October 25 at 5:51 PM 

A homeless man sleeps along 14th Street in the East Village area of downtown San Diego on Sept. 26. (Sandy Huffaker/For The Washington Post)

SAN DIEGO — California’s exorbitant housing costs are driving a public-health crisis here, as a ­developing-world disease is racing through homeless encampments in cities along the coastThe hepatitis A outbreak in Los Angeles, Santa Cruz and San Diego, long considered a model of savvy urban redevelopment, is the extreme result of a booming state economy, now driving up home prices after years of government decisions that made low-cost housing more difficult to build.

Unlike in some other large U.S. cities, the homeless population in San Diego has been rising sharply, outstripping the local government’s ability to manage its scope. State lawmakers passed more than a dozen measures in the recent legislative session to address the state’s lack of affordable housing, none of which will help resolve the crisis in the short term.

Nowhere is the need more urgent than in this prospering city, where the number of people living on the streets rose 14 percent in the past year, tracing a hepatitis A outbreak that thrives in unsanitary conditions. Health officials believe an epidemic that has infected more than 500 people statewide since March began in San Diego County, where 19 people have died as a result of the disease, nearly all of them homeless.

Extremely rare in the United States, and rarely fatal when it does occur, hepatitis A attacks the liver and causes symptoms such as fever, nausea and jaundice. It is spread when a person ingests food or water tainted by the feces of someone who is infected — that is, it is a virus that stalks the unclean places where the poor are often consigned to live. California Gov. Jerry Brown (D) declared a state of emergency as the result of the outbreak this month.

“An epidemic like this in California — are you serious?” said Timothy Berry, 48, who lives amid the mattresses and tarps lined up along 16th and Island streets outside God’s Extended Hand mission.

Berry lives below the brushed-steel apartment buildings that in recent years have remade this city’s downtown, on streets that crews now power scrub with bleach. Portable toilets and hand-washing stations mark downtown corners in the shadows of buildings where sea kayaks are visible through the glass balconies of $2,000-a-month studios.

The first of three large, city-sanctioned tents opened earlier this month to bring some of the more than 9,000 homeless people into sanitary conditions, at least temporarily. A vaccination program that already has protected more than 65,000 residents continues with guidance from the Centers for Disease Control and Prevention, which has called this outbreak the deadliest since it began tracking the disease in the United States two decades ago.

Paulina Bobenrieth, a nurse with the public health department, gives a hepatitis A vaccine to a homeless man in San Diego on Oct. 4. A hepatitis A outbreak has killed numerous homeless people and sent hundreds to hospitals. (Sandy Huffaker/For The Washington Post)

But the long-term solution is simple and elusive: constructing more housing that those on the streets, and the estimated 500,000 San Diego County residents living a missed paycheck away from homelessness, can afford.

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