Years after we first learned of the water crisis in Flint, Michigan, the small Midwestern city remains the poster child for failed city government. Now, another city government faces a growing hepatitis A problem that stems from long-running healthcare and housing issues for homeless people.

That city is San Diego, California. Unlike Flint, San Diego is a high-profile major city inhabited by more than three million people. Get this wrong, and America’s finest city – as San Diego calls itself – could relieve Flint of its title as America’s best-known embarrassment.

Revisiting Flint’s Water Crisis

Now that enough time has passed to thoroughly analyze the damage that tainted water caused in the Flint community, the numbers speak for themselves. In the years following the decision to pull drinking water from the contaminated Flint River, the fetal death rate in Flint increased more than twofold. Fertility rates decreased by 12%, and overall health of children at birth was noticeably diminished.

Flint River water had been shown to contain harmful quantities of lead, oil, human waste, and other toxic substances as early as the 1970s. The state of Michigan ordered the cleanup of 134 polluted sites along the Flint River watershed in 2001. Yet no form of solution was installed to prepare river water for public consumption.

The river was never meant to be a permanent water source for Flint, and in 2014 the decision was made to switch water supplies and use water from Detroit’s Lake Huron instead. But the changeover was delayed, and it was around this time that Flint began receiving consistent warnings to boil water.

City officials conducted multiple flushes of the communities’ water system in an effort to restore potable water supplies, but soon the level of chlorine in the water was too high for public consumption. To make matters worse, many of the city’s inhabitants came forward in 2015 with evidence of dangerously high levels of lead in Flint’s water supply.

The Environmental Protection Agency issued a warning, citing lead levels more than 10,000 parts-per-million in some samples. After numerous additional complaints, five government officials lost their jobs and 13 criminal cases were filed as a result of neglect on the part of the local government. After several lawsuits, it wasn’t until January of 2017 that Flint’s water supply would display acceptable levels of lead for human consumption. Overall, the crisis demonstrated a severe need for improvement to US infrastructure and solutions for the availability of clean drinking water, as well as a lack of care and coordination on the part of public health officials.

Why San Diego is Like Flint

There have already been 19 deaths caused by hepatitis A infections in San Diego, and about 350 people have been hospitalized. California Governor Jerry Brown has declared a state of emergency due to the outbreak. At the same time, the city has made various efforts to combat the infection through public health programs intended to treat San Diego’s homeless. While all of the deaths associated with the disease have been individuals who were previously sick or had compromised immune systems from drug use, the question remains: how did the city government allow things to get so bad?

While it is rarely fatal in people with healthy immune systems, hepatitis A can lead to death in those with liver issues or those weakened by another condition. Vaccination is the best way to defend against the virus, but Brown says the federally-funded supply of vaccines is insufficient. US Rep. Darrell Issa has urged the federal government to take action and provide emergency funding and expertise to fight the outbreak.

Homelessness in San Diego comes as no surprise to city officials, who are now under scrutiny for neglecting to provide better conditions before it got to this point. Once the infection begins to spread, it can be difficult to control.

The virus spreads through fecal coliform bacteria, which can spread rapidly in poor communities where hygiene is lax. Just passing a piece of food or a drink to a neighbor can be enough to transmit the disease. While the root cause of a hepatitis outbreak is typically traceable to contaminated agricultural products, in this instance investigations have failed to associate the epidemic with any single crop.

The Mayor Responds

Facing criticism, Mayor Faulconer posted a video on his official Facebook page. Faulconer can be seen with the head of San Diego’s Alpha Project – a non-profit organization that works to protect the city’s homeless population. He describes plans for a new shelter system centering around three tents, the first of which should be ready by December.

In addition to the tents, San Diego is installing thirty new hand washing stations. These stations might have been more helpful had they been installed back in June when they were first proposed. The first cases of the disease were reported in March of 2017, so there has been plenty of time to formulate a strategy.

San Diego health officials have administered roughly 70,000 vaccinations since the onset of the hepatitis pandemic, but the only way to ensure the disease stops spreading is for people to practices safe hygiene. The demand for plastic bags used to contain human waste is increasing as the condition becomes a more significant problem on city streets.

Should things get too out of hand, the infection could spread from the homeless population to San Diego’s more affluent community. That would be a public health disaster since hepatitis A is typically thought of as a very manageable disease.

It is sad that loss of life is required to make government stand up and take notice that the homeless population are not getting the care they need. But if all that comes of this situation is a well-needed wakeup call, the city of San Diego should consider itself lucky.

About the author

KATE HARVESTON is a political journalist and blogger, whose work across numerous outlets focusses on Human Rights and Gender Equality.