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County report critiques response to hepatitis outbreak

SAN DIEGO — A report released Thursday identifies “areas of success as well as areas for improvement” in regard to San Diego County’s response to a hepatitis A outbreak that killed 20 people and infected nearly 600 between 2017 and early this year.

Communication among jurisdictions, agencies and community partners during public health outbreaks needs to improve, according to the county report.

The county analysis also recommended the creation of a county and region-wide formal incident management structure that regularly meets. Non- emergency county staff should also be trained to handle large-scale public health emergencies, according to the report compiled by the county’s Office of Emergency Services, with input from 19 departments, agencies and groups.

County epidemiologists first reported increased hepatitis A cases in March 2017, at which point nurses began regularly administering vaccines.

The county declared a state of emergency Sept. 1 as the disease continued to spread. Linked cases in Los Angeles and Santa Cruz counties led to a statewide emergency declaration in October.

The San Diego County deceleration was terminated Jan. 23 when the number of cases ramped down following the installation of public toilets and sinks.

The outbreak disproportionately affected the county’s homeless population, partially because of lack of access to public sanitation facilities. The disease is transmitted by touching objects or eating food that someone with the virus has handled, or by having sex with an infected person.

As of April, the county had spent about $12.5 million responding the public health crisis.

The report called the county’s early detection of the outbreak a success, as well as efforts to vaccinate individuals at high risk.

The county and city of San Diego have caught flak for their handling of the outbreak, however.

The San Diego Union-Tribune reported three people had already died by the time county officials started to dispatch street teams to offer vaccinations in May 2017. Street team use quickly expanded after they proved their “effectiveness in reaching those hardest to access,” according to the county report.

County officials also took several months to install public hand- washing stations during the summer; they cited issues with bureaucratic red tape and coordination with city officials.

Critics have pointed to a lack of proactive action preceding the health crisis, as well.

A 2010 county grand jury report said homelessness in the county had “reached a tipping point” and found the lack of public toilets and the presence of human waste on streets posed a risk for the spread of disease.

That grand jury recommended city officials place public toilets in downtown San Diego and more regularly sanitize sidewalks in the area. The jury also recommended city and county officials create a “joint powers authority” to develop a regional approach to reduce chronic homelessness.

City officials and county supervisors have drawn criticism for not acting on the recommendations, and for what critics have called general inaction on a homelessness crisis that had been building for years.

This month, Assemblyman Todd Gloria, D-San Diego, requested that the Legislature’s joint audit committee examine whether city and county response to the outbreak “identified, contained and treated” the public health threat “in accordance with statutory requirements and recommended procedures.”

The lawmaker questioned in his letter to the committee whether the county properly monitored and released detailed location data of hepatitis A cases.