreak has been caused by homeless people defecating in the streets.

Is San Diego anything like the far more leftist Seattle, where cleaning human poop off the sidewalk with a power hose is considered insufficiently sensitive? And New York City has recently ended criminal prosecutions for public urinating (which is nowhere near the health hazard of public defecating).

HuffPo is quite direct about the San Diego problem and the fact that public human defecation has caused it. But it’s not as simple as blaming the homeless, because the volume of homeless people in San Diego (and certain other cities) has grown with the rise in housing costs and the lack of low-income housing. In addition, San Diego has remarkably few public restrooms:

In 2015, San Diego had just three city restroom facilities open round the clock, the San Diego County grand jury that investigates government operations reported. San Francisco had 25. San Diego had spent more than a decade trying to solve the problem, but funding difficulties, lack of support from businesses and concerns that additional facilities would attract more homeless people downtown have stood in the way, the grand jury noted.

Last week, as the crisis expanded, the city was making 14 public bathrooms accessible 24/7, and the mayor’s office said the city is hoping to install more. City officials plan to open three new temporary tented shelters with restroom facilities and other services, they announced Wednesday. At least 30 hand-washing stations have also been installed around the city, with the option to add more.

There are a lot of problems that come together here: the lack of affordable housing, the pleasant year-round climate that makes many areas of California a magnet for street people, the lack of public bathrooms, the refusal of many homeless people to go to shelters, the marginal mental status of no small number of homeless people (my guess is that this sub-population may be the one doing the bulk of the public defecating) either through chronic mental illness or drugs, and city governments that haven’t dealt with the problem adequately either because it’s not easy to solve or because they lack the political will (or both).

And why so few public bathrooms in San Diego? Lest you think it’s a simple problem with a simple solution—such as “build more of them”— please read this from 2015, before the current hepatitis outbreak:

…Portland Loo…[is] a prefabricated public restroom that’s been popping up from Seattle to Cincinnati to Montreal. The loos have real toilets and running water, and are better ventilated than port-a-potties.

But they’re controversial. The toilets turned out to be much pricier than expected, and some people complain that they could attract illicit activity – prostitution or drug use…

Portland Loos are designed to ease the daunting task of keeping a public restroom safe and clean. They can be power-washed and have slits along the bottom to make it clear if there’s somebody inside. They cost about $100,000 each, but that doesn’t include the connection to sewer lines, which is where some cities stumble.

San Diego spent more than half a million dollars installing its two loos — double the initial price tag. Now, due to more costs and residents’ complaints, it’s planning to remove one and put it in storage. A nearby homeless shelter will open its bathrooms around the clock instead…

“The homeless population is up in this area since the Portland Loo was installed,” says Jon Wantz, who runs a restaurant a few blocks away from one. “The increased activity, whether it be criminal or drug-related, or just transient-related in general, it’s not good for business.”

“Affording individuals the ability to use a private and safe space to utilize the restroom is basic dignity,” counters Heather Pollock, executive director of Girls Think Tank, a San Diego homeless advocacy nonprofit. A restroom isn’t truly public, she says, unless everyone can use it — and many people aren’t allowed in the restrooms inside stores and restaurants.

“If I walked in and was holding all of my belongings, or I hadn’t showered in a few days, there’s a very high likelihood that I would not be able to utilize that,” she says.

What a mess. Literally.

[NOTE: It is estimated that about 12% of the world’s population defecates outdoors, mostly in rural areas (where it tends not to cause as many problems) but also in many urban areas in third-world countries such as India.]

25 Responses to “Hepatitis A outbreak in San Diego: when the excrement hits the pavement”

  1. huxley Says:

    In San Francisco the subway escalators regularly stop working and have to be repaired because of human waste.


  2. vanderleun Says:

    ON the other hand, California continues on the cutting edge of legislation with this move.

    Gov. Jerry Brown signed a bill Friday that lowers from a felony to a misdemeanor the crime of knowingly exposing a sexual partner to HIV without disclosing the infection.

    The measure also applies to those who give blood without telling the blood bank that they are HIV-positive.


  3. Cornflour Says:

    Last August, Alex Tabarrok, at the blog “Marginal Revolution,” wrote a review of a book on pooping outside in India (https://tinyurl.com/y9qkcpqp). The book, by Diane Coffey and Dean Spears, is entitled “Where India Goes,” and Tabarrok calls it the best social science book he’s read in years.

