To: County of Sonoma Board of Supervisors
Department or Agency Name(s): Department of Health Services
Staff Name and Phone Number: Barbie Robinson, 565-7876
Vote Requirement: Majority
Supervisorial District(s): Countywide
Title:
Title
3:00 P.M. - COVID-19 Emergency Response Update
End
Recommended Action:
Recommended action
Receive a staff update on current COVID-19 response and enhanced COVID-19 strategy efforts.
end
Executive Summary:
On October 20, 2020, as part of the COVID-19 Response Plan, your Board approved the Department’s report detailing the enhanced COVID 19 strategies to address the ongoing operational goals, community needs, communication of COVID related information and efforts, development of partnerships within the County and the designated use of fiscal resources all targeting the underserved communities within the County.
The report provided today updates the Department’s efforts on the enhanced COVID-19 strategies, along with other updates on the COVID-19 Section overseeing the operation of the pandemic response.
Discussion:
On September 1, 2020, the Board of Supervisors approved the Department of Health Services COVID-19 Emergency Plan allowing for the continuation of the plan and authorizing a temporary COVID-19 Section to be established. Over the past two months, significant efforts have been made to recruit and onboard staff and phase out the Department Operations Center as the COVID-19 Section evolves. In this report, an update has been provided on the COVID-19 Section’s progress to date.
On October 20, 2020, the Board of Supervisors authorized DHS to execute the Enhanced COVID-19 Response Strategies in order to address socioeconomic inequities in the communities within our County. DHS has begun implementing several strategies to address healthcare services, outreach and communications, testing accessibility, and isolation and quarantine support to increase our assistance. The population that DHS is focusing on for this intervention includes those in areas that are difficult to access with some households living in crowded, impoverished conditions. The below report also provides updates on the Department’s efforts on the enhanced COVID-19 Response Strategies since their inception in mid-October.
COVID-19 Section Update
DHS continues to mobilize every resource at our disposal and collaborate with state, regional, and local partners to develop a comprehensive and coordinated response to the virus. As a key part of that effort, DHS has been working since September 1, 2020 to establish a COVID-19 Section that will take on the work of the Department Operations Center so that County employees can go back to their critical roles. DHS has hired over 60% of the staffing allocations approved by the board (130 out of 211 positions).
In terms of leadership of the COVID-19 Section, a Section Manager, and Director of Nursing have been hired. An Administrative Services Officer I and Health Equity Program Manager will be joining the leadership team later in November. Candidates were identified for these positions and they are undergoing the new hire processing. Having these positions in place will help expedite the hiring front line staff and ongoing recruitments. An ongoing challenge is recruitment of PHN’s and full-time/bi-lingual CHW’s. The BOS approved temp promote positions for the three key Supervising PHN’s in Disease Control; which will help support onboard, train, retain, and hire new staff as needed.
Staffing progress for the COVID-19 Section positions are outlined in the table below.
Table 1: COVID-19 Section Staffing Update as of October 31, 2020
|
Job Title |
# of positions |
Recruitment Status |
Filled Positions * |
|
Time-limited positions |
|
|
|
|
Section Manager |
1 |
Filled |
1 |
|
Director of Nursing |
1 |
Filled |
1 |
|
Administrative Services Officer I |
1 |
selected candidate in background/physical |
|
|
Equity Manager (Dept. Program Manager) |
1 |
selected candidate in background/physical |
|
|
|
|
|
|
|
Temp/Extra-Help positions |
|
|
|
|
Accountant |
2 |
in recruitment queue |
|
|
Biostatistician |
3 |
didn't make hire from existing list; opening new recruitment |
|
|
Community Health Worker I/II |
92 |
new continuous recruitment opening soon |
75 |
|
Community Health Worker Specialist |
21 |
selection process |
|
|
Department Analyst |
6 |
ongoing continuous recruitment |
3 |
|
Health Program Manager |
1 |
underfilled with a Dept. Analyst (temp) |
1 |
|
Microbiologist (or equivalent) |
3 |
Filled |
3 |
|
PH Lab Technician |
5 |
last candidate in background/physical |
4 |
|
PH Nurse I/II |
32 |
recruitment opening soon |
|
|
Alternate: Staff Nurse I/II or Registered Nurse |
|
continuous recruitment |
17 |
|
Licensed Vocational Nurse I/II |
|
continuous recruitment |
4 |
|
Senior Account Clerk |
1 |
Filled |
1 |
|
Senior Office Assistant |
28 |
selection process |
7 |
|
Supervising PH Nurse |
3 |
Underfill last position with Supervising Staff Nurse; opening new recruitment soon |
2 |
|
Social Service Worker I/II |
10 |
ongoing continuous recruitment |
|
|
|
|
|
|
|
* includes temp/extra-help staff transitioning from DOC |
|
|
Space has been identified on the 1st floor of 485 Neotomas where the COVID-19 Section will reside. Final preparations are being made to the space and it is projected that the first group of employees will be moved over to the new location by the third week of November.
