A Boyle Street Community Services Health Series
Since September of 2022, there has been an outbreak of Shigella amongst folks who are living rough in Edmonton’s downtown core. Shigella is a bacterium that causes extreme gastro-intestinal (GI) distress for the people who have contracted it and is extremely easy to catch.
It is most often found in disaster zones.
In this outbreak, approximately 70% of people diagnosed with Shigella were hospitalized – a staggering number - and it is unknown how many people had the illness but did not seek medical care. The illness has stayed confined to houseless people in Edmonton’s downtown core.
Shigella is not the only germ that can cause GI upset - conditions such as norovirus and food poisoning do as well. But this Shigella outbreak was made possible by the specific conditions faced by people who are houseless or in encampments, which limit their ability to manage and recover from illness. If you have ever experienced an explosive GI illness, you know it is difficult to cope with its challenges in your own home - for the folks on the street, the challenges are amplified.
Shigella symptoms include cramping, diarrhea, fever, stomach pain, dehydration, and feeling generally exhausted and unwell. Its onset is rapid. If you are living in a place where there is no bed, no warmth, no washroom, no chance to wash your hands, then your ability to manage any illness - let alone Shigella - is greatly reduced. Can you find a place to lie down, a washroom you can use immediately, running water to wash yourself, warmth, medical care, fluids? The sudden need to use the bathroom often leads to soiled clothing, tents, and blankets.
In the coldest days of winter, when tears freeze on your eyelashes and the air hurts your throat, survival is the priority. You might not be able to risk a trip to outdoor facilities, if there are even any nearby.
Your options for getting cleaned up or getting new clothing and blankets are limited. Handwashing, toilet paper, and water to drink are not easily accessible. All of this increases the potential for transmission. And when people don’t have a home, the testing for the bacteria becomes complicated and can be intrusive. However, the treatment is relatively simple - a single dose of antibiotics.
Where do you go for help?
But it is hard for people to find trusted medical care - where do you go for help? What might happen to your belongings while you are away seeking help? Do you even have any transportation? Are you exhausted, with no energy to seek care? Do you have a phone? Many don’t.
Finding enough fluids and appropriate food is challenging and having a place to rest and recover is also difficult, as there are few options for people who are sick and needing supportive care. If the person has a pre-existing illness, managing those issues while having Shigella is extremely difficult. And there is the issue of people feeling extreme shame and embarrassment if they soiled themselves.
All these challenges and more led to the Shigella outbreak. But as it continued through the fall and winter, a number of partners came together to try and stop it. In some cases, community members took it upon themselves to set up their own sick tents for friends and neighbours and provide the support they could. Radius Health and Healing, the nurses at Streetworks, and community paramedics all had access to the testing and medications for treatment. Radius - along with nurses from Streetworks - did two community blitzes to find and treat cases. The City of Edmonton expanded the number of community washrooms, and in two places installed temporary showers and washing machines. HireGood manned the stations and helped monitor the health status of people, hand out information, and disinfect the facilities after each use. They also connected people to health services.
What we did
Information was created by both Alberta Health Services (AHS) and Streetworks, recognizing the community has a generally low health literacy, reading ability, and conflicting priorities. The Food Bank made Purell wipes available and these were distributed to the community through the outreach workers from various agencies and the HireGood staff. There have been ongoing weekly meetings with the Medical Officer of Health, various AHS departments, Radius, Streetworks, the City of Edmonton, laboratory facilities, infectious disease specialists, and community agencies.
The outbreak is not over.
For the past several weeks there have been one or two new cases identified each week, recognizing that there are likely cases that haven’t been diagnosed, but still exist.
But the efforts to address this immediate outbreak continue and they have sparked good conversations about the conditions that led to the outbreak and how to prevent and respond in the future.