San Diego, CA
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:
San Diego, CA
Escondido officials need to enforce rules on illegal fireworks
Dec. 30 marked the one-year anniversary of our Facebook community group, Escondido Fights Illegal Fireworks: Coco’s Crusade. While awareness has increased, illegal fireworks continue unchecked. On Christmas Eve, our neighborhood was again bombarded. Our dog was shaking uncontrollably and had to be sedated — no family should have to medicate a pet to survive a holiday. This is not a minor inconvenience. Across the city, parents struggled to get children to sleep, residents with PTSD experienced severe distress and workers were left exhausted. These are deliberate, illegal acts that disrupt entire neighborhoods.
Other cities have taken decisive action by using drones and deploying officers on key nights. While Escondido’s mayor and council say they are listening, current measures lack urgency and enforcement. Families are fleeing town or sitting in cars for hours simply to find peace. Illegal fireworks violate noise ordinances and can constitute animal cruelty. Strong, immediate enforcement is required.
— Heather Middleton, Escondido
San Diego, CA
As shelter requests fail, San Diego leaders weigh changing who gets a bed
For years, asking for shelter in the city of San Diego has often been a first-come, first-serve process.
Everyone deserves a safe place to sleep, the thinking goes, so anyone living outside should have a shot.
But as the region’s overwhelmed shelter system continues to reject staggering numbers of requests, some leaders are considering overhauling that approach by creating a priority list based on vulnerability.
“Do we need to look at how we prioritize differently?” Lisa Jones, president and CEO of the San Diego Housing Commission, asked during a board meeting in December. “Maybe we have to look at our most vulnerable that are on our streets and think about it from that perspective.”
Local city-funded shelters have long been at or near capacity, with the pressure becoming particularly intense in recent months.
In November, San Diego received 2,442 requests for a bed, according to Casey Snell, a senior vice president at the housing commission. Only 199 of those led to someone getting a spot. That’s a success rate of around 8%.
The main reasons most requests failed were familiar ones: There just weren’t spots available.
The bigger picture is not much better. Since July, people have asked for shelter 12,275 times. A little more than 1,200 succeeded, meaning about 9 out of every 10 requests failed. “What happens with credibility and effectiveness when people repeatedly get a negative answer?” Housing Commissioner Ryan Clumpner asked during the same meeting. “Do they keep requesting, or do people, the more times they hear ‘no,’ begin becoming more resistant?”
Some residents are certainly asking more than once. November’s 2,442 beds requests were collectively made by 868 separate households, officials said. That’s an average of about 3 asks per individual.
‘It makes sense to me’
The idea of trying to rank those requests appears to have at least some supporters within both the service world and the homeless population.
Bob McElroy, CEO of the nonprofit Alpha Project, said in an interview that using vulnerability lists would be a return to how shelters operated decades ago. “I’ve been irritated all these years when they turned away from it,” he noted. Disabled residents, older adults, those who’ve been outside the longest — McElroy believes it’s only fair to give them first dibs.
That’s roughly the process already in place at Father Joe’s Villages, at least when it comes to beds relying on private, not government, funding. The stricter criteria applies to hundreds of spots in the nonprofit’s family, sober-living and recuperative care programs.
“We look at, for instance, is a person pregnant?” said Deacon Jim Vargas, Father Joe’s president and CEO. “If they have very small children, or if they’ve given birth recently, they’re considered more vulnerable.”
Gustavo Prado, a 52-year-old who’s been homeless for the last two years, agreed with the general concept. “It makes sense to me,” he said while standing on a downtown San Diego sidewalk.
Prado added that he’d been unable to get into a local shelter program. Speaking a few days before Christmas, he was trying to plan for the coming rain. “I gotta get a tarp or something.”
Shelters do sometimes focus on specific populations. There’s a program downtown, for example, for women and children, and another for young adults. But guidelines known as the Continuum of Care Community Standards, which help dictate who’s allowed in, don’t have prioritization criteria.
In response to a request for comment about changing the status quo, city spokesperson Matt Hoffman wrote in an email that “staff are always open to evaluating new tools to better serve those in need.”
Leaders will likely discuss the possibility of creating a priority list at another public meeting before a specific proposal is drawn up.
More requests
One factor potentially driving the surge in demand is San Diego’s decision to expand encampment sweeps.
In July, the city signed an agreement with the California Department of Transportation, or Caltrans, to get access to land that would normally be under state jurisdiction. Since then, many areas near freeways have been cleared of tents and dozens of individuals did receive some form of shelter. A few even made it into a permanent housing.
Yet they appear to be in the minority.
Housing commission officials have so far declined to blame the Caltrans agreement for the increase in requests, saying mainly that they’ll continue studying this trend. They did, however, note a few other factors at play.
For one, the city may be getting better at fielding requests for shelter. On the same day local crews got access to Caltrans property, San Diego opened a homelessness resource center in the downtown library. That office, known as The Hub, coordinates with the help line 211 to make it easier for people to ask for aid. “It’s actually streamlining our referral process, which is another reason you see a big jump,” added Snell, the vice president.
In addition, the San Diego County District Attorney’s Office continues to roll out a phone app that lets outreach workers look for shelter beds in the same way a tourist might search for hotel rooms. While it used to take hours to determine whether facilities had any openings, officials have said this program can flag vacancies within minutes.
San Diego, CA
11 from Point Loma High get All-CIF sports honors
Eleven members of Point Loma High School sports are among the All-CIF honorees announced recently in the San Diego Section, including a Coach of the Year.
Here are the Pointers selected:
Football
First team
Romeo Carter, wide receiver, senior
Mateo Correa, linebacker, senior
Second team
Brandon Bartocci, defensive line, senior
Owen Ice, defensive back, senior
Teams are based on a vote of media members and the Coaches Advisory Committee.
Girls cross country
Coach of the Year
Keith DeLong
DeLong guided Point Loma’s girls team to its best finish in school history this past season, placing second at the CIF Division III State Championships after winning the San Diego Section Division III title.
First team
Isabella Ramos, senior
Second team
Kelly McIntire, junior
Nicole Witt, senior
Sara Geiszler, senior
Teams are based on finishes at the San Diego Section championships.
Boys cross country
Second team
Ethan Levine, senior
Teams are based on finishes at the San Diego Section championships.
Girls tennis
First team
Noel Allen, senior
Teams are chosen based on finishes in the San Diego Section individual championships.
— The San Diego Union-Tribune contributed to this report.
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