Young Kwak photo
Some people staying at the city's Trent homeless shelter have been infected with Shigella, a diarrheal illness.
Spokane’s homeless community is suffering from a serious outbreak of Shigella — a bacterial infection that spreads through fecal-oral transmission, and can cause severe diarrhea, fever and stomach pains that can in some cases result in hospitalization.
As of Dec. 13, the Spokane Regional Health District has confirmed 63 cases in Spokane County, says Mark Springer, the health district's manager of communicable diseases and infection. Only a couple of cases have involved people who aren’t experiencing homelessness, Springer says.
The total number of cases is likely higher, Springer says, as people with milder symptoms might not get tested, especially if they are experiencing homelessness and don’t have easy access to medical care.
“What we have here is kind of the tip of the iceberg,” Springer says. “This is fairly widespread because it is so tied to access to sanitation.”
The district identified the first Shigella case in Spokane County on Oct. 29.
At a Spokane Homeless Coalition meeting last week, Erin Whitehead, an epidemiologist with the health district, said the district declared a Shigella outbreak in Spokane County on Nov. 20.
The district declared a separate outbreak of Shigella at the city’s 350-bed Trent Avenue homeless shelter last week. Springer says a little less than a quarter of cases have been associated with the Trent shelter, and that most other shelters in the city have had at least one or more cases.
“We look at this as a large outbreak in people experiencing homelessness, and within that, we’re going to have little mini outbreaks that we can identify that are maybe linked to a specific site,” Springer says.
Shigella is a gastrointestinal infection caused by fecal bacteria. Symptoms can vary in severity and be exacerbated by other chronic medical issues. Symptoms usually start one or two days after infection, and last for about a week. Springer says the total number of cases that required hospitalization was higher in previous weeks, and is now slightly less than 50%.
During last week’s homeless coalition meeting, Whitehead told providers that the infection is often spread through sharing cigarettes, drug paraphernalia, touching surfaces and sharing food.
Springer says there isn't much risk to the general population at this time, but that larger community spread is possible.
“It can move outside the community of people experiencing homelessness,” Springer says. “It’s not a hard line in terms of that community and the broader Spokane community as a whole."
In a Wednesday news release, Spokane County Health Officer Dr. Francisco Velázquez recommended people wash their hands often — especially after using bathrooms, changing diapers and preparing or eating food. People should also clean high-touch surfaces throughout the day and encourage people around them to practice good hand-washing and use hand sanitizer.
Photos showing the condition of the bathrooms and hand-washing stations at the city's Trent homeless shelter were sent to City Council members on Thursday, Dec. 7. The email did not specify when the photos were taken.
A lack of access to restrooms, hand-washing stations and clean clothes can make people experiencing homelessness especially vulnerable to Shigella, Springer says, adding that the health district has been in touch with local homeless shelters and providers to share guidance on improving hand washing and sanitation at local shelters.
“Part of that is looking at toilets,” Springer says. “That’s access to toilets, but also looking at cleaning toilets… what we're really encouraging is to up that cycle of cleaning so we’re cleaning at a much more frequent rate.”
The city’s Trent homeless shelter lacks permanent indoor toilets and running water. The people staying there use portable toilets and mobile hand washing stations, which some advocates have criticized as insufficient, unhygienic and inhumane.
Photos sent to Spokane City Council members last Thursday show the bathrooms and hand-washing stations at the Trent shelter in a pretty rough state. The email to council members doesn’t specify what date the photos were taken.
Council member Paul Dillon says the images are “horrific.”
“Human beings should not be subjected to these unsanitary conditions,” Dillon says. “This outbreak happens from not having proper sanitation and hand washing.”
Springer says the health district has done multiple walkthroughs of the Trent shelter to work with the Salvation Army — which the city contracts with to operate the shelter — to “optimize what they can do relative to what our guidance is.”
“I understand that there’s always challenges with that, and I understand with a shelter that size there can be some issues,” Springer says. “But in response to this outbreak, we’ve seen some good changes put in place to increase that frequency of cleaning and to provide some additional support.”
Springer says the Salvation Army has also taken the health district's guidance and started providing water bottles for drinking water instead of having guests use a self-serve water spigot as they have been.
The health district emailed City Council members to inform them of the outbreak last Thursday. Dillon says he’s frustrated that they weren’t informed sooner, and that the alert didn’t mention the separate outbreak declared at the Trent shelter.
“It just underscores why we need to have council representation at the health district,” Dillon says.
Springer says the number of Shigella cases in Spokane County is significant and cause for concern.
In past years, the annual number of cases logged by the district has been in the single digits or low teens, Springer says.
This is the first time an outbreak has been declared in Spokane County. Springer says King County previously dealt with an outbreak among its homeless population that lasted for several years, and that Yakima County has spent much of this year fighting an outbreak among its larger community.
Spokane dealt with a similar challenge when Hepatitis A spread among the city’s homeless community shortly before the pandemic. But Springer says the district was able to respond with vaccination.
Shigella is different, Springer says, “because we can’t vaccinate our way out.”
Although the outbreak is primarily impacting Spokane’s homeless population, Springer says the general public should still be aware and take precautions like hand washing. The holidays are an especially risky time because of parties and food sharing.
If people have gastrointestinal symptoms — even mild or moderate — they should avoid sharing or serving food to people and try to avoid contact with others. Children with symptoms should be kept home from school or daycare. Testing doesn’t require going to an emergency room, and can be done through a family doctor or urgent care setting, Springer says.
"We don't want to create an atmosphere of fear on this," Springer says. "At this point, what we want to encourage people to do is really focus on protecting their health and the health of other people."
The health district created a web-page with specific information on the outbreak for local homeless providers.
