When Elizabeth Greenwood, a Los Angeles deputy city attorney, contracted typhus from a flea bite in her City Hall East office, two things happened. First, it breathed life back into the sensational coverage of fall’s outbreak, with media outlets declaring that a fatal, medieval disease had taken up residency on the streets of Los Angeles—worse yet, it had infected the seat of civic power. Right-wing media gleefully presented the situation as evidence of the failure of Los Angeles liberalism.
Next, fingers began pointing at a possible culprit: the homelessness crisis. Councilman Joe Buscaino took the floor at a City Council meeting Friday, saying, “Rats are emblematic of how we lost control over the homeless trash and encampment issue.
“If we can’t protect the greatest symbol of our own democracy—our own City Hall, if we can’t protect our own staff from a medieval disease, then we should pack up and go home.”
But according to epidemiologists and advocates for the unhoused, this gets typhus wrong and risks further stigmatizing an already vulnerable group.
“One of the problems is that people may be confusing endemic and epidemic typhus,” says Dr. Tim Brewer, a professor of medicine and a member of the division of infectious diseases at UCLA’s David Geffen School of Medicine.
Typhus is not a single disease, but rather a group of diseases caused by different strains of bacteria. Unlike typhoid fever, which is spread by person-to-person contact, typhus gets into the human bloodstream through fleas, ticks, or lice. Murine typhus, a rarely fatal strain spread by fleas, is endemic to Los Angeles—it was here long before us and will be here long after us. Epidemic typhus, which is spread by body lice, is exceedingly rare in the United States. It occurs most often in areas of extreme deprivation, such as South Sudan or 15th century Europe, and has a much higher likelihood of causing death.
“That’s not what’s going on in Los Angeles,” Brewer says. “The problem is not the presence of the homeless people that’s causing the murine typhus outbreaks. It’s the presence of the rat-infected fleas.”
Even then, when the Los Angeles County Department of Public Health declared an outbreak of typhus October 4, the city designated Skid Row a high-risk area for typhus. Almost immediately, Mayor Eric Garcetti allocated an extra $300,000 for cleanup and sanitation efforts.
Asked whether any of the 17 cases of typhus in downtown had been traced to Skid Row, a spokesperson for the health department didn’t answer, but in earlier statements to LAist.com, officials said that they had not confirmed any cases there. Officials did point out that in eight of the 17 cases, the people diagnosed had been homeless.
“It is easy to blame folks who are unhoused, who are living on the streets of Los Angeles, who are living in encampments,” says Shayla Myers, an attorney at the Legal Aid Foundation who focuses on issues related to housing and homelessness.
To Myers, there is a bitter irony in the hand-wringing over the latest outbreak of typhus, which infected 149 people last year. “Typhus sounds awful and I would not wish it on anyone,” she says, “but there’s 150 people [with typhus] and we have 23,000 people who are living on our sidewalks and outside every day. That constitutes a true and devastating public health emergency.”
Ten miles from downtown, Pasadena also experienced a sudden uptick in typhus, with 22 cases in 2018—more than three times what health officials expected. Nonetheless, the city did not declare an outbreak of typhus. “We did not call it an outbreak because we could not pinpoint the human cases to one single geographical area,” says Adrienne Kim, public information coordinator for the Pasadena Public Health Department.
Notably, Pasadena saw more cases of typhus even while the city’s homeless population pales in comparison to downtown L.A.’s—677 and 1,552, respectively, according to the latest homeless count. None of the cases in Pasadena involved homeless individuals.
As for why the county decided to focus on L.A.’s Skid Row, some advocates suspect ulterior motives. “It’s highly, highly suspicious,” said “General” Jeff Page, widely considered the unofficial mayor of Skid Row, in an interview with LAist. “I see it as a result of the business sector putting pressure on the mayor and the City Council to do something now about Skid Row’s conditions.”
The declaration of an outbreak came one day after a highly contentious meeting at City Hall, where a group of 60 downtown residents and business owners voiced frustrations over the conditions in homeless encampments. Ten days before the declaration, the Legal Aid Foundation of Los Angeles, a law firm that represents low-income clients, sent a letter to Garcetti raising concerns about the legality of increased cleanups that allow for the “seizure and destruction of individuals’ belongings without affording them any legal protections.”
Currently, the city must abide by a federal injunction that blocks police and sanitation workers from seizing property from people living on Skid Row. The order allows for a handful of exceptions—if, for instance, the property “poses an immediate threat to the health and safety of the public,” another court case details.
“At face value, it appears to me that there’s a hidden agenda,” Page said.
A spokesperson for the county health department says that she was not aware of the October 3 City Hall meeting. The department would not respond to repeated questions about why Skid Row was designated high risk.
More broadly, this tension comes as the city plans to ramp up development in downtown. The proposal, titled DTLA 2040, would rezone Skid Row for market-rate housing, and include social service agencies and permanent supportive housing. But groups who advocate on behalf of Skid Row’s homeless community say that the plan will “connect upscale development that is already occurring on opposite sides of Skid Row, placing thousands of residents in the middle at risk of displacement”—in effect, gentrifying Skid Row.
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