This post has been updated.

In June, county officials went public with a plan to respond to the deadliest hepatitis A outbreak in decades. Two months later, they’ve got little to show for it – and people are continuing to die.

Health experts believe poor hygiene is fueling the spread of the virus, which has disproportionately pummeled the city’s homeless population, so they decided to deploy temporary hand-washing stations in places where the homeless settle.

But so far, the county’s managed to set up just two hand-washing stations – and until Wednesday both were miles away from the downtown streets that are essentially ground zero of the outbreak.

As officials have sputtered, the crisis has surged. Fifteen people have died and more than 260 have been hospitalized. The number of reported cases has more than doubled since the June announcement alone.

County officials have typical gripes about bureaucratic red tape, an issue with a vendor and an inability to swiftly coordinate with city officials. They also insist that the plan to put out hand-washing stations must first exist as a pilot program before it can be rolled out on a larger scale.

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“It’s not just as easy as just putting a unit out there,” said Dr. Wilma Wooten, the county public health officer directing the regional response to the hepatitis A outbreak.

More than two months after the idea hatched and as the crisis has continued to claim lives, Wooten and city of San Diego officials say they’re finalizing a permit that would allow the county to place hand-washing stations in areas where regional data has revealed the outbreak is most concentrated. On Wednesday, more than a month later, the county moved one of the stations to its downtown Family Resource Center at 10th Avenue and C Street. County bureaucrats say they hope to hash out separate permitting agreements with El Cajon and Escondido as well as nonprofits that serve the homeless.

County officials say the hand-washing stations are just a small piece of a more comprehensive response. They’ve sent county workers to homeless encampments to hand out hygiene kits and give vaccines, the approach experts agree is the most effective tool to prevent spread of the virus. They’ve inoculated more than 7,100 people considered particularly at risk, along with thousands more considered less so. They’ve partnered with government and nonprofit agencies across the region to spread the word and suggest sanitation changes.

Things have moved more slowly on the hand-washing stations. Hand-washing is considered the second most crucial step to fight the outbreak behind vaccinations, and many homeless people have been wary of getting vaccinated.

Dr. Rohit Loomba, director of hepatology at UC San Diego, said that while vaccines are the most potent weapon against the outbreak, increased hand-washing opportunities in areas like downtown where lots of homeless people congregate could help a particularly vulnerable population – and stem future outbreaks.

“Hand-washing is important, and we should think about not just hepatitis A, but there are other (gastrointestinal) infections also happening,” Loomba said. “They’re also preventable and cause a lot of morbidity.”

County officials say they wanted to make sure homeless people would use the wash stations and to understand maintenance needs before installing them across the county. They say they had to follow government protocols. They couldn’t just place a hand-washing station on non-county property without proper approvals. They also say the initial vendor they’d counted on for the hand-washing stations ultimately couldn’t deliver, forcing the county to ink a new contract with another vendor on July 6.

So the county started with a pilot, a sluggish process that seems more befitting a plan to increase annual flu shots than to combat a fast-growing outbreak that’s left 11 dead just since the county announced its plan.

That meant just two hand-washing stations on the county’s own property – one in the corner of a quiet county health facility parking lot that some homeless people frequent and another just paces away from an indoor restroom at the same health complex – went up on July 13. Both were more than five miles away from the downtown homeless encampments where hundreds have settled and the outbreak has spread most.

“We’re talking to everyone, trying to just deploy as many as possible,” Wooten said.

The county’s also working with city of San Diego officials on a permit to add more hand-washing stations in the city and starting discussions with officials elsewhere.

Stacey LoMedico, the city’s assistant chief operating officer, said the city stands ready to allow stations at other locations as soon as county officials finish their work on the permit.

That could happen within a few days, LoMedico said late last week.

Just a week ago, Wooten told Voice of San Diego that “politics” had interfered with efforts to install handwashing stations downtown and forced the county to look at its own properties first.

“We don’t control those areas so the best we can do is have conversations,” Wooten said.

Emails provided by Metropolitan Transit System show the agency was reluctant earlier this month when the county suggested placing two hand-washing stations at the 12th and Imperial Transit Center in East Village.

Karen Landers, MTS’s general counsel, raised flags about the transit agency’s past experiences with portable toilets once placed on MTS property in East Village. She expressed concern that hand-washing stations would create further “quality of life” challenges in an area already crowded with homeless people.