A lot of planning, and coordination is taking place to meet the increased demands to the testing, case investigation, and contact tracing teams to implement the enhanced strategies in tandem with hiring new staff to support these programs. The COVID Section has also been busy with establishing new partnerships with On the Move to implement the enhanced strategies surrounding health equity. Planning work is also underway with DHS’s Public Health Preparedness program and Immunization Coordinator to develop a COVID-19 vaccine distribution plan for Sonoma County which is due to California Department of Public Health by December 1, 2020. It is expected that increased staffing will be needed to implement a comprehensive COVID-19 vaccine distribution program in collaboration with health and community based partners in the County.
Contact Tracer Program Update
The case investigation/contact tracing team is receiving an average of 79 new cases and 63 new contacts per day for interview and follow-up. To date, the team has handled approximately 15,553 records of cases and contacts (14,176 closed and 1,377 open) through CalCONNECT, the online case and contact management platform developed as a collaboration between the CDPH, Accenture, and Salesforce. As of 11/4, all cases and contacts are being assigned for follow-up within 24 hours of receipt.
A transition plan for temporarily assigned Disaster Service Workers, including PHNs and staff from other County departments as well as State staff has been developed and the COVID Unit team is working to update standardized protocols to help orient and guide new Extra Help staff transitioning into those positions. As of November 5th, 2020, we have a total of 78 individuals supporting case investigation and contact tracing, and 19 PHN/RNs supporting outbreak investigation and complex case management tasks. These totals reflect individuals, not FTE. CI/CTs and are comprised of the following:
Table 2: COVID-19 Section Contact Tracing Staffing Update as of November 5th, 2020
|
Number |
Category |
Comment |
|
9 |
County DSWs assigned from other departments |
Returning to home departments November 20 |
|
19 |
Temporary agency hires to fill immediate needs |
Assume approximately 50% will be transitioned to Extra Help positions |
|
10 |
CDC Foundation assignees |
Rotate every 6 weeks |
|
26 |
Extra Help County staff |
Retention continues to be a challenge because of lack of benefits and underperformance of individuals hired |
|
17 |
State reassigned DSWs |
Agreement runs through end of December for many, with possibility of extension |
|
4 |
Volunteers |
High value but high turnover because of time commitment |
Enhanced COVID-19 Response Strategies Update
Strategy 1: Expand Intensive and Data Driven Testing
DHS has made significant progress in reaching the goals to provide more accessible testing to communities that are located in the most highly impacted census tracts according to the Healthy Places Index (HPI). Pop-up testing is now being conducted up to 12 times per week averaging 2-3 hours per event. DHS has begun establishing an ongoing presence in neighborhoods most impacted by COVID-19 so that community members will be more likely to access testing and other support services. On the Move, via the COVID-19 Urgent Response and Aid (CURA) project, has begun promoting DHS testing events to clients being serviced through their programs and via Community Outreach Workers. Testing Visa/Mastercard gift cards in the amount of $30 per person are also being provided at pop-up events targeting the most vulnerable neighborhoods to encourage testing.
The table below provides information on number of individuals tested via DHS pop-ups and their locations since the 20th of October.
