An outbreak of hepatitis A is spreading in Salt Lake County. But, while cases go up, it hasn’t gotten a lot of attention. One reason for that could be the population it’s primarily affecting: the homeless. Why is this epidemic so bad and what’s being done to stop it?
Steve Beach stood at the back of his SUV in the parking lot of a rundown hotel off I-15 in downtown Salt Lake. In the trunk of his car was a small blue cooler filled with vials of vaccine and a Ziploc bag of plastic gloves.
"We’ve been to this location a lot," Beach said. "This whole area. We come almost once a week."
Beach is a nurse with the county health department’s foot patrol. He was at the hotel to give people the hepatitis A vaccine.
A man walked up, asking to be vaccinated.
"I used to be a drug addict," the man said. "I have a lot of friends that are kind of caught up in this. I’ve been clean since 2003."
"Awesome. Relax as much as you can. There you go." Beach gave him a quick shot and put a cartoon-covered Band-Aid on the man’s shoulder.
Foot patrols like this one are a strategy by the health department to get the vaccine to people who need it most: homeless individuals and IV drug users. Right now, the Salt Lake County Health Department has identified 144 hepatitis A cases related to this outbreak. In a typical year, they expect five. But reaching this group, who are often suspicious of law enforcement, is difficult.
"It makes it effective just being out here on the street," Beach said. "If we had some kind of clinic, no one would come in."
Hepatitis A is a liver disease. While rarely fatal, it causes fatigue, stomach pain, nausea and yellowing of the skin and eyes. The virus is spread through poor sanitation: specifically, food contaminated with feces from an infected person. It can also be spread through shared needles.
Ilene Risk is the epidemiology director at the Salt Lake County Health Department. She's in charge of tracking the outbreak.
"This is very challenging because people don’t have the typical home address," Risk said.
In her office, she sat examining a map of the county.
"This is called a heat map. With this particular map, it shows Salt Lake County and then it shows transient camp complaints. And so what we’re looking for is where there is a greater proportion of complaints. That lets us know where we can find people to vaccinate," she said.
According to Risk, their data shows the outbreak hasn’t peaked yet.
Salt Lake County isn’t the only place with a large homeless population experiencing this outbreak. It started in San Diego last year. Since then it’s spread around California and to parts of Arizona and Kentucky.
Risk says there are factors around Salt Lake City that may be exacerbating the spread of the disease. One is park bathrooms. They get closed in the winter time so the pipes don’t freeze. That means one less place for people to wash their hands. On the macro level, Salt Lake City’s affordable housing crisis means more people without access to basic hygiene.
"Any of us could be exposed," Risk said. "It’s just that fortunately, most of us have the facilities to wash our hands."
Sandra Hollins is the homeless strategist and outreach coordinator for Salt Lake City, as well as a member of the Utah legislature. She says soon the city will open park restrooms and they’re considering new steps to improve sanitation.
"This year we’re looking in our budget to be able to provide hand washing stations. So we are able to combat the hep A outbreak," she said.
According to Hollins, housing is also an important piece.
"If folks are able to get into housing they’re able to take care of their hygiene issues, and we don’t have such a big problem. So yes, absolutely, housing plays a very big role in all of this."
In the meantime, the health department is getting creative to stop the spread of disease.
At noon at the Weigand Homeless Resource Center, near downtown's Rio Grande District, a line of men and women are coming inside for lunch. Sarah Kinnison is at the door handing out antiseptic hand wipes to lunch goers.
"Here’s your meal ticket. Wipe your hands, keep the wrapper as your ticket. Don’t throw it away," Kinnison said, instructing the visitors.
The hand wipes specifically get rid of hepatitis A. Lunch-goers have to show they’ve used them to get a meal.
The inability of many cities to stop the hepatitis A outbreak shows how difficult of a problem it is to solve. But according to epidemiologist Ilene Risk, its very presence should make us question if enough is being done to address the homeless population’s immediate needs.
"I think this is really just a red flag too, to let us know that we need to really figure out how to provide better service to the underserved," Risk said.
At this stage in her investigation, she's thinking about the outbreak two ways: how to create a stopgap to prevent it’s spread now and how to get enough people vaccinated so this doesn’t happen again in the future.