State audit slams San Diego response to hepatitis A outbreak State audit finds city and county of San Diego failed to quickly contain a hepatitis A outbreak last year that became among the largest of its kind seen in the United States in decades

SAN DIEGO -- The city and county of San Diego failed to quickly recognize and control a Hepatitis A outbreak that grew into one of the largest in recent history, killing 20 and sending nearly 400 to hospitals, according to a state audit released Thursday.

The county lacked a concrete hepatitis A prevention plan that led to a delay in getting the most vulnerable residents vaccinated, and mass vaccinations did not happen until after a health emergency had been declared, according to the audit conducted by the state auditor at the request of lawmakers.

The disease killed 20 people, most of them homeless. More than 580 were infected, and nearly 400 people were hospitalized.

The city was also slow to respond, according to the audit. Six months into the outbreak, the city began power-washing streets and installing hand-washing stations and public restrooms downtown, where streets were lined with tents of homeless people.

Hepatitis A is a highly contagious liver disease spread through dirty hands and other contact.

Mike McConnell, an advocate for San Diego's homeless population, said the more he read the audit, "the more angry I got." He said officials did not act until an affluent resident went to the county board of supervisors after getting infected and expressed his concern, and then reports of the outbreak began to affect San Diego's tourism industry.

"There was just negligence," he said. "Because the people being impacted were homeless people, there was not the same sense of urgency."

The county did not share enough information with the city when the outbreak was detected in March 2017, causing the city to not fully recognize the seriousness of what was happening and delaying its response, the audit found.

If the county had administered mass vaccinations sooner, the outbreak might not have grown to as large as it did, the audit found.

The number of new cases tripled to about 20 cases per week from May through September 2017, compared with six new cases per week during March 2017.

More vaccinations were administered in September 2017 than in the previous six months combined, and the effort led to a decline in new cases, the audit found. The county declared the outbreak over in October after 100 days passed with no new cases.

The auditor said lawmakers should enact legislation requiring local health officers to promptly notify local public entities within their jurisdictions about outbreaks that may affect them and provide the locations of where cases are concentrated, the number of residents affected, and the measures that should be taken.

The California Department of Public Health also should amend its disease outbreak response plan to include asking jurisdictions to set vaccination targets, establish dates to meet those targets, and determine needed resources, the report said.

San Diego city government officials "agree with the recommendations, particularly that the city and county should strengthen their relationship as it relates to responding to regional emergencies," said city chief operating officer Kris Michell.

San Diego County's Health and Human Services Agency said in a statement that the findings were consistent with the results of a county review and that county officials "reiterate our commitment to making the recommended improvements so that as a region we are better prepared to respond to any future health emergency."

Democrat Todd Gloria, a state lawmaker representing San Diego, said in a statement that he plans to "propose solutions to ensure this never, ever happens again."

He declined to provide specifics until after he evaluates the report but said "one thing is clear: Lives could have been saved."

Bob McElroy of the Alpha Project, which shelters the homeless, said he predicted there would be dire consequences once the city closed its cold weather shelters, forcing hundreds onto the street. Because of the outbreak, the city erected massive tents, where roughly 700 people are being housed until they can be moved into permanent housing. But it will take years to build the housing to combat the problem, he added.

The tents are slated to close in the first six months of 2019. If people end up on the streets, McAlvoy said the city risks another crisis like the outbreak.

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This version corrects that the audit was performed by California's state auditor, not the Legislature. This version also corrects the name of Bob McElroy of the Alpha Project, which shelters the homeless.