Auditor Finds San Diego’s Slow Response Exacerbated Hepatitis Outbreak

SAN DIEGO (CN) – Suggesting the city and county of San Diego’s lack of urgency in responding to an unprecedented hepatitis A outbreak in 2017 led to over 500 cases of the disease and 20 deaths, California’s state auditor said Thursday the region’s plan to avoid another health emergency still falls short.

California State Auditor Elaine Howle released an audit Thursday at the request of Assemblyman Todd Gloria to review the county and city of San Diego’s response to curbing a hepatitis A outbreak in 2017, which spilled into 2018 and hospitalized nearly 400 San Diegans.

The outbreak spread quickly among San Diego’s homeless population due to unsanitary conditions and a lack of public restrooms, but was not confined solely to the city’s unsheltered population and IV drug users.

“The lack of urgency, the lack of action for months at a time may have come from the fact we’re talking about some of the most vulnerable and most ignored people in our community,” Gloria said at a press conference Thursday.

The audit found that while the county took steps to understand the outbreak, it did not deploy nursing staff quickly enough to administer the thousands of vaccinations needed to curb the public health emergency.

Had the vaccination efforts started in spring of 2017, the number of new cases might never have tripled from the average of six new cases a week in March to 20 by September when the vaccinations were finally ramped up, the auditor found.

The county and city also dragged their feet on installing hand-washing stations and increasing access to restrooms for the homeless, delaying better access to sanitary facilities until months after their initial discussions, according to the audit.

While the California Department of Public Health worked with the city and county on changes to improve future efforts to curb the spread of disease, the auditor found these changes still lacked two critical components: establishing a timeframe for meeting vaccination targets and determining the number of nurses or health care workers needed to get those vaccines administered within that timeframe.

“Once actions sized to the scope of this outbreak began to be implemented, there was an almost immediate reduction in the number of new cases that ultimately allowed us to end the state of emergency in January,” Gloria said.

He said the “homelessness crisis” in San Diego – which the U.S. Department of Housing and Urban Development revealed this week has the fourth-highest homeless population in the nation – highlights why the audit was needed.

“I think the lesson learned from this is we may choose to ignore those people but we do it at our own peril because a lot of folks who are housed got sick too. I hope moving forward we can act not as though those people don’t matter because they do matter – this report shows they do matter. This shouldn’t happen ever again,” he added.

Gloria said state lawmakers will likely introduce legislation next year to ensure local health officials work with jurisdictions within the region to notify them about outbreaks and work collaboratively to curb them.

The auditor recommended the county and city of San Diego enter into an agreement to clarify each entity’s roles and responsibilities in public health matters.

Michael Workman, a spokesman for the county of San Diego, said in a statement the audit was “generally consistent” with the county’s own report following the outbreak and that the county is committed to making the recommended improvements.

City of San Diego Chief Operating Officer Kris Mitchell said in a statement the city agrees with the recommendation to strengthen its relationship with the county.

The auditor urged the city and county to enter into an agreement by March 31, 2019.

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