San Diego city officials warned employees about the deadly hepatitis A outbreak two times before Mayor Kevin Faulconer issued any public statements about the spreading infectious disease, newly released emails show.
The initial alerts to city workers and to more than 11,000 vendors doing business with City Hall were issued in May. Employees were warned about the threat again in August.
Faulconer first mentioned the crisis in a public statement in September, four months after city and county officials first met about the health crisis.
County public health officials began informing city leaders about the outbreak in mid-April, emails show. City officials monitored the increasing caseload before meeting with the county in early May.
Within days of that May 4 discussion, San Diego leaders began organizing mass vaccinations for the city workforce.
Councilman David Alvarez said the city administration should have warned the rest of the public sooner.
“It is undeniable that the city should have done more to address the hepatitis A outbreak as far back as May,” Alvarez said. “More people were exposed and the outbreak grew due to the lack of urgency. The city must now take extraordinary measures to address this.”
A city spokeswoman said San Diego County serves as the region’s public health office.
“The county runs the public health agency and is therefore in charge of alerting the public when an emergency exists,” spokeswoman Katie Keach said in response to questions about the emails. “The city has taken immediate action in response to every request and directive from the county’s Health and Human Services Agency.”
The email exchanges — most of which were labeled confidential — were released to the The San Diego Union-Tribune under the California Public Records Act.
The release included almost 1,500 pages of emails and other communications related to the hepatitis A crisis that has infected more than 480 people and killed 17 since November.
The employee notifications were released, but the city redacted key exchanges between senior officials. Keach said information that was withheld as a work in progress.
“We redacted draft materials,” she said.
The initial internal communication was sent to city workers May 5. It advised employees of the police and fire departments, libraries, the park and recreation department, environmental services, transportation, storm water and environmental services that they may be at risk for exposure.
“If there are other sectors or work groups within the city, not identified above, that work directly with the homeless population or illicit drug users, please provide them with a copy of the attached notice,” the internal communication stated.
Even after the employee warning, some workers were not clear on the vaccination offer.
“I’ve been out of the loop,” one public information officer wrote to colleagues five days later. “Had no idea staff needed shots.”
It was not always made clear to employees they would need an additional booster shot six months later.
“In a telephone conversations (sic) you stated to me that only 1 vaccine for Hepatitis A was needed … This situation was handled very poorly,” an administrative aide complained to one of her managers in May.
By May 12, 46 employees had requested vaccinations, most of them from Environmental Services, the emails show. The next month, management analysts pegged the cost at just under $11,000 and said each department could absorb the cost on its own.
Later in May, a risk-management official emailed a public works supervisor to confirm that employees had been vaccinated.
The pace of vaccinations picked up over the summer, as the fatality rate in the public health crisis reached into double digits. According to an August email from Battalion Chief David Picone to his boss, Fire-Rescue Chief Brian Fennessy, 444 individuals participated in the first phase and the city had 756 vaccines left.
“We are looking good for the second Hep A vaccination in the series and will not need to purchase an additional supply,” Picone wrote.
The emails also show debate within City Hall about who should reply to media inquiries.
In June, for example, after the death toll climbed to four, The San Diego Union-Tribune requested detailed responses from the city to the escalating crisis. Emails show the request bounced between the Mayor’s Office and the less political communications staff.
“I think the response should come from CommsD (the communications office),” mayoral spokesman Craig Gustafson advised his boss, deputy chief of staff Matt Awbrey and others. “This is really a county function, in terms of responding to the Hep A outbreak.”
Keach said it is not unusual for her to discuss media responses with the Mayor’s Office.
“Communications staff regularly communicate about issues of all kinds, at times to determine who has the best information available for the reporter,” she said.
Many of the emails confirm what the Union-Tribune and other media outlets have reported for weeks: Both the city and county were initially slow to respond to the public health crisis and each agency has pinned some of the blame on the other.
County epidemiologists identified the rash of hepatitis A cases in early March, and dated the infection to the previous November.
They convened a meeting between city and county officials in May, by which time three people were dead and the caseload had swelled to 80. It took the county until August to publish informational posters and September to place temporary sinks and portable toilets downtown.
The latest emails show city officials began monitoring the outbreak as early as mid-April.
In one exchange, a staffer is asked to check with the San Diego Housing Commission about how city-funded service providers were responding to the emergency.
Housing commission vice president Melissa Peterman responded that questions were better directed to the county.
“We have not yet received word from any of our partners that their clients have been affected by hepatitis A,” she wrote.
The following week, county assistant health director Susan Bower told San Diego’s assistant chief operating officer, Stacey LoMedico, that she would welcome whatever assistance the city might be able to offer.
“Stacey- appreciate any help you can provide in getting info out for people to get vaccinated,” Bower emailed on April 25. “Attached is flier.”
The exchange apparently prompted some internal criticism of the county’s efforts to alert the public to the rising hepatitis A infection rate.
“I just checked @sandiegocounty and @sdcountyhhsa and saw no mention,” Keach wrote to LoMedico and others a few minutes after the Bower email to LoMedico. “I’m happy to reach out. I would think they have more direct outreach to their service providers than Twitter.”
Inside the Performance and Analytics Department, the city shop aimed at making government more efficient, two program managers were less than surprised when the county announced in May that the number of hepatitis A-related deaths had climbed to three.
“Crazy!” one wrote to her colleague. “You called it.”
As of Tuesday, San Diego County had recorded a total of 481 hepatitis A cases and 17 deaths.