San Diego hepatitis A outbreak report helped shape COVID

Analysts found that the work done after the 2017 hepatitis A outbreak prepared the county

By Paul SissonThe San Diego Union-Tribune

SAN DIEGO — San Diego County was quick to take the COVID-19 pandemic seriously, declaring a local state of emergency on Feb. 14, 2020, weeks before the state followed suit on March 4.

Working with UC San Diego and the Padres, the local public health department collaborated on what became the state's first vaccination super station, which opened near Petco Park on Jan. 11, 2021.

And those who oversee the region's emergency medical system were among the first in the state to request special permission for paramedics to help deliver vaccines when demand for doses was at its fiercest.

The region was prepared to take early action as the novel coronavirus began spreading in the United States and, as a newly released after-action report notes, local efforts benefited significantly from recent prior experience.

State law requires local governments that declared local emergencies to complete and submit such reports to the California Office of Emergency Services within 90 days after the declaration ends.

San Diego County supervisors commissioned Illinois-based Hagerty Consulting Inc. to research and write what, with appendices, is a 281-page review of the local COVID-19 response.

After reading documentation and conducting their own interviews, consultants wrote that they detected a strong influence from the region's response to the 2017 hepatitis A outbreak, which spread largely among the region's unhoused residents, sickening 592 people and killing 20.

An after-action report from that incident recommended that the county train more public health staff in proper emergency management and in the coordination of resources among a broader group of organizations, including those outside county government.

This work, analysts found, paid dividends in early 2020 when COVID-19 appeared.

"Responding to the Hepatitis-A outbreak also played a critical role in establishing and improving upon countless partnerships at all levels of government and the private sector," the report states. "These relationships translated into the COVID-19 response immediately, putting the County steps ahead of most other jurisdictions."

Report writers complimented the use of a special "policy group" made up of local leaders and other people with significant stakes in how the pandemic was handled, providing a conduit for bidirectional information to flow more rapidly than it did when hepatitis A was the virus causing problems.

Examiners also found that financial controls were in place as hundreds of millions of dollars in federal COVID-19 response funding arrived, that social distancing programs adequately prevented outbreaks among county staff forced to work in person, and produced "accurate and actionable information in its communications with the public."

A total of 16 recommendations for future improvement are free of big shockers.

Advice ranges from continuing to conduct tabletop exercises, training and drills to examining civil service rules to "identify and address barriers to hiring staff in temporary situations."

Several recommendations have to do with better processing of large volumes of public health data which was found to be difficult during the pandemic using equipment not necessarily designed to quickly parse reams of incoming information into daily reports for public consumption.

But the report does not assess what many in the public clearly care about the most: The decisions that disrupted so many for so long, everything from stay-at-home orders to masking regulations.

Katie Freeman, director of operations for Hagerty Consulting, said in an email that these kinds of questions were outside the report's scope.

"The after-action report is focused on the emergency response activities; our scope does not include the evaluation of public health decisions made," Freeman said in an email.

After reviewing the document Friday morning, Amy Reichert, director of Reopen San Diego, a group that was critical of many local, state and national pandemic decisions, said she was surprised to see some items missing.

County monoclonal antibody clinics, she said, should have been mentioned. These clinics, she said, were underused and "could have saved lives" but for the fact that "many people were not even aware of this life-saving treatment."

"Instead, the messaging from the county was more heavily weighted on vaccination even after CDC Director Rochelle Walensky admitted on CNN that the vaccines no longer prevent transmission,'" Reichert said in an email.

"There could have been some more retrospection as to what proportion of vulnerable people has been educated and /or received available treatments from the county such as monoclonal antibodies."

The county's temporary lodging program, which paid for hotel rooms for those who needed to quarantine but had nowhere to stay where they would not potentially infect others, was another area where the activist said the after-action report came up short.

A review of the program written by San Diego State University researchers and released in 2021 found that it was effective in increasing the number of people who successfully quarantined after becoming infected, preventing the spread of disease. But there were also a significant number of problems noted.

"The most significant concern is that services, particularly those who were ill, were inconsistent and sometimes inadequate, including nursing and medication services; the provision of towels, linens, toilet paper and cleaning supplies; food services; interactions with staff; and intake and discharge services to clustered groups," the SDSU report said.

"In addition, significant challenges in serving those with behavioral health needs were noted, and given that staff reported drug overdoses, suicide attempts and other critical incidents, these challenges warrant further examination."

These kinds of observations, Reichert said, deserved to make it into the final analysis.

"Overall, it is crucial to acknowledge the shortcomings and gaps in the County of San Diego's COVID-19 response to ensure that lessons are learned and improvements are made to protect people and save lives," Reichert said.