The shadow of San Diego’s deadly hepatitis A epidemic still hangs over the city.

Those dark days come to mind whenever unsanitary disease strikes homeless residents.

Such was the case when stomach disease was reported among people living in the growing homeless encampment along Sports Arena Boulevard, which the city cited when launching two major cleanups of squalid conditions there last week.

Late last year, an outbreak of shigellosis – which can cause fever, stomach cramps and diarrhea – also brought back chilling memories of how hepatitis A spread to through and beyond the region’s homeless population in 2016-18, killing 20 people and hospitalizing hundreds.

Local government agencies were then caught off guard – despite years of warnings that such a fate was likely destined – but eventually leapt into action, setting up handwashing stations in the area, washing sidewalks high pressure and expanding shelter possibilities.

One of the few bright spots to come out of those dark times was kind of an experience of desperation. While large tents for the homeless were permitted and being set up, the city and homeless-serving agencies set up a temporary camp on a public works yard northeast of downtown.

Separate tents for individuals and families have been placed on designated spaces in a parking area. Food and transportation were provided, and restrooms, showers, play areas, and common areas with televisions were available.

News reports from the time were filled with expressions of gratitude from new residents and accompanying photographs and videos showed a tidy and orderly camp. The facility located just south of the Balboa Park golf course was a welcome ray of optimism amid the stark scene created by the hepatitis outbreak.

“It was really cool,” Bob McElroy said last week. “It worked very well.”

McElroy is the CEO of Project Alpha, the non-profit organization that runs programs to help homeless people who oversaw camp operations for the city.

Field experience at 20^and and B streets could provide lessons for possible future “safe villages,” recently advocated by the Downtown San Diego Partnership and others in response to growing numbers of homelessness and street encampments.

But the kind of success there could be a singular experience that’s hard to replicate.

San Diego, like other cities, is under increasing pressure from businesses and residents not only to clean up unsanitary conditions, but also to eliminate unauthorized homeless encampments. After the Sports Arena Boulevard operation, the people who lived there were allowed to return.

The problem is that there aren’t many places for these people to go, especially since shelters have limited or stopped accepting people due to the rapid spread of the Omicron COVID variant.

In discussing Camp 20 and B, McElroy pointed out that there were strict rules on behavior not typically found at some other camps set up by other cities. Without them, he said, he wouldn’t get involved this time around.

“I wouldn’t be interested in making a campground that would allow people to use drugs and bring paraphernalia on site,” he said. This also applies to alcohol.

He said the large tent shelters run by Project Alpha allow people of varying levels of inebriation to enter, but cannot be disruptive. Consumption of drugs or alcohol on site is prohibited. McElroy believes in enforcement and rules that compel people to behave in exchange for the safe space and services they receive.

“There has to be some kind of personal responsibility,” he said.

“Our facilities have low barrier rules, but there are rules,” he added. “The vast majority of people want to be safe. We don’t want to bring the same aspect of the street back into an establishment.

The tent camp set up in 2017 had many families with children, as well as women and men. Some camps elsewhere are not as family oriented.

Los Angeles, San Francisco, Seattle, Sacramento and other cities created camp villages using tents, small houses, pallet houses and other structures. McElroy visited some of them and declared them “disasters” due to drug and alcohol use as well as lax rules that allow people “to come and go as you please”.

A temporary “Safe Sleep Village” in Los Angeles has received mixed reviews, according to KCRW. The camp didn’t put many restrictions on substance use. If so, some residents said they wouldn’t stay there.

This highlights a dilemma. Allowing drugs and alcohol may seem contrary to helping the homeless, in addition to potentially causing problems in a camp. But many homeless people use one or both, and if the goal is to get them off the streets into a more hygienic space – and they won’t go because of the restrictions – some camp advocates believe that allowances must be made.

What the policy will be if San Diego goes ahead with a safe village pilot somewhere, as the Downtown Partnership suggests, remains to be seen.

The 136-bed San Diego camp near Balboa Park that housed some 200 people had other restrictions and services that are scarce. People there weren’t allowed to just walk in and out. Members of Project Alpha ferried adults to and from the site throughout the day for appointments and drove children to school.

There were a few bumps along the way, but nothing that couldn’t be overcome, such as a minor issue with the immediate cable TV connection.

“Nobody asked me what kind of tents to buy,” McElroy said. “They bought the wrong ones, but we made it work.”

But then the hepatitis A outbreak created a great sense of urgency to quickly get people into safe shelter.

McElroy said the 20th and B camp was up and running in 10 days.

Tweet of the week

Go to Ron Nehring (@RonNehring), former chairman of the San Diego County and California Republican Party.

“Since 1988, the Republican presidential candidate has won the popular vote exactly… once. In 2004. Governing requires the consent of the governed. Spending time trying to figure out how to change the process to win while losing misses the point. Earn more votes.