Our top story is San Diego's to hepatitis A outbreak that killed 20 people and infected nearly 600 more. It was the largest outbreak in more than two decades. There has been finger-pointing between the city of San Diego, and the county over which government bears the most responsibility for any failures in responding to the disease. This first of several expected after action report is out this week. Is on from the county. We have reached out to the county to discuss the report, they said no one was available. Joining me is San Diego health reporter Paul. Welcome Paul. >> Thank you. >> The county recommended 21 ways to improve them what were the main issues? >> I think the top of the line one was listed number one in the recommendations was a better collaboration between local governments, city governments, and gown -- County governments in a kind of an early summer, late spring there was a lot of back and forth whether enough information was being shared by County epidemiologists with the cities were some of these cases were or were all these cases were occurring. >> What is the county going to do to enact that change? >> They say next time they pay something like this, a large public health crisis, they will try to create a special meeting group of local leaders drawn from each area so they have a real-time view of what is going on with the outbreak and where cases are popping up on a much quicker basis than they did the last outbreak. >> That was 1 of their last recommendations, what are some others? >> Another one was interesting and had do with nursing. It turns out that every county in the state has a medical reserve Corps that is run by the state. It seems that many of these services were not able to get involved until after the county declared a public health emergency on September 1. They were able to bring some of them in on a special dispensation, but most of them are not able to get involved until the fall. So, they are saying that actually, if they were able to change state law, they were -- you might be able to bring those people in much sooner and I could really help them push back against an outbreak that is spreading rapidly like the hepatitis outbreak was last year. >> One of the main criticisms was that it did not declare that public health emergency until 15 people had died. Does the report address the length of time it took to declare the emergency opposed to steam -- changing the state law? >> Attacked the county a little bit on that, and they said that they felt like it called for greater collaboration and they think it does address that in some way but the report does not really dwell into, what was going on in that period of time behind the scenes. And you know why didn't the county take direct action earlier, months earlier? the book -- the report really does not dig into that issue at any depth. >> What does the county see as its top successes of the response? >> I think they're very proud of their outreach effort they did what they did were foot teams. Troops of nurses and law enforcement that went out into the ravines and canyons, and bridge underpasses and really gave vaccinations to thousands and thousands of homeless people. This is something they say, is very innovative and really has not been done anywhere but San Diego. I think they felt like it was a really very important victory that they had. And they cut this thing early, they caught it when it was just a few cases in March, I think they're pretty parol -- proud of their protection apparatus where they can look at local medical records automatically and see when infectious diseases are starting to pop up in the community. >> What is your reaction to this county report banned from members of the Board of Supervisors, or city officials? >> It seems like the Board of Supervisors, feels like it was a good report, and gave them a lot of good action point that they can act on incoming years, some city councilmembers and such have been less satisfied with it. I think there is still a lot of feeling out there that mental health is a big part of this overall picture. And is not really addressed in this report. How it is that a county and city and others will push back against mental health problems that cause much of this homelessness. >> What specifically has Councilman David Alvarez said about this report? >> Was very critical about the unaddressed mental health aspect with this crisis. Effect -- he said he felt like there should be really more attention given to that issue and that the county really kind of help causes by underfunding mental health. Supervisor Dianne Jacob pushed back against a pretty hard thing that this report is not really intended to address everything the county does but simply to look at what the hepatitis outbreak did in the community. >> Who else will weigh in on the response to the hepatitis a outbreak with their own findings? >> We have Todd Gloria who is asking the state legislature to do its own audit of this entire situation. The are going to hear his request on the 26th of this month. And additionally the city of San Diego said yesterday that they intend to do their own report which would kind of build on the county's report. So we know of 2 others that are either in the offering are going to happen. >> I've been speaking to San Diego reporter Paul. Paul thank you. >> Absolutely.
A report released Thursday identifies "areas of success as well as areas for improvement" in regard to San Diego County's response to a hepatitis A outbreak that killed 20 people and infected nearly 600 between 2017 and early this year.
Communication among jurisdictions, agencies and community partners during public health outbreaks needs to improve, according to the county report.
The county analysis also recommended the creation of a county and region-wide formal incident management structure that regularly meets. Nonemergency county staff should also be trained to handle large-scale public health emergencies, according to the report compiled by the county's Office of Emergency Services, with input from 19 departments, agencies and groups.
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County epidemiologists first reported increased hepatitis A cases in March 2017, at which point nurses began regularly administering vaccines.
The county declared a state of emergency Sept. 1 as the disease continued to spread. Linked cases in Los Angeles and Santa Cruz counties led to a statewide emergency declaration in October.
The San Diego County deceleration was terminated Jan. 23 when the number of cases ramped down following the installation of public toilets and sinks.
The outbreak disproportionately affected the county's homeless population, partially because of lack of access to public sanitation facilities. The disease is transmitted by touching objects or eating food that someone with the virus has handled, or by having sex with an infected person.
As of April, the county had spent about $12.5 million responding to the public health crisis.
The report called the county's early detection of the outbreak a success, as well as efforts to vaccinate individuals at high risk.
The county and city of San Diego have caught flak for their handling of the outbreak, however.
The San Diego Union-Tribune reported three people had already died by the time county officials started to dispatch street teams to offer vaccinations in May 2017. The street team use quickly expanded after they proved their "effectiveness in reaching those hardest to access," according to the county report.
RELATED: Medical Examiner: Homeless Deaths On The Rise In San Diego County
County officials also took several months to install public hand-washing stations during the summer; they cited issues with bureaucratic red tape and coordination with city officials.
Critics have pointed to a lack of proactive action preceding the health crisis, as well.
A 2010 grand jury report said homelessness in the county had "reached a tipping point" and found the lack of public toilets and the presence of human waste on streets posed a risk for the spread of disease.
That grand jury recommended placing public toilets in downtown San Diego and sanitizing sidewalks in the area.
County supervisors drew criticism for not acting on the recommendations, and for their perceived general inaction on a homelessness crisis that had been building for years.
This month, Assemblyman Todd Gloria, D-San Diego, requested that the Legislature's joint audit committee examine whether city and county response to the outbreak "identified, contained and treated" the public health threat "in accordance with statutory requirements and recommended procedures."
The lawmaker questioned in his letter to the committee whether the county properly monitored and released detailed location data of hepatitis A cases.
