San Diego, CA

Hepatitis C falling in San Diego, but eliminating disease will take more work

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3 hours ago

August 1, 2024

Hepatitis C falling in San Diego, but eliminating disease will take more work

Modern medicine can cure a hepatitis C infection with three doctor’s appointments and two prescription refills. For most, it is not a big ask to rid oneself of a deadly disease.

But for those without homes, keeping up with the required 12-week treatment regimen can be an overwhelming commitment.

Sitting on a metal folding chair at the edge of an empty parking lot in Balboa Park on a recent morning, Holly, a resident of San Diego’s nearby O Lot safe sleeping site, explained that visiting a doctor’s office miles away comes with significant risk.

A tent can never be fully secured, so leaving one’s possessions inside to go to the doctor’s office all but guarantees returning to find possessions missing.

“There is nobody that holds themselves accountable for your stuff, so it’s just hard for me to leave, knowing that,” she said. “Everything I have left in the world is in that campsite, and it’s easy for people to just walk right in.”

And yet Holly just completed her full hepatitis C treatment, not missing a dose over three straight months after a screening test detected her infection. Her friend, Chris, just started his second week. Like his companion, he said that because his infection had not yet progressed far enough in damaging his liver to start causing symptoms, there is pretty much no way he would have traveled to the clinic for treatment.

“You know, you just sort of put it on the back burner if it’s not causing any signs,” he said.

Finding and keeping housing trumps following up on test results. And that is the particular problem with hepatitis C, which may take decades to cause its first symptom. Often, by the time signs and signals such as easy bruising, fatigue, yellowing of the skin and weight loss appear, a person’s liver is significantly damaged, making life-altering consequences such as liver cancer much more likely.

In recognition of the disease’s slow and deadly burn, the county health department, several local medical providers and the Liver Coalition of San Diego County launched a hepatitis C elimination plan in 2021 with the goal of preventing new cases while simultaneously working to discover and treat so-called “chronic” cases that have gone undetected.

Though recent results are skewed slightly due to a change in how hepatitis C cases are counted, the overall case trend has been downward since 2019 when 4,249 chronic cases were confirmed or suspected compared with 2,298 in 2023.

A big part of driving that number down, said Dr. Christian Ramers, medical director for research and special populations at Family Health Centers of San Diego, has been more aggressive outreach to those at increased risk of hepatitis C infection. Because the virus transmits in human blood, injection drug users are at an increased risk as are those with HIV.

The crusade to eliminate hepatitis C started with increasing screening to detect chronic cases and with the region’s first needle exchange programs, helping drug users avoid re-using and sharing needles. Many have recently begun to realize that those techniques, while effective, are not enough.

Chris and Holly’s recent experience in a Balboa Park parking lot involved a physician assistant with Family Health Centers whose job is to take many services, including the checkups and medication delivery necessary to cure the disease, out of doctor’s offices and into the places where people with reduced mobility live.

“Really, the only way is to bring the care to this population,” Ramers said. “They’re not going to come in and meet us at the clinic, so we have to find a way to go to them.”

And, simply showing up in tent encampments for checkups and to fill prescriptions is not enough. Family Health Centers workers have learned that the usual practice of delivering one month’s worth of medication at a time does not work. Such a large supply is likely to be stolen before it can be consumed.

Instead, workers deliver seven pills at a time, making weekly visits and using those encounters to discuss other health matters that a person might also be experiencing.

But eliminating the disease will not be accomplished only by embracing street medicine for those experiencing homelessness. Scott Suckow, executive director of the Liver Coalition of San Diego County, said recent modeling by researchers at UC San Diego found that reaching intravenous drug users in many different types of venues will be key to winning this fight.

More work could be done, he said, in organizations that treat substance use disorder, often combined with mental health care, to screen for hepatitis C and to make sure that those who test positive are referred to medical providers for treatment.

The state, through the ongoing reform of its Medi-Cal health insurance system for needy residents, has recently approved paying substance use treatment and behavioral health providers for “enhanced care management” when treating patients with substance use disorder. This additional benefit allows for a more holistic set of services that can go beyond drug and alcohol treatment.

Driving hepatitis C infections lower, getting more people screened and treated, Suckow said, is likely to see a significant benefit from the enhanced care management benefit if the disease is included in the host of additional health problems that doctors look for when care management is engaged.

“The position we’re taking is that it’s the behavioral health and substance use disorder treatment community’s responsibility if they’re providing whole-person care, to make these linkages, especially if they know that a client has hepatitis C or they’re at risk for it,” Suckow said.

Why couldn’t this simply be a mandate of the county health department, which spends millions per year contracting with substance use treatment programs serving patients whose care is covered by Medi-Cal? Why couldn’t a mandate to test all substance use treatment patients for hepatitis C infection just be written into county contracts?

