Plastic-bag ban led to hep A health crisis?

“The plastic bag ban is the main reason for the hepatitis outbreak,” says the homeless man who writes the Homeless Survival Guide. “The hepatitis outbreak was completely predictable — it's why I left San Diego.”

Homeless people learned long ago that pooping in plastic-bag-lined containers meant you could wrap the session up and dispose of all the stuff without touching it, he said in a long email. So when it got harder to get the bags after the ban went into effect late last year, it became harder to find the bags and people who were able to keep things clean had to work a lot harder.

Plenty of people discounted the plastic-bag theory but San Diego County Public Health Officer Wilma Wooten was not one of them.

“Yes, absolutely, we know people use the bags for that,” she said. “We know people don’t have bathrooms and they can put bags in cans and buckets and maintain good hygiene. That’s why we put plastic bags in the hygiene kits we’re handing out. That’s what we expect people will use them for.”

The hygiene kits include wet wipes, hand sanitizer, bottled water, and plastic bags for poop and waste — tampons and menstrual pads can carry the virus, too. The county had handed out 2400 kits as of Thursday (September 7).

Hepatitis A is spread by contact with feces or blood of an infected person. It can be trace amounts and it can be months old, Wooten said. “This is a hardy virus. It thrives in cold temperatures and you have to heat it to 185 degrees to kill it,” she said. “It can live for months outside the body.”

That means that someone with infected hands who handled a door knob or a stair railing before you or who handled your food can leave behind enough to infect people long after they are gone. If you feed yourself or touch your nose or mouth with that hand, you may have completed the infection process.

In April, David Gibson was one of the participants who cleaned up a one-acre site in Grantville, behind the Fairmount Avenue Home Depot. Several dozen people had lived there, some for a few years. Police and San Diego River Foundation volunteers found a big bicycle chop shop with dozens of stolen and stripped bikes. They also found a nauseating stench, said Gibson, who is the executive director of the Regional Water Quality Control Board. Gibson doesn’t think it’s as simple as a lack of plastic bags.

“Given what I saw at the Grantville encampment and other smaller ones, I doubt very much that plastic bags would have made much difference,” he said. “I saw firsthand multiple buckets of waste, most likely fecal, at the Grantville site and no shortage of plastic bags. Moreover, at many sites fecal wastes can be found on the ground in the riverbed encampments as well as in and around parking lots with no shortage of bags then or now.”

At the outbreak’s core is the truth that homelessness is “not a healthy way to live for many reasons,” he added. “Not being able or willing to practice basic hygiene measures we take for granted in our homes and businesses is a key part of the public and environmental health issues that transcend something as simple as a ban on plastic bags.”

Amy Gonyea, the chief operating officer with the Alpha Project (which runs shelters and programs that include transitional and permanent housing for homeless people), said she’s been hearing it’s the lack of those once-plentiful bags that’s spreading the virus among homeless people.

“We have heard the same thing from our clients and our outreach team,” Gonyea said. “We’ve heard it on numerous occasions. Our staff hears it from our clients, and we think they know what they’re talking about.”

The ban was approved in June 2016 and officially took effect in November, about the time the first cases definitively tied to the outbreak showed up. So far, 15 people have died out of about 398 confirmed cases. The federal Centers for Disease Control and Prevention have sent two staffers and offered resources to the county, as has the state Department of Public Health.

The CDC tests identified the genome of the virus, which is how they know all 398 cases are linked, Wooten said. The county usually sees a dozen hepatitis A cases a year, and 12 other cases that are not genetically similar to those 398 have also been diagnosed and reported, she said. “Those are our garden-variety cases, distinct from this outbreak.”

Detroit and (to a lesser degree) Santa Cruz are also in the midst of hepatitis A outbreaks, Wooten said. While 65 percent of those cases are tied to people who are homeless and/or drug users, 35 percent are not.

“Of the other 35 percent, 23 percent have contact with the high-risk population — for example, food handlers and people who work in the jail,” Wooten said. “The remaining 12 percent — 48 people — we have not been able to document how they came in contact with the virus.”

It isn’t just downtown — half the people who’ve contracted the virus are somewhere else. The second largest cluster of cases is in El Cajon, and there are others in Oceanside, National City, Santee, and the unincorporated county, Wooten said.

The best defense is getting vaccinated — which is free because of the epidemic. The vaccine used to cost about $100. If you’ve traveled to the third world, you’ve probably gotten the two injections a month apart. It’s good for life — no boosters needed. The county is giving away the vaccine at no cost, and it’s available at the Family Health Centers, the San Ysidro Health Center and Vista Community Clinic, and La Maestra’s City Heights and El Cajon clinics.

The county is also scheduling mass vaccination events, Wooten said. And wash your hands. You don’t have to use hot water — in fact you’ll take your skin right off if you use water hot enough to kill the virus. Just soap up well and take 20 seconds to work the lather around, then rinse thoroughly, the CDC says.