    Many of the issues in India are different, but analogous, to those that we have with outdoor poopers in west-coast cities. I thought that was interesting. To think that pooping has become a multicultural study … if only I were young again and searching for a fertile research topic.

    Here are a couple of passages from the review:

    “Drawing on the academic literature, Coffey and Spears show that open defecation sickens and kills children, stunts their growth, and lowers their IQ all of which shows up in reduced productivity and wages in adulthood.”

    “In the villages the idea of open defecation is also associated with clean air, exercise, and health. Thus, in surveys ‘both men and women speak openly about the benefits of open defecation and even associate it with health and longevity.’ Even many women prefer open defecation if only because it gives them a chance to get out of the house and have some freedom of movement.”

  4. Oldflyer Says:

    When does civilization cease to be civilized?

    I suspect that permanent, or semi-permanent housing for the homeless could be in ample supply, but that the homeless would shun it. And homeless rights activists would rally for their right to turn public places into the equivalent of stys.

  5. John Guilfoyle Says:

    “The Big Beautiful Wall” needs to be between California & the rest of us…on both sides.

    Then it will look like a giant elongated toilet…and it’s fast approaching that anyway.

  6. Ymar Sakar Says:

    Here comes the plagues, as a warning.

    Israel, the 12 tribes, often had diseases and famines as a warning that they were in legal problems with divine laws.

  7. Ymar Sakar Says:

    The Left doesn’t have to kill you all in a civil war using guns and execution squads.

    They can summon in a spirit like Lucifer kun or another Watcher class elohim entity, and the diseases alone will kill you all off. See, everybody wins.

  8. huxley Says:

    Several years ago I ran into a health comparison of India and Pakistan.

    Somewhat to my surprise Pakistan did better than India and it boiled down to the Islamic vs Hindu strictures on outdoor defecation.

  9. parker Says:

    We need to bring back poor farms.

  10. Frog Says:

    Why do we have to keep re-discovering history?

    The vast majority of the so-called “Homeless” are psychotics, alcoholics, drug addicts or some combination thereof. They are NOT healthy people who just got evicted because their rents went up.

    The crazies have the civil rights to refuse medication, the addicts are necessarily engaged in illegal behavior, and the drunks are the irremediable drunks who have refused to seek help for their powerlessness in the face of booze. All have the bizarre ‘right’ to harm and kill themselves while engaging in gross and uncivilized conduct at great cost (e.g., Hep A) to the rest of us.

    This all has its roots in the good old 1960s when shrinks like Thomas Szasz, who wrote in 1961 a work entitled “The Myth of Mental Illness”, shook psychiatry to its roots, especially with the concurrent emergence of first generation anti-psychotic drugs like Thorazine. Mental hospitals and involuntary incarceration for the crazies soon ceased to exist, replaced by sidewalks. And eventually, Community Mental Health Centers, for ambulatory care only, nothing comprehensive like incarceration in a mental hospital with food, clothing, shelter, nurses and docs and medicines.

  11. J.J. Says:

    12 years ago Seattle launched a plan to end homelessness. How did that work? Not well. The homeless problem has only grown much larger. Maybe 30% of the homeless can be returned to being self sufficient. Most will never make that change. Why? They are mentally ill and/or addicted. Nearly every day in Seattle I read of homeless people who die of overdoses, knifings/shootings, and accidents.

    The Seattle policy was to offer more shelter and a chance to clean up. The shelter was accepted, the second/third/fourth chance was not. The open, friendly policy attracted more homeless people. The new Seattle policy is now not to end homelessness, but to make it “rare and brief.” Yet they have not changed their policies. My guess is that the problem is going to continue to grow.

    No hepatitis reported in Seattle…..yet. Maybe our frequent rains help. Most of the homeless encampments are no go areas for normal citizens. Only social workers accompanied by cops go into these pitiful areas.

    It breaks my heart to see these poor humans who are adrift on a sea of liberal good will and misguided ideas that only make their situations worse. Institutionalization isn’t great but that is where most of these people would be better off – at least safe and warm with toilet facilities. And society would be better off as well. But no liberal city would contemplate that.