Dr. Nicole Esposito, chief population health officer for the county’s behavioral health department, said that contracting is not seen as the right solution for promoting better coordination between different types of medical providers serving Medi-Cal beneficiaries.

Better coordination of care is not, she noted, about only one disease.

“The goal of care coordination is to really assess all of the needs of the whole person, rather than programmatically calling out specific diseases in contracts,” Esposito said. “Then it becomes like a patchwork where we have the hepatitis C expectations and the HIV expectations and we have some that get missed.

“I think the goal is to put the person at the center and work across all of the various factors, whether it’s all of the illnesses they might have or housing needs or social needs or school needs, rather than trying to do it with line item contract language.”

Medi-Cal changes, she added, will make it easier for different types of providers to securely share patient information electronically, making it easier for referrals to be made across organizations that are engaged in different missions.

“I think the big hope for significant progress lies in the fact that, in the future, we’re going to have a lot more data sharing so that there will be more visibility of whether tests were done, what were the results, was treatment started, was treatment completed,” Esposito said.

Originally Published: August 1, 2024 at 11:40 a.m.

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San Diego, CA

How will push for high-rises reduce housing costs?

Published

10 hours ago

August 1, 2024

Press Room

How will push for high-rises reduce housing costs?

Re “San Diego finalizes plans to transform Hillcrest, University City with high-rises, transit” (July 30): After Hillcrest and UC have both been built out into shiny new high-rise downtowns, San Diego home prices will continue to soar, and the experts will once again declare a “housing crisis.” And then some other parts of San Diego will become targets for downtowning. And after those areas too have been downtowned, San Diego home prices will once again continue to soar, and the experts will once again declare a “housing crisis.”

The experts need to tell us now: Where and when does this all end?

— Richard Gleaves, La Jolla

Originally Published: August 1, 2024 at 5:00 a.m.

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San Diego, CA

Dodgers swept in San Diego as Clayton Kershaw struggles

Published

17 hours ago

August 1, 2024

Press Room

Dodgers swept in San Diego as Clayton Kershaw struggles

SAN DIEGO — The windup looks the same, his arms stretching toward the sky and one leg paused in mid-air before delivery. The stuff coming out does not.

In his second start since returning from shoulder surgery, Clayton Kershaw was roughed up by the San Diego Padres for seven runs and failed to get through four innings in an 8-1 loss for the Dodgers on Wednesday night.

“Not very good,” Kershaw said afterward. “Just not a lot went well at all. Just got to pitch better.”

The same could apply to the Dodgers as a whole.

The surging Padres completed a sweep of the two-game series and have won nine of their past 10 games. The Dodgers finished with a losing record in July (11-13), their first losing record over a full calendar month since April 2018.

The combination has pulled the Padres to within 4½ games of the Dodgers in the National League West – the smallest the Dodgers’ lead has been since May 4.

“It’s a long year,” Dodgers catcher Will Smith said. “There’s going to be injuries. There’s going to be tough times. There’s going to be good times which have been this year. So, yeah, it’s part of it. We’ll come out of it. No doubt about it. We’re the Dodgers. We’re the best team in baseball.”

There has been precious little evidence of that recently – and even farther back than just July. Since May 20, they are 30-29, the ninth-best record in the National League.

“The defense I love. We’re playing hard. I think offensively, the guys we run out there are prepared. They’re putting good at-bats together,” Dodgers manager Dave Roberts said. “Overall, the pitching in general, we just haven’t had the effectiveness, the command. There’s a lot more homers in the last 30 days, in the month of July. The walk is up from all the pitchers. And it just puts a lot of stress on the offense.

“Yeah, we’re going to get back to health. I still like the guys we got. I still feel good every time we start a game. But we still have to go out there and play 27 outs.”

Kershaw could only get 11 of those against the Padres.

When Kershaw made his comeback start against the San Francisco Giants last Thursday, he allowed six hits in four innings – but he also struck out six and got 14 swings-and-misses in all, eight on his slider.

There was none of that against the Padres. He didn’t strike out a batter – the first time in his career that Kershaw started a regular-season game and didn’t record a strikeout. He didn’t get a swing-and-miss until his 23rd pitch (a slider to Padres catcher Luis Campusano) and got just one more (on the 81st of his 83 pitches).

In his four innings against the Giants, Kershaw’s fastball averaged 90.6 mph – in line with his average fastball over the three seasons before shoulder surgery. Against the Padres, it dipped below 90 mph.

“Just wasn’t executing,” Kershaw said. “Wasn’t throwing really anything that I wanted to, where I wanted to. Frustrating overall.”

Roberts said it’s not surprising that Kershaw’s return from surgery would have its bumps.

