With 16 dead and well over 400 documented as infected, it is fair to say San Diego is in the midst of an epidemic of Hepatitis A. Now, the perfect storm of a large population of individuals who are homeless,a significant number of individuals who use injectable drugs, a conspicuous absence of public bathrooms, and a push to consolidate those who are homeless in a concentrated geographic region in the city all appear to have combined to produce this epidemic. San Diego's homeless population is reported to have grown by over 25 percent in the last year, which may also play some role here. Still, other cities with large populations of homeless individuals should be afraid, very afraid. I'm looking at you: Detroit, Salt Lake City, Santa Cruz, and others. It is significant that there already appears to be a satellite outbreak in Santa Cruz. We are, at present, witnessing the second largest U.S. based Hepatitis A outbreak in decades.
Maybe all of this would have stayed below the radar, given the populations involved, but it is all hands on deck in full crisis mode now that public health authorities have had to try to reach customers of a popular tourist restaurant who may have been exposed through contact with a kitchen worker, who may have been exposed through a partner. I note that responsible articles go out of the way to elaborate that restaurant transmission is not a common ocurence, though a drop off in business at the particular restaurant has already been reported.
This means the fear of Hepatitis A transmission in California has officially made the leap from what I call "them to us." Restaurant and food service workers are statistically likely to be younger and lower income. This also means, in the United States, that they are more likely to lack health insurance. Hepatitis A, with its fecal-oral transmission route is not the only contagious disease that may appear in this group. The American Public Health Association has been concerned with the health of food service workers since the 1920's.
Then why are we so laissez-faire? First, it is and was invasive to require physical health examination of all food service workers for contagious diseases, even in the 1920's. Second, it costs money, whether born by public health authorities or by food service employers and it is money spent examining a low wage workforce with high employment turnover. Third, we do not want to acknowledge that our health as food service product consumers is deeply intertwined with the health status of our food service industry workers. Admitting otherwise punctures two popular American myths — the first that we are all almost completely in control of our own health and disease status as individuals and, the second, that your lack of health insurance or lack of easy access to health maintenance care is your problem and not mine.
I always ask my students who contend that the individual choice to obtain health insurance and health care is just that– an individual choice– if they eat out much.