A bacterial infection called Shigella has been rapidly spreading through homeless encampments in Portland, Oregon over the past few weeks, causing concerning outbreaks that public health officials say have reached crisis levels.
Over 170 Cases Confirmed So Far
As of December 28th, 2022, over 170 cases of Shigella have been confirmed in Multnomah County, mostly among the homeless population clustered in downtown Portland’s “Old Town” area (source). The outbreak is concentrated around tent encampments near the Willamette River, where lack of access to toilets and hygiene services has accelerated the spread of the highly contagious bacterial infection.
While Shigella outbreaks are not uncommon during Portland’s wet, rainy winters, the number of infections this year is the worst public health officials have seen in recent memory.
“This is a crisis situation,” said Multnomah County Health Officer Dr. Jennifer Vines. “The number of cases is the highest we’ve seen in at least five years.” (source)
Shigella’s Painful Symptoms
Shigella is a highly contagious intestinal infection caused by a family of bacteria called Shigella. According to the CDC, typical Shigella symptoms include:
- Diarrhea (often bloody)
- Fever
- Stomach cramps
- Urgent need to have a bowel movement
- Nausea
- Vomiting
For vulnerable populations like the homeless, Shigella can cause severe dehydration, malnutrition, and even death without access to medical treatment.
How Shigella Spreads
Shigella spreads quickly and easily through contaminated surfaces, food, liquids, and poor hygiene practices. According to Portland-area disease specialists:
- Shigella can spread through direct contact with an infected person’s feces during sex or limited access to toilets
- Contaminated surfaces and objects like clothes, bedding, or tents can harbor Shigella bacteria
- Unsanitary living conditions like lack of running water and toilets can propagate outbreaks
- Person-to-person contact and crowded spaces make transmission easier
“The combination of lots of people living outside very closely together without regular access to hygiene services, to sanitation, puts people experiencing homelessness at high risk of outbreaks like this,” said Multnomah County health officer Dr. Jennifer Vines. (source)
Portland’s Homeless Bear the Brunt
While occasional Shigella cases pop up across the Portland metro area every year, the vast majority of recent cases are concentrated among unhoused residents clustered in makeshift encampments near the Willamette River.
Lack of access to toilets, sanitation, medical services, and health education resources have created a crisis point for disease transmission among Portland’s homeless. Many were already immunocompromised before the recent outbreak, facing chronic malnutrition, underlying conditions, and substance abuse disorders.
Portland officials have tried providing portable wash stations and toilets to homeless encampments with mixed success. But without running water and bathroom access directly inside shelters and affordable housing units, major Shigella outbreaks seem likely to continue.
At least 10 people have already been hospitalized due to Shigella infections this winter. Health providers warn that the real number could be even higher.
Mounting Public Health Crisis
Between Portland’s ongoing homelessness crisis, rising cases of other infectious diseases like HIV and Hepatitus C, woefully inadequate shelter capacity, and threadbare street medicine and hygiene resources, public health officials say this latest Shigella outbreak was an predictable tragedy.
“We are past the point of crisis into outright catastrophe,” said Dr. Rachel Solotaroff, President and CEO of Central City Concern, which provides healthcare services to Portland’s homeless. “How many preventable outbreaks and deaths will it take before we act?” (source)
With Portland housing prices rising out of reach for many low income residents, shelter capacity vastly overwhelmed, and sweeps of homeless encampments continuing despite having nowhere else for people to go, Mayor Ted Wheeler and Multnomah County leadership face mounting pressure to address the spiraling intersecting public health crises among unhoused Portlanders.
What Comes Next?
Health officials are urgently working to contain the current Shigella outbreak through expanded vaccination efforts, sanitation measures, medical treatment, public awareness campaigns, and disease monitoring:
- More vaccine doses and antibiotics are being deployed to reach as many homeless Portlanders as possible
- Increased sanitation services, including more publicly accessible toilets, hand washing stations, trash collection, and medical waste disposal are temporarily being provided in key locations
- Public health alerts and medical outreach aim to educate homeless residents on Shigella risks, containment protocols, and treatment options
- Ongoing testing and surveillance will track the outbreak’s size and spread
However, health experts universally agree that the only long term solution is expanding housing availability and access for Portland’s homeless residents. Without safe, stable living conditions that include integrated healthcare resources, outbreaks of Shigella and other communicable diseases seem inevitable.
“Make no mistake, housing is healthcare,” said Terese Dubreuil, Executive Director of Do Good Multnomah. “The key is getting people access to permanent supportive housing with wraparound health services. Until then, Band-Aid measures will only stem, not stop, this public health crisis.” (source)
Uncertain Future
With Shigella cases expected to keep rising as winter drags on, fraught political battles over expanding regulated camping, shelter capacity, sanctioned encampments, and long term housing access will continue. Portland’s new voter-approved measure to dedicate hundreds of millions of dollars towards homeless services could take years to implement meaningful improvements.
In the meantime, public health officials are bracing for more cases and potentially fatal outbreaks of infectious diseases like Shigella among the thousands of Portlanders surviving on the streets. Without urgent action, the public health crisis will continue getting worse.
“The health disparities we’re seeing should shock the conscience of our community,” said County Chair Deborah Kafoury. “We must rally together to care for those most marginalized among us. We all have a role to play in crafting humane solutions.” (source)
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