“I think it’s hard to ever bet again Clayton,” he said. “The last one (against the Giants) I thought was very good and tonight just wasn’t great. I think he’ll be the first to say that. But it’s part of the process. I just don’t think that anyone can expect him to come back and be lights out every start out, certainly after two starts.”

Kershaw acknowledged that there might be some rust after rehab.

“Physically I feel fine,” he said. “I mean honestly I felt pretty good with the last one overall. But this one obviously, this was really bad. I didn’t think there was rust, but maybe. I don’t know. Just got to pitch better.

“There’s a lot you can overanalyze when you pitch bad, but for right now I’m just going to say it was bad and try to pitch better the next one.”

Kershaw’s troubles started in the second inning when the Padres scored four times on three singles, a walk and a wild pitch. Kershaw could have limited the damage but he fumbled Bryce Johnson’s squeeze bunt, allowing a run to score and extending the inning for Jurickson Profar’s two-out RBI single.

“I gotta make that play,” Kershaw said. “That was an easy out at home right there. The bunt was right back to me. Have to make that play, and the inning’s a lot different. That’s on me. That was super easy. That was a super frustrating mistake there.”

He retired the side in the third but gave up a one-out home run to Campusano in the fourth and then singles to Johnson and Profar wrapped around an error by second baseman Gavin Lux. After Xander Bogaerts drove in the third run of the inning with a sacrifice fly, Roberts pulled Kershaw rather than have him face Manny Machado for the third time in four innings.

Four of the Padres’ runs off Kershaw were unearned, still leaving him with a 5.87 ERA after two starts. More troubling perhaps, the two lineups he has faced have batted .333 (12 for 36) against him.

“I just think it’s executing it, where it’s getting to,” Smith said. “It’s nothing concerning to me at all. It was just one of those days.”

Padres starter Dylan Cease was making his first start since pitching a no-hitter against the Washington Nationals and a three-start stretch in which he allowed a total of two hits in 22 innings. Cease was not as dominant. He only went 5⅔ innings and needed 101 pitches (only 59 strikes) to do that.

But the Dodgers managed just one run against him on an RBI double by Lux in the third inning. They struck out six times against Cease and four more times in 3⅓ hitless innings against the Padres’ bullpen.

While losing four of the first five games on this road trip (which continues in Oakland this weekend), the Dodgers’ depleted lineup has managed 31 hits while striking out 66 times.

“Those guys – Mookie, Muncy, Freddie, other guys – those are dudes. Those are dudes that help us win ballgames so it’s tough,” Smith said of the key parts missing from the Dodgers’ lineup. “We still have a really good ballclub here without those guys. We just need to play better and win some ballgames.”

Originally Published: July 31, 2024 at 8:28 p.m.

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San Diego, CA

The best things to do this weekend in San Diego: Aug. 2-4

Published

1 day ago

July 31, 2024

Press Room

The best things to do this weekend in San Diego: Aug. 2-4

Here are some of the best things to do this weekend in San Diego from Friday, Aug. 2 to Sunday, Aug. 4.

Friday

Latin American Festival and Mata Ortiz Pottery Market: Artists from Mexico, Guatemala, Peru, Ecuador and other Latin American countries will showcase Mexican folk art, traditional clothing and textiles and Mata Ortiz pottery. There will be live music and artist demonstrations of woodcarving, painting and weaving. Admission is free and free parking is available at the Caltrans parking lot across the street after 5 p.m. Friday and all day on Saturday and Sunday. 10 a.m. to 8 p.m. Friday and Saturday. 10 a.m. to 5:30 p.m. Sunday. Bazaar del Mundo Shops, 4133 Taylor St., Old Town. Free. bazaardelmundo.com/event/latin-american-festival.

First Friday Art Walk: The First Friday Art Walk, a La Jolla Village event, will highlight more than two dozen galleries along with emerging artist pop-ups. Attendees can stroll through galleries and view artwork and enjoy sips and snacks. There is free admission and an all-day parking pass, along with an advance copy of this month’s Art Walk map. 4 to 7 p.m. Aug. 2 at LIK Fine Art La Jolla, 1205 Prospect St. lajollabythesea.com.

‘Rent’ in concert: Vocalists and the San Diego Symphony Orchestra will bring to life musical performances from the Broadway hit, “Rent.” 7:30 p.m. Friday. The Rady Shell at Jacobs Park. Tickets start at $66. theshell.org/performances/rent-in-concert/

Sarah O’Connor solo show: Culture Brewery and Tasting Room will present an exhibition of Pacific Ocean-themed paintings by this San Diego artist titled “Textures of Water and Light: Exploring the Timeless Moment.” Opens Friday and runs through Aug. 31. 111 S. Cedros Ave., Suite 200, Solana Beach. sarahoconnorart.com

