Connecting state and local government leaders

Public Health Emergency Declaration Extended in San Diego

The San Diego County administrative complex in downtown San Diego.

The San Diego County administrative complex in downtown San Diego. Michael Grass / Route Fifty


Connecting state and local government leaders

While local officials think a deadly hepatitis A outbreak has eased somewhat, they’ve faced challenges in communicating the continuing risk.

SAN DIEGO — In the restroom of a busy downtown restaurant near the historic Santa Fe Depot, an unusual handle is attached to the door: a “sanitary” opener where you can maneuver the door with your wrist instead of your hand.

While such an opener, affixed to the door above additional advisories encouraging proper hand washing, may seem like an overly cautious design feature, San Diego County has been in the middle of a serious public health emergency in recent months.

(Photo by Michael Grass / Route Fifty)

Twenty deaths in the county have been connected to a local hepatitis A outbreak, which has, as of Monday, infected at least 544 people in and around California’s second-largest city.

On Sept. 1, the San Diego County Board of Supervisors declared an emergency to address the situation and mobilized an aggressive public health response to curb the outbreak, which included city crews washing some streets and sidewalks with bleach, the deployment of handwashing stations, the opening of additional bathrooms and a vaccination effort.

Hepatitis A is spread primarily when a non-infected person ingests food or water contaminated with the feces of an infected person. The “the highly contagious virus can spread explosively” in homeless camps, which are common in San Diego, according to the PBS News Hour. The lack of adequate bathroom facilities for the homeless, experts have said, made it “only a matter of time” that a major outbreak would hit the city and county.

With the number of hepatitis A cases continuing to tick upward—albeit more slowly—county supervisors voted on Monday to extend the emergency another two weeks.

San Diego County’s public health services and community partners have given 90,735 vaccinations, including 76,982 to at-risk populations, according to the county's most-recent update.

The focus of concern has been with the area’s homeless population, especially in the ZIP code that covers the downtown area and adjacent central city neighborhoods.

A line outside a public restroom in San Diego's Gaslamp Quarter on Monday evening. (Photo by Michael Grass / Route Fifty)

Communicating the health risk has been challenging for local officials.

When San Diego County released maps a few weeks ago that plotted confirmed hepatitis A cases, officials were criticized for not being more specific about locations. But a more detailed level of geographic specificity raises privacy concerns, plus it’s not always helpful information due to the nature of how hepatitis A spreads.

As Eric McDonald, who leads San Diego County’s epidemiology and immunization efforts, told Voice of San Diego in early October.

”The problem is this disease, because it has a two- to seven-week incubation period, what you’d have to do is put a big blob on the map of where somebody’s been for the last seven weeks and it’s not helpful,” McDonald said. “If somebody really and truly was in one spot for seven weeks, then maybe you can say that’s where they got infected.”

The San Diego Union-Tribune pointed out the public communications quandary on Monday:

Supervisor Ron Roberts noted that the weekly escalation in cases in deaths gives the public the feeling that, every time a tally grows, that means the outbreak has grown.

But that’s not the case. Because new numbers are not added to outbreak totals until they’ve been confirmed by genetic testing that can take weeks to perform, the weekly numbers are not a perfect barometer of the outbreak’s current severity.

Roberts directed officials with the county Health and Human Services Agency to find a way to give the public a better sense of how many cases have occurred since the last update.

Beyond the local homeless population, health officials have advised that men who have sex with men ensure they're vaccinated, especially after hepatitis A outbreaks in the MSM population in Michigan, New York City and Colorado.

“We’re broadening our ongoing efforts to reach the MSM community because this is an area where the outbreak could potentially spread,” Wilma Wooten, the county’s public health officer, said in a statement. “We are encouraging people to get vaccinated to protect both themselves and their close contacts.”

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Michael Grass is Executive Editor of Government Executive’s Route Fifty and is based in Seattle.

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