Dr. Marc Siegel: Ancient typhus is plaguing modern day Los Angeles – How did we get here, what should we do?

Medieval life has made its way to modern-day Los Angeles, where groups of 4,000 or more homeless people huddle together on city streets constituting a “typhus zone.” In the heart of this west coast metropolis, storm drains are used for bodily waste, garbage piles up, and rats – yes, rats - (carrying fleas with typhus bacteria) swarm.

The rats are everywhere, climbing over the people, feeding off the garbage. Unfortunately, many of the fleas carry a tiny bacteria, a rickettsia, known as murine typhus. The fleas spread typhus to humans when flea-feces comes in contact with a victim’s cuts or their eyes.

What is typhus? Typhus is an ancient scourge that has been around for thousands of years. It’s the name for a group of infectious diseases that can leave patients with severe headaches, a fever, and a rash.


Of course, it has no place in a modern advanced society but there doesn’t seem to be any way for L.A. to get rid of it. The mayor of Los Angeles, Eric Garcetti, has pledged his support and funding to clean up the garbage, but so far the problem is getting worse, not better.

Ironically enough, this past week the typhus endemic spread to L.A. city hall itself, with rats and fleas infesting the old building to the point where LA officials are considering ripping out all the carpeting. Deputy City Attorney Liz Greenwood, who contracted typhus in City Hall said, “It felt like somebody was driving railroad stakes through my eyes and out the back of my neck.”

Indeed, typhus does cause a severe headache. It also may cause fever, muscle aches, fatigue, and a rash. It can be treated effectively with an antibiotic (doxycycline). Unfortunately, most of the homeless on the streets of L.A. don’t have access to the treatment.

L.A.’s homeless populations lives in cars, in tents, in lean-tos, in cardboard boxes. These streets were never intended for human habitation. There is a serious housing shortage in L.A. which has contributed to the growing numbers of homeless.

Homelessness surged by 75 percent from 2012 to 2018, due to a shortage of shelters or crumbling buildings to seek refuge in.

There are currently over 50,000 homeless people in L.A. County, with over 30,000 of them in the city of LA alone.

The homeless population is varied. First, almost a third of the homeless in Los Angeles are suffering from chronic mental illness. Second, among homeless adults with children, almost a third have reported working at least part-time. Imagine how dangerous it is from a public health point of view for working mothers with children to be living on the streets.

Unfortunately, L.A.’s restrictive land use policies have exacerbated the housing shortage brought on by businesses pulling up stakes and leaving town.

In New York City, which has put billions of dollars into its shelter system, only 5 percent of the homeless population does not have access to shelters, in L.A. by contrast, the number is a whopping 75 percent. Whereas the New York City government allocates roughly $17,000 for each homeless person, in LA it is only $5,000.


Cheap affordable subsidized housing in the form of projects and shelters are crucial to addressing the garbage/rats/fleas/typhus problem, even as regulations are loosened to attract more businesses. In addition, I believe that access to treatment for chronic mental illness including schizophrenia could be combined with placement programs.


We also need more direct public health services in terms of disease screenings and available antibiotics to treat typhus, which infected at least 124 people last year in L.A., and probably hundreds more whose symptoms went unreported.

Simply cleaning up the garbage in so-called “typhus zones” will not solve the problem, as people who have nowhere to go and nowhere to dispose of their waste will simply make more. And more garbage means more rats which means more fleas which means more typhus. Perhaps now that typhus has reached City Hall, the message will finally be received.