A Winnipeg doctor says she’s worried governments are only offering Band-Aid solutions as hepatitis A continues to spread more than a year after Manitoba declared an outbreak.
Dr. Kiran Jhinger, an internal medicine physician at Health Sciences Centre, said seeing cases of the infectious liver disease has become commonplace even though they were a rarity at the hospital not long ago.
“It’s rare in the past six months for me to come to work and not have at least one patient with acute hepatitis A,” she said.
The province said last week 601 hepatitis A cases have been reported since an outbreak began in northern Manitoba last year, with 131 of them in Winnipeg. The outbreak has led to 133 hospitalizations, five intensive care unit admissions and three deaths.
Jhinger said vulnerable populations — including people who are homeless or use drugs— are at particular risk, adding the surge in cases shows many Manitobans’ basic needs are not being met.
“This happens when there’s a lack of proper sanitation, there’s a lack of sewage management, there’s a lack of access to clean water to drink,” Jhinger said.
“I’m very worried that more vulnerable people are going to be hurt,” she said, adding the disease is “absolutely preventable.”
In a statement, Winnipeg non-profit Main Street Project said it’s implemented several measures, such as increased cleaning of high-touch areas, at its shelter amid the outbreak.
Staff are also performing extra washroom cleanings, added more soap dispensers and repaired water fountains for quick drainage, among other measures.
Dr. Carol Kurbis, medical officer of health in communicable diseases with the Manitoba government, said the disease can be difficult to control.
“You can be contagious for up to two weeks before symptoms develop and up to a week afterwards. So, you can be spreading the virus before you’re even aware that you’re sick,” she said.
“Here in Manitoba, we haven’t had a significant hepatitis A outbreak really since the ’80s.… So, it’s been a long time since we’ve seen an outbreak like this.”
Kurbis said there have been sporadic hepatitis A cases in some regions but most are still connected to communities dealing with existing outbreaks.
Cases were initially centred around communities in Island Lake, with Garden Hill — one of the four First Nations in the area — declaring a state of emergency in November.
Alex McDougall, grand chief of Anisininew Okimawin — which represents the four communities — said Wednesday the crisis has made addressing a lack of critical infrastructure for the remote First Nations more urgent.
“It’s hitting our communities and our families very hard,” he said.
McDougall said a five-year-old boy from Wasagamack was among the deaths linked to the disease.
Indigenous Services Canada said in a statement it’s been supporting community-wide vaccination clinics. But McDougall said the federal government had done little to address the issues that led to the outbreak to begin with.
“Most of our homes don’t have running water, they don’t have plumbing,” he said. “It’s a challenge to keep homes healthy, and the members that reside in them.”
McDougall said they did receive federal funding to determine what was needed to improve the infrastructure, but that only applied to Garden Hill. He’s waiting for officials “to come to the table with a solution.”
Indigenous Services said it’s funded the purchase of water delivery trucks and for cisterns and sewage holding tank repairs at Garden Hill.
“We had anticipated this would become a [provincewide] issue,” McDougall said.
“It’s unfortunate … there seems to be very little in proactive planning to stop the spread of hep A from its source.”
Manitoba Health Minister Uzoma Asagwara said the province is happy with steps the federal government has taken to address the outbreak at Island Lake so far, but more must be done.
Last May, the province expanded eligibility for free hepatitis A vaccines to Island Lake residents who were six months or older. Eligibility has also been since also expanded in Peguis, War Lake and Bloodvein River First Nation.
‘Clearly an emergency’
People who travel to those First Nations or receive visitors from them, and inmates of correctional facilities, are also eligible. Those who are experiencing homelessness, use drugs or have high-risk certain conditions might also qualify.
Jhinger said provincial officials should declare a public health emergency for hepatitis A like they did with HIV last week, saying the situation was “clearly an emergency.” She said there should be a mass community outreach campaign to inform people about hepatitis A, and get them vaccinated.
Kurbis said declaring an emergency wouldn’t necessarily change what the government is doing.
“We have released a public health advisory to make sure that everyone is aware of the issue.… So, in some senses, we’re already doing the steps that we would, you know, if it was a formal declaration,” she said.
Asagwara told reporters Wednesday the province will follow guidance from public health experts.
“We are a government that believes in science,” the minister said. “We believe in evidence and data.… So, we’ll continue to work with our officials here.”
Dr. Kiran Jhinger, an internal medicine physician in Winnipeg, says the province is irresponsible for failing to declare a state of emergency amid a hepatitis A outbreak.
