At Radius Community Health, a clinic in Edmonton's inner city, every client who walks through the door is screened for symptoms of a shigella infection.
The clinic is on the front lines of the outbreak spreading in Edmonton's core that experts say underscores the disparities in the area. Shigella — a bacteria that can be picked up through contaminated surfaces, food or water — tends to be more easily transmitted in unsanitary conditions common to people experiencing homelessness or living in encampments.
Last year, an outbreak swept through Vancouver's downtown Eastside. Symptoms of shigellosis include persistent diarrhea, stomach cramps, vomiting and fever.
According to Alberta Health Services, as of Wednesday, there were 172 confirmed cases in Edmonton and 115 people had to be hospitalized — but physicians expect the actual number is much higher. The health authority said the first person became ill on Aug. 17, and the majority of the cases to date are "within the city's inner-city population," but no deaths have been reported.
Tricia Smith, executive director of Radius Community Health, formerly Boyle McCauley Health Centre, said the high hospitalization rate worries her.
"It's concerning because the population that it's affecting doesn't really have the resources that's needed to stop this spread," she said.
'A disaster' for those experiencing homelessness
The clinic has put up posters alerting clients to shigella symptoms along with a staff worker who screens for symptoms at the front doors.
Dr. Louis Francescutti, an emergency physician in Edmonton, said shigella is not much of a problem for healthy people who have easy access to bathrooms, laundry facilities and antibiotics.
"But for someone who's living rough or experiencing homelessness, this is a disaster," he said.
"You have to go to the bathroom six, seven times and at times, it could be very explosive diarrhea … And if you don't treat it, the bowel lining can become so weakened that bacteria gets into your blood and then you become very sick."
Every shift, Francescutti said he sees several patients suffering from shigella.
"In 2022, to have over 100 of these cases in Edmonton is frankly an embarrassment," he said.
'Overwhelming' experience for those sick
Joshua Bell lives in the inner city and said he started experiencing symptoms a few weeks ago.
"It was overwhelming, just awful," he said.
"The non-stop vomiting and the non-stop pooping — it was out of control. It scared the hell out of me."
Bell said he almost went to the hospital because he was so dehydrated, but went to the walk-in clinic instead. He received antibiotics and started to feel better within a couple of days.
It's "almost impossible" to maintain good hygiene when living in conditions like his, he said.
"Look around — there's not much fresh running water, heated water, soap," he said, adding he is trying to maintain good hygiene so he does not contract shigella again.
Social agencies on alert
Smith, of Radius Community Health, said she's concerned that the outbreak will worsen as the weather gets colder, saying people tend to huddle for warmth in tents or shelters.
"That potential for the illness then to pass from person-to-person becomes increased," she said.
Mustard Seed program director Kris Knutson said the social agency in the heart of Edmonton is working with janitorial crews so high-touch points are continually disinfected throughout the day.
"We're really on heightened awareness because of the symptoms of it and just how impactful it can be on our homeless population," he said.
Public washrooms were installed outside the Mustard Seed last week. They operate from 10 a.m. to 9 p.m. and are consistently staffed.
"Just the dignity of having a place where you can access a washroom and clean up if you need to," Knutson said.
"They'll make a huge difference. Not all our drop-ins and our centres are open 24 hours a day so to have something available for people to come and access when they need to is really important."
Knutson said the facilities are cleaned and disinfected after each use.
LISTEN | Health-care workers raise alarms about shigella:
Dr. Francesco Mosaico, medical director at Radius Community Health, was part of an unprecedented outreach effort in the city on Nov. 8.
Mosaico, along with a couple dozen physicians, nurse practitioners, licensed practical nurses and outreach workers, canvassed encampments in Edmonton's river valley and inner-city neighbourhoods. They spoke with more than 250 people about shigella and offered them medication.
"About 10 per cent of them were still symptomatic and we were able to treat, and the vast majority, though, explained that they had already suffered through an infection," he said.
Mosaico said the outreach was organized because many clients are either too sick to seek help or too embarrassed to go in public because they are soaked in fecal matter.
"I've worked in the inner city for over 15 years and I don't think I've ever seen this degree of suffering, this degree of indignity, this degree of really marginalization amongst the people who are in the margins of our society," he said.
The outbreak is centered on inner-city Edmonton currently, but Francescutti said it can spread anywhere.
"It stays on surfaces. You touch it, you put it in your mouth, it's transmitted," he said.
He said the most simple treatment is to ensure those who live rough have stable housing.
Francescutti is spearheading a temporary housing project in west Edmonton so those who experience homelessness and who frequent the ER have a place to be discharged to, instead of going back out on the streets.
"Once the encampment disappears, shigella disappears," he said.