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Around the county, a spot check of hospitals shows a half dozen or more cases being diagnosed in some emergency rooms every week. “It is now the single most common cause of skin infections, which is remarkable, because five years ago it was close to zero,” says Dr. Gregory Moran, clinical professor of medicine in the department of emergency medicine and the Division of Infectious Diseases at Olive View–UCLA Medical Center. “It has quickly emerged as a cause of these infections in regular people out in the community. We now have showed that it is not just limited to people in specific risk groups. Now potentially everyone in the community is at risk. Healthy young people are getting it.” Moran says he sees one or two fatal cases of Skid Row staph annually.
Health officials do not even keep track of staph cases — unless they amount to an outbreak, where many people are infected in a short amount of time. Such an epidemic rages in L.A. County’s seven jails, where up to 300 cases are diagnosed every month. Eleven months ago, the infection claimed its first known jail inmate, a 53-year-old Los Angeles man.
The bacterium that transmits staph can be passed through touch, shared surfaces and personal items like razors or towels. It can stay on clothes or bedding for five days. The infection often is dismissed as a large pimple, ingrown hair or a spider bite, but it comes on quickly and is extremely painful. In some cases, it looks more like a rash or cellulitis. Most cases are easily treatable with antibiotics; in rare instances, staph can cause blood, bone and lung infections.
The increase in cases acquired outside the jail has unsettled some city officials, who believe that the city and county are not doing enough to monitor it, and that they are downplaying its seriousness, especially on Skid Row. More and more of the cases seen in the jail system originated on the streets.
“It is hard to believe that nobody has died from it when I have two people in my station who are at death’s door because of it,” says Smith. “One of my officers has been fighting it for weeks now. If I have two people out of 335 who nearly died from it, and these are young, healthy people with health insurance, I shudder to think of the people who are living in cardboard boxes and on the street that may be dying because of it.”
Emma (not her real name), 24, is sitting on an old wooden school chair with her right arm propped up on a small exam table at Homeless Health Care L.A.’s needle exchange and wound-care clinic on Fourth Street in the heart of Skid Row. Her young face is streaked with dirt and peppered with impetigo, a highly contagious form of Skid Row staph that causes blisters and itchiness. She’s lived on Skid Row on and off for four years. Her home is a sidewalk at Fifth Street and Broadway. She is skittish from years of crack and heroin abuse.
Unlike most of the clients, Emma, who is wearing a filthy yellow hoodie, a tank top, jeans and slip-on slippers, has returned to have her bandages changed. She gets infections regularly, mainly around the marks left by needles. She picks and pulls off the scabs. She whimpers and clutches the big red ski hat that covers her coarse yellow hair as Dr. Susan Partovi discards the dirty bandage from her wrist and drains the abscess that is bleeding and oozing pus. Partovi gently cleans the wound and chats amiably to Emma, who is getting more squeamish. In between gasps, Emma briefly talks about her husband, who is in jail, and her infant daughter, who is being taken care of by her mother. Partovi quickly tackles the wound on Emma’s left thigh, then gives her a brown paper bag full of Q-Tips, gauze, packing, bandages and a pair of scissors — just in case Emma doesn’t come back.
Partovi operates the wound-care clinic three days a week. It opened two years ago inside the needle exchange when doctors started seeing a large number of patients with staph infections. Partovi treats six patients a day. Ninety-five percent live on the street. Most of her patients, like Emma, are intravenous-drug users. Eighty percent get infected where the needle entered their skin.
“It is pretty bad,” says Partovi, who, along with another doctor, contracted the infection last year. “One of the issues we deal with at needle exchange is harm reduction, which includes decreasing the risk of getting infections. Using new needles, new filters and sterile water. We give them everything we can except for the heroin. That is one way we try and control it.”
Other health-care clinics in Skid Row have also seen a rise in cases. Union Rescue Mission reports at least three new cases a week. The Weingart Center treats six new cases.
“At a certain point, we won’t think of it as an epidemic but a new normal,” says Dr. Elizabeth Bancroft, a medical epidemiologist with the L.A. County Department of Health Services’ Acute Communicable Disease Control Program. “Doctors will just take it for granted and assume it will be [Skid Row staph].”