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

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 coast.

The 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/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.

"At the heart of this homeless crisis is a housing crisis," said Jim Vargas, a Roman Catholic deacon who runs Father Joe's Villages, one of California's largest providers of services to the homeless. "Low vacancy rates and high rents is a very toxic combination for our population. Our clients don't stand a chance against that dynamic."

Permanent housing

California often has limited development in its most desirable areas, either through heavy regulation or popular referendum. The practice has boosted property values. But those without a foothold in the market have found it increasingly difficult to find a path in.

The state's poverty rate has become the highest in the nation, a direct result of housing costs that statewide exceed twice the national average.

A long policy debate over how to address homelessness has coalesced around "housing first," an approach that emphasizes getting the homeless into permanent housing as quickly as possible and then treating the mental illness, addiction and other issues that often surround those living outside.

It is one of the few policy areas where California's political leadership agrees with the Trump administration. Secretary Ben Carson's Department of Housing and Urban Development prioritizes funding for permanent housing projects. While this has proved more effective than treating the homeless in shelters or temporary housing, the approach places an even higher premium on available housing stock that many California cities do not have.

Amid a state budget crisis six years ago, Brown decided to steer money once available to cities for low-income housing construction toward debt servicing and schools. San Diego has lost an estimated $200 million in affordable housing funds.

The result has been that little, if any, affordable housing has been built since then in cities that at the same time have approved high-end redevelopments, typified by the apartment buildings with names such as Urbana and Fahrenheit that line the streets around Petco Park — home of the San Diego Padres — a baseball stadium the city subsidized when it was built 13 years ago.


San Diego’s homeless population struggles as the state’s housing crisis grows. (Sandy Huffaker/The Washington Post)

State officials — and concerned voters — are scrambling to make up for lost time. Brown signed legislation in September that will place a $4 billion bond measure on the ballot next year to finance the construction of low-income housing.

In Los Angeles, where more than a dozen people have received diagnoses of hepatitis A in the past month, voters last year approved a $1.2 billion bond measure to build housing for the homeless. Such ballot initiatives often fail to achieve the two-thirds majority needed for approval, but this one exceeded it by 10 percentage points.

"It demonstrates the frustration people are feeling," said Jonathan Herrera, the senior adviser on homelessness to San Diego Mayor Kevin Faulconer (R). He spoke of the Los Angeles vote but said such sentiments over the state of the homeless and the condition of a recently remade downtown were rising in San Diego.

Herrera, who has been in the job only a few months, said the surge in homelessness is linked to the state's decision to redirect ­affordable-housing money. A count conducted in January found that 9,116 people are homeless in San Diego County — the fourth-highest population in the nation — with more than half living on the streets.

Faulconer, considered a possible Republican candidate for governor, has been sharply criticized by homeless advocates and his base within the San Diego business community. In recent weeks, he has outlined more than $100 million for affordable housing to be spent over the next several years. Nearly a dozen "surplus" city buildings also have been identified for possible renovation into low-income housing.

"San Diego is at a tipping point, and the tipping point is: 'What do citizens here want the city to look like?' " said Gordon Walker, chief executive of the nonprofit Regional Task Force on the Homeless.


A homeless woman walks with her belongings in San Diego. (Sandy Huffaker/The Washington Post)

Walker came to San Diego from Utah, where he oversaw a sharp reduction in homelessness as the state director of housing and community development. He is a blue-blazer guy in a board-shorts town, a former Reagan administration official who points to Utah's plentiful stock of affordable housing and a government committed to preserving it as reasons for the success there.

"I look at this situation here as the growing gap between the haves and have-nots," Walker said. "This is where you need political will. It's political will that is needed to solve these social problems, and the decisions are not easy."

There is some good news in the numbers here: San Diego is a Navy town, and many of its homeless people are military veterans. That population declined in the past year, in part because of federal government programs directed at homelessness among veterans.

The number of homeless families also declined slightly, but there are unprecedented numbers of young people and chronically homeless people — defined in part as people who have been on the street for more than a year.

Vargas, of Father Joe's Villages, emerged from a rough South Bronx to spend a career at Citicorp and Copley Press before his ordination as a deacon a little more than a decade ago.

The operation he runs is vast: a collection of shelters and training centers; retail stores that sell donated goods; medical and dental clinics that care for his clients; and a finance arm that is embarking on a private, $531 million endeavor to build low-income housing and turn the city's fading motels into affordable apartments.

The shelters have a waiting list of 200 people every night. The length tends to discourage people from even trying, he said, keeping hundreds of homeless people from getting close to help. Last year, 20 children were born in the agency's housing and shelters.

"Why are they not with us? Because the inn is full," Vargas said. "The inn is always full."

On a warm recent evening, Michael McConnell, a volunteer advocate for the homeless, headed south through "carmageddon," the boom city's stop-and-go rush hour traffic, toward City Heights, where he was scheduled to lecture a police advisory board on what he calls the "criminalization of homelessness."

To the west, a skyline of cranes looming over new apartment buildings stands against the Pacific Ocean, "For Lease" banners flying from the unfinished developments. The rents will be too high for federal subsidies to fill gaps, and landlords, regardless, have too many potential clients to take what many view as a risk on once-homeless tenants.

McConnell is a small-business owner turned civic activist, a dealer in gold and rare coins who is self-taught in homelessness advocacy. The unruly inside of his Honda SUV signals that his first priority lies elsewhere: in seeking to convince a frustrated city that the homeless should not be punished with fines and jail time for not having homes, especially in a white-hot real estate market.

"We cannot make homelessness disappear," McConnell told the advisory board, criticizing a recent weeks-long campaign to break up highway homeless encampments and past tactics such as spreading sharp rocks beneath highway underpasses to keep people from sleeping there.


Homeless people are more susceptible to hepatitis A because of their living conditions, but it is difficult for them to afford California’s exorbitant housing prices. (Sandy Huffaker/The Washington Post)
Tension on the block

Along Island and 16th streets, the night air is laced with the smell of urine. A child plays tag with his father against the mosaic wall of the Extended Hand Mission, dodging scattered toys, a bicycle, the remnants of a handout sandwich and other detritus of street life and former lives.

Since the hepatitis A outbreak, the charitable food deliveries have grown more infrequent amid fear of the contagious disease. The hunger causes tension on the block; one woman said that homeless people from outside their little enclave have become a threat.

"They have been coming by and stealing your backpack, your money," said Jeanette Reynolds, who has been living on the streets of San Diego for nine years with her partner, Ralph Bennett, a Marine Corps veteran. "It's gotten frightening now."

For Donna Gaines, her place here is new and, she hopes, temporary. A security guard who for a dozen years lived in federally subsidized housing, Gaines was recently evicted from her building after it failed to pass inspection. She used to pay $1,075 a month and has not been able to find anything in that range since her eviction.

Her home for the past few months has been her dented Hyundai Santa Fe, which she shares with her dog, Brownie. She parks near Reynolds and the Humble Heart Thrift Store, hoping strength in numbers proves true on the street.

"We watch over each other," Gaines said, waving down a passing group of volunteers ladling soup. "But really it's just me and my dog. He's the only thing keeping me going right now."

After the cup-of-soup dinner, Gaines drove south for her shift in an Otay Mesa warehouse. Her parking space outside the thrift shop awaited her when the Hyundai again became her home.