San Diego County’s demanding the city immediately bolster access to public restrooms and hand-washing stations in the wake of a growing hepatitis A outbreak hammering the region’s homeless population.

In a Thursday letter, County Administrative Officer Helen Robbins-Meyer directed the city to place hand-washing stations in 30 locations throughout the city, including in more than a half dozen locations downtown, where the outbreak’s been most acute.

The city pledged to expedite its processes to ensure the county can install the stations immediately – demonstrating a sense of urgency that has been lacking for months as the health crisis raged, claiming 15 lives.

“The city continues to stand ready to support the County’s Health and Human Services Agency in its plans to provide vaccinations, sanitation and education to San Diegans as we battle this outbreak,” Mayor Kevin Faulconer said in a Friday statement. “We must continue to work collaboratively to stop this crisis and save lives.”

The letter obtained by Voice of San Diego and the city’s response comes more than two months after the county announced a pilot program to place handwashing stations in areas where homeless San Diegans congregate. Public health experts have said homeless San Diegans’ poor hygiene is fueling the spread of the virus.

In the weeks since that announcement, 11 people have died and the number of reported hepatitis A cases has more than doubled.

Yet until Wednesday, the county had set up just two hand-washing stations, and both were originally located miles from the downtown streets that are ground zero of the outbreak. County workers moved one of the stations downtown Wednesday.

Now the program appears to have officially moved beyond the pilot stage.

In the Thursday letter to San Diego Chief Operating Officer Scott Chadwick, Robbins-Meyer included a list and map of locations for the hand-washing stations and directed the city to respond within five business days stating when it could comply.

“Action by the city to immediately comply with this directive is essential to prevent the further spread of hepatitis A within the city,” Robbins-Meyer wrote.

A spokesman said the county has proposed an additional 10 hand-washing locations since sending the Thursday letter.

Robbins-Meyer also called for the city to immediately update its protocol for cleaning downtown streets and sidewalks, noting the particular issues in downtown San Diego.

The protocol detailed in a letter the county sent the city last week calls for city sanitation workers to use a bleach solution to clear sidewalks where feces, blood or other bodily fluids are left behind.

A city spokeswoman said earlier this week that the city does not currently use bleach for sidewalk cleaning.

In a statement early Friday, the city committed to implement the new protocol within the next 10 working days.

Mayor Kevin Faulconer’s office also urged the county to declare a state of emergency that might allow it to receive a burst of state and federal money to help address the outbreak.

“Additional funding could go to a variety of programs that could curb the spread of the virus,” Faulconer’s office wrote.

A county spokesman said the county’s now in the process of exploring an emergency declaration.

Faulconer isn’t the only city official to call for an emergency declaration this week.

City Councilman David Alvarez on Thursday asked Faulconer to declare a shelter crisis in light of growing street homelessness and the hepatitis A outbreak, hoping that step would allow the city to cut through regulations and quickly provide more shelter beds.

Faulconer’s new point person on homeless, Jonathan Herrera, has since countered that the mayor’s already declared a homelessness state of emergency two years in a row.

Alvarez, who plans to run for county supervisor in 2020, on Thursday criticized the county’s response on Twitter.

BTW, this doesn’t mean the county is off the hook on this. They are the biggest problem, but in absence of them giving a shit, we should.

— David Alvarez (@AlvarezSD) August 31, 2017

Lisa is a senior investigative reporter who digs into some of San Diego's biggest challenges including homelessness, city real estate debacles, the region's...

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