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Program - Responding to San Diego County Epidemics

San Diego County Chief Medical Officer Dr. Nick Yphantides is an advocate for those in his community who need it the most. He currently serves as the Chief Medical Officer for San Diego County and its 3.2 million residents (1% of America's population). He is the Founding Co-Chair of San Diego's Childhood Obesity Initiative, was the Chief Medical Officer (CMO) of one the largest network of Community Clinics in San Diego County, the CMO of the Council of Community Clinics and was the publicly elected Chairman of the Board for Palomar Health, the largest Public Hospital District in California. His passion and mission is to Prevent  the  Preventable!

Dr. Yphantides began as a volunteer Chief Medical Officer nine years ageo, when the county was in the grip of a swine flu epidemic. He recognized that the things that most impacted community health were in the community environment rather than what happened in a doctor's office. Every year our health system wates time and mone REACTING to preventable things. By focusing on integration of health and public policy, prevention and politics, Dr. Yphantides changed the way San Diego County has responded to epidemics.

In late 2017, the county began dealing with a Hepatitis A outbreak, which provided a perfect example of how social conditions influence community health. Hep A is a highly contagious disease, easily transmitted through inadequate hygiene as much as lifestyle. The average incubation period for Hepatitis A infection is 28 days, and an individual can be contagious up to two weeks before developing symptoms or 1-2 weeks after onset of symptoms. The virus is very hardy, and can live outside the body for months, depending on the environmental conditions. The repercussions of this are that an infected individual, even without having symptoms or knowing they were infected, could leave the virus on common public surfaces, such as a railing at a bus station or a table top at a restaurant. That virus can then spread to anyone who touches the same surface. Vaccination with the full, two-dose series is the best way to prevent infection.

The challenge for containing the outbreak was that prevention needed to include providing services to the large San Diego homeless population, a process that was politically challenging. However, by framing the efforts as protecting not just the "at-risk" homeless population, but the health and economic welfare of the general population, the response team was able to get the funds and manpower to distribute Hep A vaccines to those at the highest risk. Over 125,000 vaccinations provided at public health centers, medical institutions, jails during intake and to inmates, substance use disorder treatment programs, homeless service providers, single room occupancy hotels, encampments, ravines, culverts, and other areas in the field with homeless outreach workers, sometimes including homeless outreach team workers or police officers and Emergency Departments. Other responses included sanitation efforts and education. This aggressive outreach contained the outbreak to 584 cases.

Just before Christmas, flu hit San Diego, causing another unexpected potential epidemic. The challenge for the health team was that the flu hit sooner than expected, which left larger swaths of the population unprotected. The County ended up reporting 17,375 cases, almost 3X as many as a 'typical' flu season. 283 people have died from complications to the flu. 

The vaccine is the best public health tool to prevent flu, and annual vaccination recommended to everyone over 6 months. Develops protection against flu in 2 weeks and lessens severity if one gets the flu. The challenge in educating the public to this benefit is the two-week "window" where the vaccination is not yet fully effective, and when there is an early outbreak, many people then question why they or their loved ones get sick. Dr. Yphantides explained that the biggest challenge to "Preventing the Preventable" is that it's hard to quantify the results, because they don't occur. In the case of the flu epidemic, the appearance was that the vaccines were ineffective, but in truth the illness spread before the prevention took hold.

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