San Diego’s Hepatitis A outbreak—which spread to Los Angeles last week—is threatening to overwhelm the medical community as the disease has claimed 16 lives, 250 hospitalized and over 400 infected forcing the city to take extreme measures to prevent further spread of the disease.

So far, San Diego city and county officials have taken the following emergency actions:

Set up portable hand-washing stations

Sanitary street washing

Massive tents

On Monday of this week, city officials announced that the City of San Diego has opened an Emergency Operations Center led by the Office of Homeland Security with operations based out of City Hall, according to San Diego’s NBC affiliate.

The Emergency Operations Center was established on Monday to help coordinate the city’s “Vaccination, Sanitation and Education” campaign efforts, according to a statement. The Emergency Operations Team consists of 12 people, led by the city’s Homeland Security Executive Director John Valencia.

The San Diego Tribune reports that the medical community is baffled by the intensity of the outbreak, especially those relapsing:

“Over the course of a week and a half to two weeks [a patient] went into liver failure and died,” Wooten said. “It was a case of relapsing hepatitis which occurs in 10 percent of patients, but it’s not something I have seen in my career before.” In recent months that has been the experience in several San Diego hospitals closest to the places where the region’s ongoing hepatitis outbreak has continued to grow. These are cases that no one has seen in recent memory. “Hepatitis A illness is usually pretty mild. They may seek care or they may not seek care, but, in the past, it has usually not been severe enough to be admitted to the hospital,” Wooten said. However, the situation has been different in this case because hepatitis A is infecting homeless people and drug users, a population known to be medically vulnerable.

According to CBS Evening News, a number of influential people within San Diego have criticized the slow initial response of the city and county, asking why they failed to act swiftly to head off what has become a major public health crisis:

Stephen Zolezzi, president of San Diego’s Food and Beverage Association, which represents 1,200 businesses, believes the city should have been doing more long before this outbreak. “Where were they two or three or four years ago,” Zolezzi asked. “It’s great that they’re coming up with some solutions now, but they’re really closing the barn door after the horses already left.”

Tim Donnelly is a former California State Assemblyman and Author, currently on a book tour for his new book: Patriot Not Politician: Win or Go Homeless. He also ran for governor in 2014.

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