King County, Washington, which includes Seattle, has been hit with dual outbreaks of hepatitis A virus (HAV) and coronavirus, The Seattle Times reports.

Local health officials largely expected the hep A outbreak, given the recent major outbreak in San Diego. Experts and advocates had maintained that Interstate-5, which connects the major West Coast cities, would ultimately serve as a conduit by which hepatitis A would travel north to King County.

Since the beginning of the year, more than 100 people have contracted hep A in King County. This compares with just five to 16 people contracting the infection during each of the last ten years.

Nearly half of the new cases of hep A have been among people experiencing homelessness.

As Seattle’s real estate market has boomed in recent years—thanks in no small part to the extraordinary success of Amazon, which is headquartered there—the city’s homeless population has also exploded. Homeless encampments are scattered across the city.

Seattle was the first major U.S. city to experience a significant outbreak of coronavirus. In recent weeks, however, New York City has far surpassed any other city in its rates of coronavirus diagnoses and deaths.

Lockdown restrictions in Seattle, as in other cities across the country, have severely restricted the availability of public bathrooms.

Homeless advocates have faulted Seattle for not doing enough to ensure that people living outside have access to toilets and clean drinking water—vital factors in the effort to prevent hep A.

In a Seattle City Council hearing, Deputy Mayor Casey Sixkiller stated that the city has experienced challenges in providing new hygiene resources for people experiencing homelessness, including vandalism of hygiene stations and staffing concerns.

Then there’s the matter of cost. Seattle Mayor Jenny Durkan, has repeatedly requested additional resources, including funding from federal and state coffers and staffing, to support such hygiene stations. She reported having written to the Federal Emergency Management Agency and Vice President Mike Pence.

In March, the Centers for Disease Control and Prevention established guidelines that encouraged local governments to provide access to handwashing stations and portable toilets in order to prevent the spread of coronavirus.

To read the Seattle Times article, click here.