Santa Barbara County Board of Supervisors Response to the Santa Barbara County Grand Jury 2024-25 Report “Is the Santa

The Santa Barbara County Public Health Department has not developed proactive pathogen specific risk assessments based upon evidence-based risk analysis. The Board of Supervisors partially disagrees. County Health proactively monitors global, national, and statewide viral variants for trends, risks, and mutations that could increase the potential for epidemics, and has developed pathogen-specific monitoring and response procedures for known pathogens with high-epidemic risk, such as Pertussis, Anthrax, Measles, and Hepatitis A, as examples. County Health coordinates closely with the California Department of Public Health (CDPH) on emerging threats, and has access to multiple disease surveillance datasets, including model-based projections of current and emerging respiratory virus spread in California. While disease risk profiles of pathogens may change rapidly due to mutations and new variants, County Health acknowledges and recognizes that implementation of additional disease software and syndromic surveillance tools locally may provide more robust information regarding risk assessment and the early detection of possible epidemic threats in Santa Barbara County. 2

The Santa Barbara County Public Health Department has not developed proactive pathogen specific disaster plans based upon evidence-based risk analysis. The Board of Supervisors partially disagrees. As a best practice for ongoing epidemic response planning, County Health has cataloged known pathogen-specific diseases, and has implemented a countywide Infectious Disease Emergency Response Plan, dated June 2024 (See Attachment C). This disease response planning effort is a proactive strategy to effectively respond to both known, and unknown (or emerging), disease pathogens based on general routes of transmission (such as airborne, 3 person-to-person contact, bloodborne, sexually-transmitted, vector-borne or food and water transmission, as examples). County Health finds that it is often infeasible to develop pathogen-specific disaster plans due to the continually changing risk profiles of pathogens and the rapid pace of viral mutations into new variants that can quickly emerge as a disease threat. In response to this ever-changing landscape of pathogen threats, the County’s Infectious Disease Emergency Response Plan includes a tiered response to potential epidemics utilizing an evidence-based risk analysis for known pathogens of concern. Disaster planning for specific pathogens is conducted where feasible; and County Health continues to improve response plans, policies, and procedures based on disease transmission routes, severity, and likely impact.

The Santa Barbara County Public Health Department has not employed current, more comprehensive software for the early detection of potential epidemic risks. The Board of Supervisors partially disagrees. County Health currently utilizes a variety of disease surveillance tools for monitoring circulating diseases; however, more comprehensive software for the early detection of potential epidemic risks would benefit Santa Barbara County residents and further consideration of available technological tools is ongoing. Existing surveillance tools employed by County Health are used with varying frequency, ranging from daily to monthly to as needed, but routinely assist County Health with potential epidemic risks by comparing local disease reporting data to epidemic triggering benchmarks and thresholds.

The Santa Barbara County Public Health Department has the obligation to ensure wastewater testing is carried out throughout Santa Barbara County but is not currently fulfilling its responsibility. The Board of Supervisors disagrees. County Health actively encourages wastewater service providers to participate in disease testing surveillance programs that are available through the California State Department of Public Health (i.e. Cal-SuWers Program). As indicated in the Grand Jury report, wastewater epidemic testing is a useful sentinel surveillance tool for the determination of epidemic risks and community prevalence of disease transmission, as evidenced nationally during the COVID-19 pandemic. However, limitations to its utilization as an augmentation tool in determining epidemic risk locally should also be acknowledged. Wastewater testing for viruses is limited only to known pathogens that may be shed in human feces (i.e. SARS- CoV-2, influenza (flu), poliovirus, and monkeypox), not all infected individuals shed virus in their feces, the sample results do not indicate whether individuals have new or residual infection, results provide only community-based information that cannot distinguish the location of early outbreaks for public health mitigation efforts, and current sequencing platforms for virus testing in wastewater are not available locally in Santa Barbara County. Ongoing costs to wastewater utilities to collect on-site samples, prepare and ship samples, and for the laboratory analysis is often a consideration for wastewater providers to participate in wastewater surveillance testing programs. Under existing State laws, County Health’s authority and responsibility to protect the public from sewage spills that may directly impact individuals should not be conflated with being able to also require surveillance testing for the presence of other viruses that may be shed in wastewater, but that pose no direct disease risk to populations when discharged to waters of the State. Wastewater service providers are currently regulated through the California State Water Resources Control Board pursuant to the State regulations, and perform wastewater testing as may be required by their discharge permits rather than for purposes of epidemic surveillance.

Even though bioterrorism is a growing threat, Santa Barbara County has not established effective channels of communication with federal, regional, and other stakeholders to learn of and apply threat assessment at the local level. The Board of Supervisors disagrees. A process for identification and communication of threats, bioterrorism or otherwise, within Santa Barbara County is well-established. This process includes the Santa Barbara Sheriff’s Office (SBSO) participating as a member of the Joint Terrorism Task Force (JTTF) in conjunction with regional, State, and federal agencies. In the event a threat is identified, the SBSO would take the lead and coordinate needed actions, with County Health responding as needed based on the specific threat. Due to the nature of investigations and the work of the JTTF, information received by County Health will dictate a response using established processes identified within the Infection Disease Emergency Response (IDER) Plan and/or Mass Casualty Incident Response Plan.

7 The Santa Barbara County Public Health Department has not established a process to assure effective communication between regional healthcare providers regarding local epidemic risks. The Board of Supervisors partially disagrees. Local epidemic risks are routinely reviewed by County Health staff and leaders. When an elevated local epidemic risk is identified, County Health leaders are notified and this information is communicated directly with regional healthcare providers by fax or email as a health alert, informational broadcast, or press release via its Public Health Broadcast System. However, the County Health Department acknowledges that there is room for improvement and has initiated the development and implementation of policies and procedures to ensure local epidemic risks and prevention tools are clearly communicated in a standardized and routine fashion to healthcare providers, community leaders, and the residents of Santa Barbara County.