Table 3: Pop-up Testing Sites and Total # Tested
|
SITE |
TYPE |
TOTAL TESTED |
TOTAL POSITIVES |
POSITIVITY RATE |
|
SONOMA PARK AND RIDE POPUP |
TARGETED TESTING |
52 |
2 |
3.8% |
|
BURTON REC CENTER POPUP |
TARGETED TESTING |
112 |
25 |
22.3% |
|
CODDINGTOWN - POPUP |
TARGETED TESTING |
119 |
8 |
6.7% |
|
ANDY'S UNITY PARK POPUP |
TARGETED TESTING |
105 |
11 |
10.5% |
|
HEALDSBURG DAY LABOR POPUP |
TARGETED TESTING |
87 |
2 |
2.3% |
|
GUERNERVILLE POPUP |
TARGETED TESTING |
46 |
1 |
2.2% |
|
CLOVERDALE POPUP |
TARGETED TESTING |
91 |
3 |
3.3% |
|
ROSELAND LIBRARY POPUP |
TARGETED TESTING |
160 |
13 |
8.1% |
|
BURTON REC CENTER POPUP |
TARGETED TESTING |
75 |
6 |
8.0% |
|
SMART N FINAL LATINX |
TARGETED TESTING |
137 |
14 |
10.2% |
|
ROHNERT PARK HEALTH CENTER |
TARGETED TESTING |
128 |
9 |
7.0% |
|
ST. VINCENT DE PAUL CHURCH |
TARGETED TESTING |
104 |
17 |
16.3% |
In addition to the neighborhood pop-up testing, DHS continues to do daily testing of contacts (contact testing) at the Public Health Lab as well as outbreak testing in various facilities based on need.
Table 4: Total # Tests Conducted at All Sites- October 20 - November 02, 2020
Table 5: Total # of Tests Conducted at Neighborhood Pop-up Sites - October 20 - November 02, 2020
Pop-up testing in collaboration with health care partners is in the planning stages and contracts are under development with facilities. Health care partners require support from DHS for bi-cultural and bi-lingual Community Health Workers (CHWs) which DHS is in the process of recruiting. Once we are able to hire additional CHWs to support this work, we will be able to add an additional 6 weekly pop-ups, for a total of about 3 pop-ups per day.
Strategy Improvement 2: Enhanced Outreach to the Latinx Community Update
DHS is collaborating closely with the COVID-19 Urgent Response and Aid (CURA) Project coordinated by On the Move, a locally based non-profit organization. The CURA Project is already delivering much-needed supportive services, connection to healthcare and testing navigation, and emergency financial assistance to the LatinX and Indigenous communities in Sonoma County.
CURA has worked to enhance effective collaboration between community-based entities and local government by supporting increased interfacing opportunities. CURA staff and partners have participated in multiple meetings and conversations hosted by Sonoma County Supervisors, County Leaders and City Leaders and have developed strategies to strengthen access to needed services for vulnerable populations. For example, through this collaboration, representatives from CURA are working on website redesigns and improved navigation, shifted communication to be more culturally responsive and developed co-messaging opportunities to ensure inclusive unified messaging.
CURA staff have partnered with County DHS staff to provide outreach and support at the pop-up testing sites. CURA staff are able to engage those being tested, inform them about the resources available and develop the relationships that are essential for effectively supporting individuals through quarantine and isolation.
Ten bilingual, bi-cultural Community Health Workers and 5 volunteer health care professionals have been identified and received training and will soon begin holding outreach and education events at vineyards, in the fields and other high-risk areas in an attempt to provide education about COVID-19, distribute PPE, link individuals to a medical home and assist in the process to sign up for a testing appointment.
Total Outreach Events: 26
Total Individuals Reached Through Outreach Efforts: 508
Strategy Improvement 3: Financial Assistance Programs
Testing Event Gift Cards
CHWs at testing events targeting the lowest quartile neighborhoods, and eventually with health care partners on testing days, are distributing a gift card to every adult over the age of 18 participating in testing in an effort to increase the volume of our target population being tested.
