An outbreak of Invasive Streptococcus A is spreading among Montreal’s homeless population and public health officials say it's already killed at least one person.
A letter sent by the CIUSSS for the south-center of Montreal called for shelters and other places that offer aid to the homeless to be vigilant,as six cases of streptococcus A have been found since March 13, with another two cases suspected but not confirmed. The warning notes that all cases carried the same genotype, one which is rare in Quebec and has not been seen in Montreal in several years.
Sam Watts, CEO of the Welcome Hall Mission, said he’s very disturbed by the outbreak.
“It’s very troubling because here’s the problem,” he said. “Vulnerable people don’t generally go to see a doctor, they don’t go to hospitals, they don’t like doing that. The problem is they don’t get treatment and if they don’t get treatment, then a disease like this can progress.”
Among those who have been infected in the current outbreak, all have been men between the ages of 44 and 75-years-old.
Kyle Foley, a resident of the Welcome Hall Mission, said there’s a small amount of places where Montreal’s homeless can go to sleep at night, which forces them into close contact with each other.
“When they’re in there and it’s hot, everyone knows virulent strains of disease, they grow bigger,” he said. “Not having any kind of training, scholastically, I would think it’s hygiene, a lot of guys don’t put a lot of emphasis on their hand hygiene.”
Brian Ward, a professor of infectious diseases and microbiology at the MUHC, said the homeless are at greater risk of medical conditions caused by microorganisms, including strep A. According to the CIUSSS warning, another outbreak of the same strain of strep was detected among Toronto’s homeless in March, 2016.
“Many homeless people have limited access to showers and bath and so many homeless people have problems with skin conditions,” he said. “If you have breaks in your skin, that’s a place where something like streptococcus A can enter.”
Ward said the outbreak likely doesn’t pose much of a threat to the general population. While he noted that in rare cases the disease can end in necrotizing fasciitis, or a bacterial infection that kills the body’s soft tissue, “as a general rule, it might live on our skin for a little while and then it’s beaten out by our normal flora.”
“There’s quite a large separation between homeless shelters and the general public,” he added. “Relatively few people go from the homeless shelters into the general community and people with group A strep and other skin infections come into the hospital all the time and we don’t panic.”
As shelters spread information to their inhabitants on how best to quell the current outbreak, Watts called on the government to stop others before they begin.
“I think the government needs to provide more resources to people who are on the front lines, like Welcome Hall Mission,” he said. “What we need to do is accompany people to medical appointments so we can get the kind of care you and I can get because we can advocate for ourselves. They have a great deal of difficulty advocating for themselves in the medical system.”