  12. AesopFan Says:

    J.J. Says:
    October 16th, 2017 at 11:09 pm

    It breaks my heart to see these poor humans who are adrift on a sea of liberal good will and misguided ideas that only make their situations worse. Institutionalization isn’t great but that is where most of these people would be better off – at least safe and warm with toilet facilities. And society would be better off as well. But no liberal city would contemplate that.
    * * *
    One of several political subjects where GWB was never given sufficient credit* was his direction to build housing for the homeless without any “clean act” provisions; just get them inside. This indicates the success of much of your suggestions – but very few MSM outlets publicized it because, Bush was Hitler donchaknow.


    “The “housing first” strategy gets much of the credit for a 30 percent decline in U.S. chronic homelessness from 2005 to 2007. The number fell from 176,000 to 124,000 people, according to the best available census of street people.

    The chronically homeless, estimated to be between a fifth and a tenth of the total, are the hardest group of street people to help. A chronically homeless person is someone with a disabling condition who’s been continuously homeless for a year or more or for four or more episodes in three years.

    If a “housing first” strategy seems absurdly generous to them, it’s proved to be crazy like a fox for many of the more than 200 U.S. cities that have adopted the approach.

    The earliest adapters, including Denver, Miami, New York, Philadelphia, Portland, Ore., and San Francisco, found that the added cost of homes and support services for the chronically homeless wasn’t burdensome. In fact, it was largely or entirely offset by reduced demands on shelters, emergency rooms, mental hospitals, detox centers, jails and courts.

    Instead of shuttling between them, chronically homeless people “are staying housed and starting to look for employment,” said Nan Roman, the president of the National Alliance to End Homelessness, the leading advocates of the approach. “A lot are reconnecting with their families.”

    Just being off the street is healthy, said Sheila Crowley, the president of the National Low-Income Housing Coalition. “Even if they continue to drink, they’re eating better, sleeping better and interacting with people better.”

    For the chronically homeless, the life change is sudden and profound.”
    — see, Conservatives really can be compassionate, and in deeds, not just in words like Progressives (I never did understand the complaints against Bush’s “compassionate conservative” meme, other than that the Left used it as a hammer — like they would with anything else uttered by Republicans — cf “binders of women”).

    *Another two were AIDS treatment (especially in Africa) and Green Living (the Crawford Ranch was more environmentally “progressive” than Gore’s Mansion).

  13. AesopFan Says:

    Credit where it’s due, Obama’s administration continued the process. I suspect that’s due more to the guy pushing it in both admins (named Mangano) than the Prez’s themselves, but at least he didn’t terminate the programs (bad optics there, I suppose).


    I don’t know why CA is letting the homeless still use the streets when a proven successful program is available.
    If they quit buying useless rail lines and almost-useless green cars and energy, they could easily take care of everyone.

  14. Gordon Says:

    The Hep A issue is downstream of the basic issue: allowing crazy/addicted people to shove everyone else around.

    I do a lot of work in downtown Minneapolis. Retailers in downtown have shut off access to restrooms for customers. It only takes a few shoplifters or masturbators using the restroom privacy to convince a retailer to lock the doors. An owner cannot put staff at risk by allowing that kind of stuff.

    There is a shelter now in Minneapolis that lets residents continue to use drugs/booze. Residents get a locker at the entrance in which to keep their stuff. They are not allowed to use in the building. It works. Addicts are capable of following rules if the consequences are enforced.

    But no one, no one, wants a shelter near them, for good reasons.

  15. Gordon Says:

    Oh, yeah: Gandhi was endlessly fascinated by poop. Somehow that didn’t make it into Attenborough’s movie, but he typically greeted friends by asking about their bowel movements.

  16. steve walsh Says:

    Sorry Neo, but I find this story so abhorrent and disgusting that I just can’t read the entire thing.

    I was in the SF Bay area recently and witnessed several of the small tent cities built under various spots along the freeway, in both SF and Oakland. I also observed a marked increase in the number of homeless people meandering the streets of the city. It was interesting to listen to the clueless musings of the locals as to why and how the situation has gotten so much worse in recent years.

  17. John in Palm Springs Says:

    This is a statewide problem in California. San Diego, LA, San Francisco and yes, even Palm Springs is awash in homeless people, most of them mentally ill/self-medicating with drugs and alcohol and literally invading the city. They can be found in your back yard, condo swimming pools and hot tubs. The progressive government of Palm Springs moved the only homeless center to the only black neighborhood in town; fortunately the residents rebelled and the city had to back down. Tell me again how colorblind our liberal friends are.

