Hepatitis A is spreading through poop on the streets. Philly is betting public bathrooms can stem the outbreak.

This article originally appeared on PlanPhilly.

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Public bathrooms will be deployed in Kensington as the city’s newest weapon in its battle against a growing Hepatitis A outbreak. The spread of the viral liver infection has been traced in part to human feces on the streets and parks in the River Wards neighborhood, the epicenter of the outbreak.

“We will be deploying hand washing stations as quickly as we can,” said Brian Abernathy, managing director for the city. “We intend to also provide some public toilets and public facilities, but that’s a harder challenge, especially as it relates to making sure they are safe and secure.”

The stand-alone hand-washing facilities could be installed in Kensington “in the next couple of weeks,” Abernathy said.

He said the city does not yet have a timeline for the installation of public toilets.

Philadelphia usually sees no more than six cases of Hepatitis A annually, said Abernathy. City officials count 117 confirmed cases this year to date, with more under investigation.

The Kensington, ground zero of the region’s opioid crisis, where many people struggling with addiction live on the streets, has grappled with poop on the street, in parks and on porches for years. Hepatitis A spreads primarily through contact with fecal matter.

“There’s so much human feces on the ground it’s unbelievable,” said  Jacelyn Blank, a board member of the East Kensington Neighbors Association and the co-founder of the group Philly Tree People, which plans and cares for trees in the city’s many leaf-deprived neighborhoods.

Blank recently contracted Hepatitis A.

The longtime community activist began feeling ill at the beginning of July. Her doctor diagnosed her with the virus after her skin and eyes began to turn yellow because of her failing liver.  Blank, 42, suffered from vomiting, diarrhea, and intense fatigue in the weeks leading up the diagnosis.

After returning home from the hospital, Blank ran into a friend who told  her that several other neighbors they knew had been exposed to Hepatitis A as well. All of them had recently handled neighborhood soil.

“The only thing we had in common is that we do urban gardening, we plant trees, clean green spaces,”  Blank said. “I can only deduce that even though I wear gloves, somehow I got in contact with infected human feces and somehow it got into my mouth.”

‘So much human feces on the ground’

Abernathy said the city has contemplated putting some kind of public bathroom facilities in Kensington for at least a year, going back to the erection of the encampments under three bridges near the Somerset elevated train stop.

Community leaders were originally split over the question, with some fearing that public restrooms would encourage more people to stay in the neighborhood.

“It’s been hard to get a community consensus, but I think that has shifted over the last month given the increase in hepatitis A,” said Abernathy. “I think most community members understand the need and we will be moving forward as quickly as we can.”

Public restrooms used to be much more common in cities, but they broadly fell out of use in the second half of the 20th century. Now many municipalities are seeking to reintroduce them, both to help unhoused people and to make downtown tourist zones more hospitable.

Hepatitis A, long on the decline, is another motivating factor. The viral disease is on the uptick in other U.S. cities grappling with homelessness and opioid addiction. Between 2016 and early 2018, San Diego saw almost 600 infections.

Los Angeles declared an outbreak among the unhoused and intravenous drug users  last autumn.

The California city now operates 31 public restrooms, including seven automated toilets and nine mobile bathroom stations that are open and staffed from 7 a.m. to 7 p.m. L.A. officials estimates a cost of $339,000 a year per toilet.

Abernathy said the city is reviewing several models, ranging from traditional portable toilet stalls to mobile bathroom stations with toilets and showers, similar to L.A.,  or something called the “Portland Loo.”

The Portland toilets are essentially stainless steel porta potties that connect directly to the plumbing system. The loos, patented by the City of Portland, are more expensive to install but easier to clean and maintain.

The Portland model also has the advantage of being difficult to tamper with, while still being unmanned.

Many other models either proved very sensitive to vandalism — Seattle recalled its 2003 public toilet program — or very expensive due to the labor costs of watching over the facilities.

This isn’t the first time that Philadelphia leaders have attempted to reintroduce public restrooms. During John Street’s administration, the city placed a pilot automated toilet on the apron of City Hall. The program never moved beyond that test phase.

“In this administration we’ve also looked at facilities and whether it makes sense to provide restrooms in Center City and Kensington and other high-tourist areas and areas with a larger number of homeless individuals,” said Abernathy. “We haven’t been able to find the model that makes sense and I think the difference in Philadelphia is that we have very narrow streets and sidewalks, so finding the space for facilities is also a challenge.”

The ongoing Hepatitis A outbreak has provided an impetus for swifter change. For residents like Blank, who has a young child, the facilities can’t come quickly enough.

She is frustrated that it’s taken the city this long to take action.

“The only thing I can do is wait for my liver to rejuvenate itself,” Blank said. “Otherwise I’m just stuck.”

In addition to sanitary infrastructure in the neighborhood, the city is also making vaccinations widely available.