It turns out battling a public health crisis doesn’t come cheap – and officials in budget-strapped San Diego think the county should help with its bills.

County officials, on the other hand, aren’t eager to chip in.

The county reports it’s spent nearly $3 million on its hepatitis A response since declaring the outbreak in March, bankrolling public nurses’ visits to homeless camps and tens of thousands of vaccines.

The City Council on Monday voted to approve up to $2.2 million in payouts to contractors power-washing city sidewalks and standing guard outside newly installed public restrooms downtown.

City and county leaders expect the bills to continue to pile up.

The county alone predicts it’ll continue spending at least $1.5 million a month to try to stop the spread of hepatitis A, which has left 18 dead and sickened 490 people.

The city hasn’t released estimates of its spending thus far.

County Supervisor Dianne Jacob, who represents East County communities, has said that the county’s financially prepared for the crisis.

“This money was already budgeted and available for emergency situations,” Jacob said in a statement.

A county spokesman said the county’s relied on already budgeted money and in some cases, dipped into its substantial reserve accounts to cover expenses.

City leaders are facing a different budget reality, including an expected deficit for the upcoming year that one city councilman predicted could hit $32 million.

So multiple City Council members are already asking whether other agencies – namely, the county – could help.

City Councilman Chris Ward, who represents the downtown areas considered ground zero of the outbreak, questioned city officials at Monday’s City Council meeting about options to cover the growing expenses.

“I’m wondering, is there any opportunity out there to have some cost recovery on this? Are there grant opportunities we can seek?” Ward asked. “Are there any responsibilities that the county may be able to help out with given that this is addressing a public health issue?”

The answer: City officials aren’t sure yet but they’re tracking expenses just in case.

Fellow City Council members continued to zero in on whether the county, the local entity charged with leading the public health response – and that also happens to have significant cash in the bank – could help.

City Councilman Scott Sherman said he was “just trying to figure out how to get the county to step up” after he questioned whether the federal Centers for Disease Control and Prevention may have given money to the county to help with its response. (It has not.)

City Councilwoman Barbara Bry, who chairs the City Council’s budget committee, had a direct question minutes before the City Council voted to ratify the power-washing and bathroom security contracts: “Are these expenses that we could be asking the county to reimburse us for?”

Assistant Chief Operating Officer Stacey LoMedico said that was a “discussion for a future time.”

“That is a conversation that we will have at some point with the attorneys on what could be viable,” LoMedico said, noting the city’s now focused on other priorities, including the homeless campground opened Monday at 20th and B streets and the three industrial-sized tents it hopes to open in coming months.

Bry said she plans to speak at Wednesday’s County Board of Supervisors meeting, and asked LoMedico to follow up if there was anything she should raise with supervisors.

It’s not likely the supervisors will extend Bry and the Council much sympathy.

In separate statements, Jacob and Supervisors Greg Cox and Ron Roberts all said that cities like San Diego – not the county – should take the lead on sanitation and thus, sanitation costs within their boundaries.

“Every local government jurisdiction has the regulatory and legal responsibility for doing whatever it takes to maintain basic sanitation in its own public places,” Cox wrote. “The county has that responsibility in the unincorporated areas.”

And he threw in a dig about the amount of time it took to ramp up sanitation efforts in the city.

“It should not take a Hepatitis A outbreak and a Public Heath Officer’s directive for city officials to clean human feces out of public areas and provide public facilities to ensure a basic level of sanitation,” Cox wrote.

The supervisors also underlined the county’s commitments to fighting hepatitis A and homelessness.

Roberts listed the county efforts, including the dozens of hand-washing stations it’s deployed, the thousands of hygiene kits it’s handed out and nurses being sent to homeless camps to administer vaccines.

“As this unprecedented Hepatitis A outbreak has progressed, the County of San Diego has proven its ongoing commitment to support the responses of local leaders in our 18 cities,” Roberts wrote.

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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