    In the Union Square area of San Francisco, the heart of the upscale shopping area, you must now step over not only drunk and drugged people laying on the street, but over the mounds of human feces left everywhere. And for this you get to pay some of the highest housing costs in the nation. The street poles are falling over, eroded by a constant stream of human urine. Special paint is being used to make it splash back on people who pick public walls to piss on.

    Welcome to the People’s Republic of California.

  18. DNW Says:

    “In the Union Square area of San Francisco, the heart of the upscale shopping area, you must now step over not only drunk and drugged people laying on the street, but over the mounds of human feces left everywhere. And for this you get to pay some of the highest housing costs in the nation. The street poles are falling over, eroded by a constant stream of human urine. Special paint is being used to make it splash back on people who pick public walls to piss on.

    Welcome to the People’s Republic of California.”

    But, but, but … there’s so much need!!!!!

    From each according to his ability, to each according to the dictates of the postmodernist bureaucrat: now that’s real social and moral progress.

    Your retrograde mentality has misled you into assuming that you have the same rights to life and association which they – the victims of life, or of themselves which amounts to the same thing – do. Not so. Some exist to consume, some, like you, to be consumed. You are a mere dish on the banquet table of leftist sensibilities. The sooner you realize that the happier you will be.

  19. Mr. Frank Says:

    A friend of mine used to live in Fargo,ND. He was fond of saying twenty below keeps the riff raff out.

  20. Gringo Says:

    Several years ago I ran into a health comparison of India and Pakistan. Somewhat to my surprise Pakistan did better than India and it boiled down to the Islamic vs Hindu strictures on outdoor defecation.

    World Bank: World Development Indicators definitely agree with your point about outdoor defecation: for improved sanitation facilities coverage in 2015, we have 63.5 % for Pakistan versus 39.6% for India. However, in 1990 the difference in 1990 between Pakistan and India for improved sanitation facilities was 23.7% coverage for Pakistan versus 16.8% coverage for India. That indicates to me that religious strictures have less to do with the difference today than different government policies.
    In addition, most of the health indicators the World Bank uses point to a slight advantage for India.

    Country Name Indicator Name 2015
    India Mortality rate, under-5 (per 1,000 live births) 47.7
    Pakistan Mortality rate, under-5 (per 1,000 live births) 81.1
    India Mortality rate, infant (per 1,000 live births) 37.9
    Pakistan Mortality rate, infant (per 1,000 live births)65.8
    Pakistan Life expectancy at birth, total (years) 66.4
    India Life expectancy at birth, total (years) 68.3
    Pakistan Improved water source (% of population with access)91.4
    India Improved water source (% of population with access) 94.1
    Pakistan Improved sanitation facilities (% of population with access) 63.5
    India Improved sanitation facilities (% of population with access) 39.6
    Pakistan Health expenditure, total (% of GDP) 2.6
    India Health expenditure, total (% of GDP) 4.7
    Pakistan Fertility rate, total (births per woman) 3.6
    India Fertility rate, total (births per woman) 2.4
    India Death rate, crude (per 1,000 people) 7.3
    Pakistan Death rate, crude (per 1,000 people) 7.3

  21. Gringo Says:

    In 1990, India was slightly better than Pakistan in rural coverage of improved sanitation facilities.

    improved sanitation facilities, rural (% of rural population with access)1990 and 2015
    India 5.7% 28.5%
    Pakistan 4.9% 51.1%

    Pakistan made up the difference- and more.

    World Bank link in previous comment.

  22. Gringo Says:

    While the Indian government has a program to eliminate outdoor rural defecation by 2019, it is finding out that it is easier said than done.India’s trouble with toilets: Government sanitation drives fail to sway those who believe going outdoors is more wholesome.

    In the lanes of Parvar Poorab, a peaceful North Indian village set amid monsoon-soaked fields, Savita stares suspiciously at the concrete lavatory outside her home. “The government employee who constructed it told me we had to use it now and we shouldn’t go in the open”, says the slight and sombre 22-year-old who goes by only one name.

    “But it’s better to go in the open. The pit is very small and will fill up very soon. We only use it in an emergency or at night. I like going outside.”

    Millions of Indians like Savita continue to defecate in the open despite having a household toilet, frustrating government hopes to wean more than 600 million of its citizens off the practice and questioning the assumptions behind its mass toilet-building programme.