MTS security director Manuel Guaderrama brought up more specific concerns.

“My only thoughts are that this would probably become a magnet for homeless people to come onto our property just to use the sink (take a bath, brush their teeth, wash their dishes, etc.), especially during non-revenue hours,” wrote in an Aug. 15 email. “Perhaps the health department can set up locations with just the sanitizer.”

Public health officials have cautioned that hand sanitizers and wipes are not as effective as hand-washing in preventing the spread of the virus.

Wooten said last week the county was continuing to talk with MTS but has since discussed installing hand-washing stations at nearby Father Joe’s Villages and outside the Neil Good Day Center just a couple blocks away.

Update: This story has been updated to reflect that the county moved one of its two hand-washing stations to a downtown location on Wednesday, after this story first published.

    This article relates to: Government, Homelessness

    Written by Lisa Halverstadt

    Lisa writes about San Diego city and county governments. She welcomes story tips and questions. Contact her directly at or 619.325.0528.

    dave hamrah
    dave hamrah subscriber

    Foot dragging is the result of priorities. The problem of homeless people is unsavory and certainly not "sexy" for the bureaucrats. Is it a stretch to say the topic is sticky and political?  While we can understand the reluctance to tackle the issue, now it has become a public health issue ready to explode when it didn't need to.  Bottom line, though, seems to be in the lack of leadership and in making this a top priority.  It seems like no one wanted to touch the issue or everyone involved didn't have any direction. Now San Diego is famous for Hep B. Our children are at risk - particularly if they are riding public transportation or living in neighborhoods where homeless people have move to, such as hillcrest, north park, normal heights and many others.  If even a few children come in contact with Hep B, schools will become the first epicenter.  Its time to stop avoiding the issue and whining about "lazy, dirty, crazy" homeless people and start dealing with this issue. 

    Glenn Younger
    Glenn Younger subscribermember

    The Hep A crisis may be the tipping point to again view homelessness as a public health issue. 

    Many of the laws we view as "quaint", like no spitting on the sidewalks & no camping on city streets, are attempts from the 1800's and 1930's to increase public sanitation.  Those laws made it harder, and illegal,  to live outside in an urban environment.  People were arrested, thrown in jail, or sent away, as at the time it was thought of as for the good of public sanitation.  

    With public assistance available for all, and available beds going unused, it begs the question; Why is living in the public right of way, and open defecation, no longer considered a crime?

    Jennifer Spencer
    Jennifer Spencer subscriber

    Besides the hand washing stations should be porta-potties.  Putting out just the hand washing stations only solves half of the contagion problem. 

    La Playa Heritage
    La Playa Heritage subscribermember

    Permits are not required for Temporary Plastic Hand Washing Stations and Restrooms. Especially during Public Health Emergencies like Hepatitis A and Homelessness.

    Permits are required for Permanent Hand Washing Stations and Restrooms only.

    "We wished we could help, but it would be illegal" needs to be challenged. 

    MTS refuses to provide restrooms for commuters.  The MTS Board should take up the issue of sanitation and allow Public Restrooms on MTS private property owned for the benefit of the public. 

    lorisaldana subscriber

    FYI: Another person died of hepatitis this week.

    See: for weekly updates

    Aug. 15: 11 deaths, 333 cases
    Aug. 22: 14 deaths, 352 cases
    Aug. 29: 15 deaths, 378 cases

    Molly Cook
    Molly Cook

    This is entirely inexcusable and unacceptable...I begin to wonder if city officials have the slightest grasp of the problems and also wonder if they'd just as soon see the homeless population die off.  San Diego is a lovely place with very ugly politics.

    rhylton subscriber

    @Molly Cook Remember, these are the officials who "hard-scaped" the sidewalks to dissuade the homeless.

    Molly Cook
    Molly Cook

    @rhylton @Molly Cook 

    Yep...I'm proposing a class action suit against the city on behalf of all residents affected by the problem, ordinary people who want to see the homeless sheltered (not against the homeless).  The suit would be against the city and its officials for not doing a damn thing for so many years even though funds were available.  It's time somebody took some action that might get them off their fat dimes and get these people into safe shelter.

    When the best the officials can do is appoint one more czar or one more panel to meet endlessly, it's time for change.  Real change.

    mike murphy
    mike murphy

    so, "officials" come  up with  a plan, but don't have a clue how it  goes ?