A grand jury report following one of the worst outbreaks of Hepatitis A in the United States in 20 years faulted the response of San Diego city and county officials on Thursday and recommended improving communications to prepare for future health emergencies.
The outbreak killed 20 and sickened 577 people between November 2016 and October 2017.
The review, titled "The San Diego Hepatitis A Epidemic: (Mis)handling a Public Health Crisis," criticizes the county and city for inadequate coordination that delayed sanitation procedures that could have slowed the spread of the disease, especially among the homeless population.
The report "correctly points out that there really was no playbook for dealing with what was an unprecedented health crisis," San Diego Mayor Kevin Faulconer said.
"It's clear there needed to be better coordination and communication when the outbreak was first identified and there were a lot of lessons that will help us going forward," the mayor said. "The biggest lesson is that our community can't put off difficult decisions on homelessness because it makes the problem worse."
The Centers for Disease Control and Prevention says Hepatitis A is a vaccine-preventable, communicable disease of the liver caused by a virus. It is usually transmitted person-to-person or by consuming contaminated food or water. Symptoms include fatigue, low appetite, stomach pain, nausea, and jaundice.
The 20-page report commended officials for effectively contacting at-risk residents and getting them vaccinations, according to the San Diego Union-Tribune. Among the recommendations in the report are updating the county's emergency operations plan, establishing clear lines of authority and designating a medical professional to report directly to the mayor.
It also recommends building more secure restrooms and hand-washing stations in areas where homeless people congregate.
Officials vaccinated more than 100,000 people, installed scores of hand-washing stations and cleaned streets with a bleach solution to contain the virus that lives in feces. The emergency ended in January.
The mayor said the city is undertaking a massive expansion of homeless services that includes building shelters and adding new restroom facilities.
The grand jury, which consisted of 19 retired professionals, interviewed administrative personnel from the county Health and Human Services Agency, upper-level management from several local cities and law enforcement personnel throughout the region before drawing its conclusions, the newspaper said.
Written reports, including local media accounts, professional medical papers and internal emails were also examined.
This story has been updated.
Correction: The Associated Press reported erroneously that the outbreak, with 20 deaths and 577 cases, was the worst in the U.S. in 20 years. An outbreak of Hepatitis A in Michigan surpassed San Diego's in late 2017 or early 2018, with 27 deaths and 836 cases, according to the U.S. Centers for Disease Control.