    In rural India, a strong cultural resistance to the build-up and disposal of excrement, and the view that going outdoors is more wholesome, is leading to rejection of the new latrines.

    The most pressing reason to banish the practice, as Prime Minister Narendra Modi has vowed to do by 2019, is its effect on public health – spreading infectious diseases and stunting children’s growth by circulating faecal bacteria in the environment.

    In this densely packed country, even people using toilets will still be exposed to germs unless everyone in the community abandons their routine of trudging to the nearest field, pond or railway track to relieve themselves.

    Which illustrates the difference between a democracy and a totalitarian regime. Mao’s China followed his Four Pests campaign, but found out that contrary to what Mao knew, sparrows were not a pest. Sparrows were actually quite useful in eating insect pests. Whooda thunk it? Similarly, Mao’s being able to get 550 million rural Chinese to follow his cockamamie ideas on how to increase agricultural production resulted in the death of some 30 million.

  23. neo-neocon Says:

    steve walsh:

    Oh, I can understand not wanting to read it. But I had to follow where the story took me.

    About six or seven years ago I was in San Francisco in some tourist area (I think near Ghiradelli Square) and a guy about ten or fifteen feet from me pulled down his pants, squatted, and defecated on the pavement. There were crowds of people around; nothing happened. I wondered for a moment if I really saw what I saw. I did; it happened. That was my first clue about all of this.

  24. Gordon Says:

    Mr Frank is right. -20 does keep the riff-raff out, away, whatever. That’s why they move to warmer climes in the winter, from Minneapolis or Fargo. But Minneapolis, at least, does have a homeless infrastructure now. The downtown skyway system, with an entrance just a block from the largest shelter, provides a very large place to spend the day. Most do not try to camp out in the winter, but some do. When it gets really cold–below zero–there are emergency shelters that open up.

    Minneapolis is not San Francisco, not yet, although many dream of making it so. The two cities are similar in size and population.

  25. GRA Says:

    As someone who’s surrounded by “it’s a basic dignity” in terms of rights rhetoric aka give the poor and maligned everything I find this amusing.

Leave a Reply

XHTML: You can use these tags: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>

About Me

Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.

Monthly Archives


Ace (bold)
AmericanDigest (writer’s digest)
AmericanThinker (thought full)
Anchoress (first things first)
AnnAlthouse (more than law)
AtlasShrugs (fearless)
AugeanStables (historian’s task)
Baldilocks (outspoken)
Barcepundit (theBrainInSpain)
Beldar (Texas lawman)
BelmontClub (deep thoughts)
Betsy’sPage (teach)
Bookworm (writingReader)
Breitbart (big)
ChicagoBoyz (boyz will be)
Contentions (CommentaryBlog)
DanielInVenezuela (against tyranny)
DeanEsmay (conservative liberal)
Donklephant (political chimera)
Dr.Helen (rights of man)
Dr.Sanity (thinking shrink)
DreamsToLightening (Asher)
EdDriscoll (market liberal)
Fausta’sBlog (opinionated)
GayPatriot (self-explanatory)
HadEnoughTherapy? (yep)
HotAir (a roomful)
InFromTheCold (once a spook)
InstaPundit (the hub)
JawaReport (the doctor is Rusty)
LegalInsurrection (law prof)
RedState (conservative)
Maggie’sFarm (centrist commune)
MelaniePhillips (formidable)
MerylYourish (centrist)
MichaelTotten (globetrotter)
MichaelYon (War Zones)
Michelle Malkin (clarion pen)
Michelle Obama's Mirror (reflections)
MudvilleGazette (milblog central)
NoPasaran! (behind French facade)
NormanGeras (principled leftist)
OneCosmos (Gagdad Bob’s blog)
PJMedia (comprehensive)
PointOfNoReturn (Jewish refugees)
Powerline (foursight)
ProteinWisdom (wiseguy)
QandO (neolibertarian)
RachelLucas (in Italy)
RogerL.Simon (PJ guy)
SecondDraft (be the judge)
SeekerBlog (inquiring minds)
SisterToldjah (she said)
Sisu (commentary plus cats)
Spengler (Goldman)
TheDoctorIsIn (indeed)
Tigerhawk (eclectic talk)
VictorDavisHanson (prof)
Vodkapundit (drinker-thinker)
Volokh (lawblog)
Zombie (alive)

Regent Badge