If we don’t act fast, Hepatitis A will become a national epidemic

As a physician who is concerned about public health, I am glad that President Trump has been shining a spotlight on homelessness and associated squalor in many of our major cities. One associated public health concern is Hepatitis A, a virus that spreads through contaminated food and water. 

The Philadelphia Department of Health has correctly just declared hepatitis A as a public health emergency, due to a recent upsurge of cases, with 67 percent of those infected saying that they have used drugs and 26 percent reporting themselves to be homeless. 

Florida also declared Hepatitis A as a public health emergency, with more than 2,000 cases in 2019 so far— that’s four times the number of cases reported in all of 2018. At particular risk are those with chronic illness, the homeless, drug users and prison inmates. 

Hepatitis A is a virus that affects the liver. I had it myself many years ago, and I can tell you that it made me quite ill and weak for several days — and I was healthy to begin with. Imagine how devastating it can be to those with chronic illnesses, especially those affecting the liver, and to those who are immuno-compromised.

Hepatitis A can cause high fever, jaundice, fatigue, nausea, vomiting, dark urine, diarrhea, joint aches, abdominal pain and more. Since 2016, the Centers for Disease Control (CDC) has reported ongoing outbreaks across 25 states affecting more than 20,000 people; 59 percent of these cases have required hospitalization.

Fortunately, the vast majority of people with hepatitis A do recover.

The contagion is not something that can be easily contained to the areas where an outbreak first occurs. Since the virus is spread by contaminated food, water and waste, anyone who comes in contact with the live virus can then spread it to others, out into a much larger community. 

What can be done? The hepatitis A vaccine is quite effective and, according to the CDC, a single dose has been shown to control outbreaks and to provide up to 95 percent protection in healthy adults. 

Unfortunately, it is difficult to achieve compliance in the homeless and drug-using populations, and the problem of contaminated food and water remains unless the streets can be cleaned up and the homeless offered temporary shelter. This has been achieved in New York City, where 95 percent of the homeless now have access to shelters. Working in Bellevue Hospital in the late 1980s and 1990s, I saw this transition decrease the spread of contagious diseases, including hepatitis A. Currently, New York is not one of the states with an ongoing outbreak. 

Tampa Bay, Fla. has been particularly hard hit, and health department officials literally have been walking the streets, offering free vaccines, targeting homeless shelters, drug treatment facilities and prisons. 

Unfortunately, half of the homeless population is unsheltered, which makes it a particularly difficult population to vaccinate, in part because of resistance to health officials and lack of public health education. 

In California, especially in San Francisco and Los Angeles, close to 69 percent of the homeless are unsheltered and live amid garbage and human waste. Diseases, including hepatitis A, are thus rampant and difficult to control. 

President Trump pointed to California cities in his recent Cincinnati rally. “Nearly half of all the homeless people living in the streets in America happen to live in the state of California,” Trump said. “Look at Los Angeles with the tents and the horrible, horrible disgusting conditions. Look at San Francisco.”

I am not as interested in the politics of which mayor or which political party is in charge of these cities as I am interested in the public health risks presented by street-based homelessness. In my 1998 novel “Bellevue,” I called homeless people living without shelter “the bedless.” In public health terms, “bedlessness” means having no proper waste disposal, and easily contaminated food and water. It means hepatitis A. I’m all for extensive public health vaccination campaigns for “the bedless,” as well as for the unvaccinated in communities that surround them. But sheltering the homeless provides the best solution, and better targets for the vaccine.

Without aggressive administration of the vaccine, and without shelters and drug treatment programs, hepatitis A will continue to surge and will soon become a national epidemic.

Marc Siegel, M.D., is a professor of medicine and medical director at Doctor Radio at NYU Langone Health. He is a Fox News Medical Correspondent. Follow him on Twitter @drmarcsiegel.