Tiki Oasis: For five nights and four days, attendees to this cultural festival can experience live music, DJs, pool lounging, sunset dinners and tropical cocktails. At the Tiki Marketplace, 150 vendors will be selling a unique selection of tiki carvings, fine art, jewelry and vintage clothing all inspired by the tiki charm of the 1960s. Attendees can also immerse themselves in tiki culture at 40 different seminars. Some events are free to the public; check online for details. 8:30 a.m. to 2 a.m. Friday and Saturday; 8:30 a.m. to 11 p.m. Sunday. Town and Country Resort, 500 Hotel Circle North, San Diego. $45-$699. tikioasis.com/ticket

‘Beatles Experience’ at Moonlight: A performance, “Yesterday & Today: The Interactive Beatles Experience,” will be held at 7:30 p.m. Aug. 2 at the Moonlight Amphitheatre, 1250 Vale Terrace Drive. Admission is $22-$45. Visit moonlightstage.com.

Nat at Night: On Fridays in the summer, the Natural History Museum stays open late. Visitors can compete in trivia at 7 p.m. or enjoy food and drinks from Wolf in the Woods. Admission is half-price after 5 p.m. Fridays. San Diego Natural History Museum, 1788 El Prado, San Diego. $12 for adults, $10 for seniors and military, $7 for youth. sdnhm.org/calendar/nat-at-night

Free dance classes at First Friday: As part of First Friday activities at the ARTS DISTRCT in Liberty Station, free dance classes will be available for teens and adults. This month features the Beg Modern style. 5 p.m. Friday. TILTshift Dance, 2650 Truxton Road, San Diego. Free. libertystation.com/events/calendar

Saturday

All American Car Show: The All American Car Show features American cars, imports, classics and new models. The event is presented by the Mopar Club San Diego. Proceeds are donated to a designated charity or charities serving San Diego’s military community, including active-duty service members, reservists, veterans and families. 7:30 a.m. to 3 p.m. Aug. 3 at the Embarcadero Marina Park North, 400 Kettner Blvd., San Diego. moparclubsandiego.net/AACS.main.html.

Library event features pony rides, petting zoo: A Summer Celebration with pony rides and a petting zoo will be hosted as part of the library’s summer reading program. Highlights include crafts for kids. 10 a.m. to 1 p.m. Aug. 3 at the Mission Valley Branch Library, 2123 Fenton Parkway. sandiego.gov/public-library/locations/mission-valley-library.

A concert featuring 90s House Party: Kid ‘N Play, Tone Loc, Young MC, & Rob Base will bring a 90s house party to Vista. 7:30 p.m. Saturday. Moonlight Amphitheatre, 1250 Vale Terrace Drive. Admission is $52-$95. Visit moonlightstage.com.

Luann de Lesseps: The “Real Housewives of New York” star brings her “Marry F Kill!” show to El Cajon. 7:30 p.m. Saturday. Magnolia, 210 E Main St., El Cajon. $38.50. magnoliasandiego.com

Sunday

Major League Rugby Championship: Locals who are catching rugby fever from the Olympics can see top athletes in the sport compete in the Major League Rugby Championship on Sunday. The Seattle Seawolves will face off against the New England Free Jacks. There will also be a performance by Marshmello at the game. 1 p.m. Sunday. Snapdragon Stadium, 2101 Stadium Way, San Diego. $34.85. snapdragonstadium.com/events/detail/major-league-rugby-championship

Movies on the Beach at Hotel del Coronado: At the Hotel del Coronado, guests can watch this week’s screening of “Some Like It Hot” by the ocean. The hotel will be setting up an outdoor theater on the beach. General admission guests will be able to watch from the rows of chairs in the sand, while guests who purchase the Roast Family Movie Package, will have a private movie experience which includes a separate bonfire and s’mores. 8 p.m. Wednesday. 1500 Orange Ave, Coronado. General admission is $26.50 and the Roast Family Movie Package is $330. hoteldel.com/events/movies-on-the-beach

David Borgo Quartet to perform: The Friends of the Encinitas Library will host the David Borgo Quartet in a free concert. Saxophonist and composer David Borgo will present selections from his latest album, “Persistence.” The concert also features John Opferkuch on piano, Doug Walker on bass and Richard Sellers on drums. 2 to 3 p.m. Sunday. Encinitas Library, 540 Cornish Drive. Doors open at 1:30 p.m. Visit encinitaslibfriends.org.

Jazz concert features Wayne Shorter tribute: The Chase Morrin Trio will host a free Wayne Shorter tribute concert celebrating jazz saxophonist and composer Wayne Shorter. Morrin, who grew up in San Diego, is a graduate of the New England Conservatory and Harvard. He lives in Boston. 5 p.m. Sunday. Tio Leo’s Mexican Restaurant, 5302 Napa St. chasemorrin.com.

Originally Published: July 31, 2024 at 2:55 p.m.

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