For 2018, 15 states declared outbreaks of hepatitis A virus (HAV), which affects the liver and is spread via contaminated food, oral-anal sex, close personal contact with someone with the virus, using contaminated water for intravenous drug use and unsanitary conditions. The virus has largely affected homeless populations across the country.

The crisis reveals much about America’s failing public health system, suggests an article on the Huffington Post. Cases of hep A more than tripled in the United States in 2018, and more than 10,500 people have been affected. Some of the most notable HAV outbreaks have occurred in California, Kentucky, Ohio, West Virginia, Colorado, Indiana and Missouri—states where the opioid epidemic continues to take its toll and homelessness is on the rise. 

States, counties and cities have spent millions trying to fight their local outbreaks. But the spending has revealed a dark secret about the nation’s public health system—namely, that it’s collapsing as a result of funding cuts and can’t meet the demands of a growing at-risk and notoriously hard-to-reach population.

For example, officials report that more than 56,000 local health department jobs have been eliminated since 2008. Meanwhile, the costs of battling hep A have been astronomical for cities caught in the crisis.