California likely leads the nation in socially activist government kindness. It also leads the nation in homelessness, chronic homelessness, and homeless veterans. The US Council on Homelessnesses estimates that, on any given day, 129,972 Californians are homeless, including 6,702 family households, and 10,836 veterans; 34,332 people are listed among “the chronic homeless”. That is, Californians with a disability who have been continuously homeless for one year or cumulatively homeless for 12 months in the past three years. No other state comes close to these numbers. The vast majority of these homeless are in the richer areas of two rich California cities: Los Angeles and San Francisco (mostly Los Angeles). Along with the homeless in these cities, there’s been a rise in 3rd world diseases: cholera, typhoid, typhus, etc. I’d like to explore the relationship between the policies of these cities and the rise of homelessness and disease. And I’d like to suggest a few cures, mostly involving sanitation. 

Most of the US homeless do not live in camps or on the streets. The better off US homelessness find it is a temporary situation. They survive living in hotels or homeless shelters, or they “couch-serf,” with family or friends. They tend to take part time jobs, or collect unemployment, and they eventually find a permanent residence. For the chronic homeless things are a lot grimmer, especially in California. The chronic unemployed do not get unemployment insurance, and California’s work rules tend to mean there are no part time jobs, and there is not even a viable can and bottle return system in California, so the homeless are denied even this source of income*. There is welfare and SSI, but you have to be somewhat stable to sign up and collect. The result is that California’s chronic homeless tend to live in squalor strewn tent cities, supported by food handouts.

Californians provide generous food handouts, but there is inadequate sewage, or trash collection, and limited access to clean water. Many of the chronic homeless are drug-dependent or mentally ill, and though they might  benefit from religion-based missions, Los Angeles has pushed the missions to the edges of the cities, away from the homeless. The excess food and lack of trash collection tends to breed rats and disease, and as in the middle ages, the rats help spread the diseases. 

The first major outbreaks of the homeless camps appeared in Los Angeles in August and September of 2017. They reappeared in 2018, and by late summer, rates were roughly double 2017’s. This year, 2019, looks like it could be a real disaster. The first case of a typhoid infected police officer showed up in May. By June there were six police officers with typhoid, and that suggests record numbers are brewing among the homeless.

To see why sanitation is an important part of the cure, it’s worth noting that typhoid is a disease of unclean hands, and a relative of botulism. It is spread by people who go to the bathroom and then handle food without washing their hands first. The homeless camps do not, by and large, have hand washing stations. and forced hygiene is prohibited. Los Angeles has set up porta-potties, with no easy hand washing. The result is typhoid epidemic that’s even affecting the police (six policemen in June!).

Historically, the worst outbreaks of typhoid were spread by food workers. This was the case with “typhoid Mary of the early 20th century.” My guess is that some of the police who got typhoid, got it while trying to feed the needy. If so, this fellow could become another Typhoid Mary. Ideally, you’d want shelters and washing stations where the homeless are. You’d also want to pickup the dirtier among the homeless for forced washing and an occasional night in a homeless shelter. This is considered inhumane in Los Angeles, but they do things like this in New York, or they did.

Typhus is another major disease of the California homeless camps. It is related to typhoid but spread by rodents and their fleas. Infected rodents are attracted to the homeless camps by the excess food. When the rodents die, their infected fleas jump to the nearest warm body. Sometimes that’s a person, sometimes another animal. In a nastier city, like New York, the police come by and take away old food, dead animals, and dirty clothing; in Los Angeles they don’t. They believe the homeless have significant squatters rights. California’s kindness here results in typhus.

The last of the major diseases of the homeless camps is cholera. It’s different from the others in that it is not dependent on squalor, just poor health. Cholera is an airborne disease, spread by coughing and sneezing. In California’s camps, the crazy and sick dwell close to each other and close to healthy tourists. Cholera outbreaks are a predictable result. And they can easily spread beyond the camps to your home town, and if that happens a national plague could spread really fast.

I’d discussed R-naught as a measure of contagiousness some months ago, comparing it to the reproductive number of an atom bomb design, but there is more to understanding a disease outbreak. R-naught refers merely to the number of people that each infected person will infect before getting cured or dying. An R-naught greater than one means the disease will spread, but to understand the rate of spread you also need the generation time. That’s the average time between when the host becomes infected, and when he or she infects others. The chart above shows that, for cholera, r-naught is about 10, and the latency period is short, about 9 days. Without a serious change in California’s treatment of the homeless, each cholera case in June will result in over 100 cases in July, and well over 10,000 in August. Cholera is somewhat contained in the camps, but once an outbreak leaves the camps, we could have a pandemic. Cholera is currently 80% curable by antibiotics, so a pandemic would be deadly.

Hygiene is the normal way to prevent all these outbreaks. To stop typhoid, make bathrooms available, with washing stations, and temporary shelters, ideally these should be run by the religious groups: the Salvation Army, the Catholic Church, “Loaveser and Fishes”, etc. To prevent typhus, clean the encampments on a regular basis, removing food, clothing, feces and moving squatters. For cholera, provide healthcare and temporary shelters where people will get clean water, clean food, and a bed. Allow the homeless to work at menial jobs by relaxing worker hiring and pay requirements. A high minimum wage is a killer that nearly destroyed Detroit. Allow a business to hire the homeless to sweep the street for $2/hour or for a sandwich, but make a condition that they wash their hands, and throw out the leftovers. I suspect that a lot of the problems of Puerto Rico are caused by a too-high minimum wage by the way. There will always be poor among you, says the Bible, but there doesn’t have to be typhoid among the poor, says Dr. Robert Buxbaum.

*California has a very strict can and bottle return law where — everything is supposed to be recycled– but there are very few recycling centers, and most stores refuse to take returns. This is a problem in big government states: it’s so much easier to mandate things than to achieve them.

July 30, 2019. I ran for water commissioner in Oakland county, Michigan, 2016. If there is interest, I’ll run again. One of my big issues is clean water. Oakland could use some help in this regard.