As Kaiser looks for the source of a coronavirus outbreak that infected at least 60 staffers and killed one at its San Jose hospital, Santa Clara County has launched an investigation into the healthcare chain’s handling of the superspreader event.

County Executive Jeff Smith said public health officials were tipped off by an employee complaint before any formal notice from Kaiser. And they only found out about the scope of the outbreak from news reports this past weekend.

Because public health rules require immediate notification about positive Covid-19 tests, the county plans to fine Kaiser $44,000, Smith said. That’s $1,000 for each of the first 44 cases linked to the Christmas Day outbreak.

“Yes, Kaiser is getting a notice of violation about the lack of reporting of the initial 44 people that they identified,” Smith confirmed in a phone call today. “Yes, they were late.”

Though the county’s opting for civil enforcement in this case, Smith noted that it has authority to file criminal charges. “This is a violation of the public health order,” he said, “so it’s technically a misdemeanor.”

Or, potentially, 44 of them.

When reached for comment Tuesday about the alleged violations, Kaiser responded with lengthy prepared statements—none of which addressed the charges. In a follow-up email the next morning, a hospital spokesman said Kaiser is looking into the matter and will respond later with more information.

The outbreak at Silicon Valley’s 16th busiest hospital drew national attention because of its size and the way Kaiser said it may have been transmitted: by an employee wearing an air-inflated Christmas tree get-up.

Kaiser officials told reporters that all confirmed cases involved employees who were in the emergency department on Dec. 25, when the costumed staffer was making the rounds to spread holiday cheer. Irene Chavez, senior vice president and area manager for Kaiser Permanente San Jose Medical Center, said any exposure from the incident “would have been completely innocent and quite accidental.”

“The individual had no Covid symptoms,” she said, “and only sought to lift the spirits of those around them during what is a very stressful time.”

County officials express doubt over the suggested cause of the outbreak. The infections proliferated too quickly to have all originated from the tree costume, county officials said, so it’s likely that the initial transmission happened sooner.

“Certainly, there are components that are confusing to explain,” Smith said. “For example, if everyone was wearing PPE, how come it spread so fast?”

As part of its investigation, he added, Santa Clara County Public Health Department is conducting genetic testing to get a clearer picture of how the spread transpired.

The Kaiser outbreak is among the largest in the county to date, Smith said. Others include superspreader cases at nursing homes and an outbreak involving more than 100 people associated with a local youth basketball team. But the Kaiser outbreak “is one of the more concerning,” Smith said, “because of the risk involved.”

Chavez, the Kaiser VP in charge of the company’s South Bay medical facilities, said the San Jose emergency unit is undergoing intensive sanitation, “in addition to the already rigorous cleaning protocols in effect.”

“All our healthcare workers will be offered weekly testing for Covid-19,” she added, “and expedited testing for anyone with symptoms or exposure to a person with Covid-19. Masks are required in all areas and we are further reconfiguring our processes and common spaces, such as staff break rooms, to limit any staff gatherings.”

Meanwhile, a Kaiser spokesman added, doctors have reached out and offered Covid-19 tests to 70 patients who were treated and discharged from the emergency unit on Dec. 25.

“Because Covid-19 continues to be widespread, and is often without symptoms, we are all still vulnerable and it remains critical for everyone to continue using the methods to help protect ourselves and others—especially masks, hand washing, avoiding gatherings, and social distancing,” hospital officials said in a statement emailed today.

Smith said the timely reporting mandate is vital to controlling the pandemic.

“It’s critical to know what’s going on in event of an outbreak because there’s the risk of spread to other individuals in the community,” he said. “Each of these people who tested positive has family members. There’s patients who go in and out of emergency rooms. There’s non-medical personnel they come into contact with. So it’s important to have appropriate follow-up—it’s important for us to know.”

The county on Tuesday recorded 1,115 new Covid-19 cases and 11 deaths amid a post-holiday coronavirus surge that’s pushing hospitals to capacity and ambulance wait times to several hours. By the latest tally, 709 people are hospitalized from the virus while 8 percent of ICU beds are available.

Since the start of the pandemic 10 months ago, more than 76,000 people in the county have tested positive; 771 have died.