Sounding Off: Dr. Drew on How LA's Homeless Problem Is a Public Health Emergency

Drew Pinsky, MD, cannot understand how the situation on the Pacific Coast, and Los Angeles, in particular, is being tolerated.

“It’s beyond anything that is sustainable or rational or morally allowable,” he said of the humanitarian crisis that’s driving a rise in infectious diseases there.

Contagion® recently spoke with Pinsky, an internist, addiction medicine specialist, and prominent media personality, about the situation out West, what contributing factors are at play, and how health care providers can help.

Here is our full Q&A with Dr. Drew:

Contagion®: What factors are contributing to the rise in infectious diseases on the Pacific Coast and, particularly, Los Angeles?

Dr. Drew: We have a horrible humanitarian crisis in Los Angeles where the government has been unable, because of various legal maneuvers taken against them, to enforce local laws as it pertains to people sleeping on the streets. Not only sleeping on the streets, but also anything that they accumulate while they’re on the streets also can’t be touched because that’s “their belongings.” Even if it’s a schizophrenic who’s rolling his or her stool up into balls and saying, “that’s my belongings.”

We have just an atrocious situation. It’s almost without exception that the people who are really languishing on the streets and decaying have severe mental health issues, [the] most common being drug addiction, primarily opiate and stimulant, but also chronic severe major mental illness like bipolar disorder and schizophrenia. For some reason, the government has taken the position that this is a housing problem, which, of course, housing is a piece of this, but for most—and by most I mean the vast majority of people on the streets—their condition makes them unwilling or unwanting to go indoors. So, even when they correct the housing issue, they’re still going to have the same problem on the streets.

This is a result of the decay of the system we once had in place for treatment of the chronically mentally ill, which was strangled following the Community Mental Health Act in 1963. It was systematically completely eviscerated. There were no provisions given to the patients who were pouring out of these institutions…so they spilled into the prisons, the nursing homes, and the streets and that’s what started the spiral into our current situation.

Sanitation has also been ignored by the city. The sanitation circumstances around the homeless encampments has broken down to a point that I don’t think we’ve seen certainly not in the history of this country, and probably not anywhere in the last 800 years. It is an absolute complete breakdown where the people living on the streets are defecating and urinating on the streets and every excrement, every byproduct of what they’re eating and food and everything else is just piling in the streets. On some streets, it’s literally 2 stories high. These gigantic unsanitary accumulations…they’re just profound, they’re all over the city. By the city I mean the San Diego Valley, all the way to the beaches, it’s now spilled everywhere. It’s just uncanny.

Contagion®: What about the rise in “medieval” diseases not seen since the Middle Ages?

Dr. Drew: All of these dumps are completely overrun by rodents, just exploded with rodents. I became aware of this last summer when my own home became overrun and I thought, “Oh my God, I’ve never seen anything like this.” Having practiced medicine for 35 years in the San Diego Valley, I thought “Oh my God, we’re going to have a typhus outbreak.” Typhus is endemic in the region. It’s usually in the possums, the racoons, maybe the bats. But with the volume of rodents, I thought, “Wow, this is everywhere now and of course typhus is going to spread.” And it came. It was huge, it was terrible in the San Diego Valley, particularly in Pasadena. It spread all the way to the ocean. It did something I’ve never seen before; it crossed the 405 freeway, which is sort of a barrier between inland and coast. All the while the city denying that this was going on and taking the position that typhus is not a serious illness.

Things continued to deteriorate. I started talking to my infectious disease colleagues, and they were telling me that they were starting to see explosions of tuberculosis…Measles started breaking out…My concern was what happens when it gets into the homeless population, it could absolutely just tear through there.

So we have tuberculosis, measles, typhus…I started looking at what usually comes on the heels of typhus in this area, what’s endemic in this area, and that’s Yersinia. I spoke to an expert about this and, lo and behold, the last outbreak of bubonic plague (Yersinia) in this country was in Los Angeles when they had a major rat bloom. It was controlled because of some very clever maneuvers by several physicians. One of the maneuvers was killing over 2 million rats. I daresay this time we’d have to kill 12 million. It’s massive and it has spread. It’s been documented on the squirrels, and it’s just a matter of time before it gets on the rats, on then our pets, and then on us.

In the middle of this, we had a typhoid fever outbreak in a police precinct. We also have a large immigrant population coming in carrying parasites and tuberculosis.

I really dread what’s coming this year. We have essentially every means of transmission of infectious diseases represented in these outbreaks. We have oral-fecal with the typhoid. We have airborne with the tuberculosis and measles. We have rodent-vector with the typhus and the Yersinia. So here we go. Every major means and component of severe dangerous epidemic infectious disease are set up to go and nothing is being done.

Contagion®: What can be done to address these issues—from a health care provider standpoint and a policy standpoint?

Dr. Drew: People say it’s complex; I think it’s simple. First thing, I would go out and vaccinate all the homeless with MMR. My second move would be to go to the state legislature, which I’ve already done, and change the Lanterman-Petris Act, and we have to change the criteria for greatly disabled. In the 1960s, it changed from “need for treatment” to “harm to self or others” and that’s a giant gap. We have to have things like “unable to care for medical needs.” We have to be able to help people and protect their wellness.

What I would tell my peers is, why do we treat dementia—cognitive brain disorders—different from say, schizophrenia? Schizophrenia causes confusion and abnormal behaviors and lack of insight and impaired judgment. Same as dementia. But somehow dementia, of course we take these patients and help them. With schizophrenia, you can’t touch them. Our laws in California have privileged psychiatric symptoms over the wellness of the individuals and the ability of caretakers to get in and help them...It’s ridiculous. It’s the most absurd thing I’ve ever seen and it’s causing massive a decay in civilization and it’s going to endanger tens of thousands of people. We already have 1000 dead homeless people in Los Angeles so far in 2019. I think we all know how quickly that could click to 10,000. How many have to die before we do something?

First thing, is we revisit Lanternman-Petris Act. Second thing is we expand conservatorships. Third thing is we create some sort of facilities or focal areas of wraparound services for the chronically mentally ill. Fourthly, we start enforcing drug laws and helping motivate drug addicts to get better.

This is a humanitarian emergency.

The problem is the politicians are telling me I’m too early. My theory is I’m too late. If I’m too early, what is too late? When there’s 100,000 dead? I don’t understand the alchemy; I don’t understand the math. I wake up every day beside myself. As a physician, all my susceptibilities are activated to do something. It’s beyond anything that is sustainable or rational or morally allowable.

Contagion®: What are your words of wisdom to your peers in health care?

Dr. Drew: Physicians cannot, any longer, remain silent. Ideology, whenever it rules the day, does great harm to human beings. In California, ideology is absolutely ruling the day and it’s destroying our state. Physicians have to speak up about the health consequences of allowing ideologies to rule the day.

Speak up and talk about what you’re seeing in the emergency rooms and in the clinics. We are the early detection systems. We know what’s going on before anybody. We see the trends, we know what they are, we see it coming. I personally feel like I’m standing on the railroad tracks waving at a train trying to tell him the bridge is out and getting flipped off by the engineer. I’m encouraging you to stand on the tracks and wave if these things start happening in your community. If not us, who?