Initial report shows what health director has said previously: No spikes in reportable illness or ER symptoms

By Paul Sisson

March 27, 2024 7:10 PM PT‍

SOUTH COUNTY — The county public health department is stepping up its public reporting on gastrointestinal illness in the South Bay amid growing public calls for a stronger focus on sewage-related suffering connected to the Tijuana River.

Announced Wednesday afternoon, the launch came just hours before the start of a special river pollution workshop featuring updates from five key organizations, including the U.S. Environmental Protection Agency and the International Boundary and Water Commission.

A new “surveillance bulletin” will be posted once per week on a special “GI Concerns” website every Thursday, showing the prevalence of gastrointestinal symptoms observed among recent emergency department patients and also the number of newly reported cases of illness caused by six different infectious agents commonly associated with wastewater exposure including: campylobacter, giardia, hepatitis A, salmonella, shiga toxin-producing e.coli and shigella.

The inaugural report shows exactly what local public health officials have repeatedly said in recent months. South Bay has not seen and is not seeing a spike in the kinds of symptoms or reported infections that would be expected from exposure to polluted water.

“For those illnesses that are reportable, we aren’t seeing an increase,” said Dr. Seema Shah, medical director of the county’s epidemiology and immunization services branch.

It is likely to be an unsatisfactory finding for those who have recently reported headaches, diarrhea and a host of other symptoms that seem to increase when wet weather causes the river to swell, putting more sewage into the riverbed and, quickly thereafter, into the Pacific Ocean.

Why start regular reporting of this information if it does not show an increase? Shah said that the regular weekly updates are intended to better answer the public’s questions about illness in the South Bay that might be connected to the river.

“We, like many South Bay residents, are very concerned about what’s been happening, and we wanted to make sure that, you know, that we’re taking these reports very seriously,” Shah said. “Transparency is important, so sharing the data, we felt, was very important.”

One area medical provider, South Bay Urgent Care, has recently reported increases in gastrointestinal symptoms such as diarrhea this winter with the onset of heavy rains. In early February, the county dispatched investigators to the clinic to try and get to the bottom of why this location seemed to be reporting an increase in such cases when other providers in the area were not.

Thus far, the health department has not shared the results of its investigation with the public, though a report is expected in the next 30 days.

Doctors Kimberly and Matt Dickson, who run South Bay Urgent Care, have noted that the public health system does not catch everything. Not all infections are required to be reported to public health agencies, and some who experience gastrointestinal symptoms may not go to emergency departments, meaning that their illnesses would not show up on reports that track only those encounters that end up in hospitals.

“There is an uptick of illness, but not all of it is reportable,” Kimberly Dickson said in an email after reading the county’s announcement and inaugural South Bay gastrointestinal illness report.

She said the rains brought an uptick in diarrhea among South Bay Urgent Care patients who live near the Tijuana River Valley.

“The majority of the patients did not have ‘reportable’ illness, but they still had symptomatic diarrhea,” Dickson said. “There is a pattern that, when we see increasing rain events, there is increasing flow in the Tijuana River and increasing amounts of diarrhea we see in our clinic.”

The county’s solution, as expressed in Wednesday’s announcement, is to avoid direct contact with sewage-contaminated water.

“South County residents deserve access to clean beaches and waterways,” said Dr. Ankita Kadakia, a county deputy public health officer. “While we continue to closely monitor reports of illnesses and await steps to lessen and clean sewage flows, it remains very important for people to avoid going into water that is contaminated.”

But after reading that statement, Dickson pushed back.

“The patients we are seeing were not surfers or swimmers in the ocean,” she said. “These are community members who live and work locally; the sewage doesn’t just cause illness for swimmers in the ocean, we are seeing (it) in the general community.”

Water is far from the only factor of current concern for South Bay residents. Residents have reported experiencing symptoms such as nausea after being regularly exposed to strong odors emanating from the river, causing local air quality authorities to increase monitoring of chemicals such as sulfur dioxide and hydrogen sulfide.

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