Eligibility for cards will be limited to once per month. Monetary testing incentives such as this have been successful in significantly increasing testing for other infectious and communicable diseases (e.g. tuberculosis, syphilis) amongst disenfranchised populations. DHS estimates increasing the demand for testing by approximately 50-75% in our target groups based on data from other similar interventions.
Gift cards have been purchased locally but due to the volume of need, we have created an account with a gift card registry allowing for bulk purchases. CHWs at testing events targeting the lowest quartile neighborhoods, and eventually with health care partners on testing days are distributing a gift card to every adult over the age of 18 participating in testing. We have developed a system to allow for tracking of the gift card incentive as they are distributed based on the individuals unique specimen testing number. Testing locations are provided a starting inventory of 120 cards and conduct tracking of the gift cards distributed during the event. A physical accounting and matching of cards returned is provided at the conclusion of the event.
Since October 20 through November 2, the testing team has issued 1,462 gift cards
Financial Assistance to Safely Isolate and Quarantine
County case investigators and contact tracers have been working through the CURA Project mechanism to provide support to the neediest members of our community. Since early October, 214 individuals have been referred to CURA for support (as of 11/4/2020).
Procedures for distribution of County-allocated financial assistance ($1,216) for people with COVID who must isolate are being finalized, pending contract modification. Similar to the CURA application process, County case investigators and contact tracers perform a preliminary screening for eligibility at the time of initial interview. Those who are provisionally qualified are forwarded to the County resource team for collection of needed documentation, approval, and referral to On The Move for issuance of an assistance check. Training for the case investigators/contact tracers took place on 11/5/2020 and referrals are scheduled to start 11/9/2020.
On the Move, via the CURA project, is ensuring individuals have access to the medical connections and financial resources necessary to safely isolate and quarantine. In addition to providing financial incentives to isolate/quarantine, CURA has worked with health care partners to develop a specialized hotline to ensure anyone exhibiting symptoms is able to be immediately connected to their local health center to receive the necessary medical case management and connection to testing. Additionally, CURA is working with DHS and IsoCare to streamline the referral process and ensure those meeting the eligibility requirements and requiring in-depth support in order to safely isolate is referred to, and supported by IsoCare. The below table provides information on the numbers of individuals that have benefited from these services as of October 31, 2020.
Table 6: CURA Project Beneficiaries as of October 31, 2020
|
|
North County |
West County |
Sonoma Valley |
South County |
Santa Rosa |
TOTAL |
|
Individuals Referred to Case Management Services |
69 |
7 |
51 |
33 |
248 |
408 |
|
People Approved for Emergency Financial Assistance |
35 |
6 |
33 |
30 |
185 |
289 |
|
Emergency Financial Assistance Distributed |
$32,000 |
$4,500 |
$12,250 |
$9,250 |
$106,750 |
$164,750 |
Strategy Improvement 4: Partnerships with Business Community
Sonoma County DHS has had discussions with several business groups (agriculture/farm workers, wineries/dairies/breweries, hair salons/barber shops, tourism/hotels/vacation rentals, restaurants, casinos) as well as the Economic Development Board to discuss the expanded COVID strategy and how businesses can contribute to the response. A list of CDPH approved laboratory companies that can assist businesses with surveillance testing of their staff was provided to the EDB for businesses or business groups to reach out to. DHS met with the EDB and the PIO team to further answer questions about testing recommendations and expectations. DHS will also provide an introduction for interested businesses to Curative, a local testing company. DHS participates in the weekly EDB meetings to continue fostering the DHS/business community relationship in the COVID response.
The following activities are being led by the County Communications Team to enhance outreach to key businesses in Sonoma County. Developing partnerships with Sonoma County businesses is a critical step toward implementing infection control practices and educating employees about best practices to reduce transmission in the workplace. The details of this partnership program are still in development, but it envisions:
Testing Partnerships:
• Overall sponsorship of enhanced COVID strategies program: Economic Development Board is promoting and publishing key information to business through its website, email communications, social media, and with partner organizations.
• Sponsorship of pop-up testing, particularly at places of employment: options include partnering with third-party contractors to host testing at workplaces and reserving blocks of testing through one of state-run testing sites. Additionally, some businesses may provide paid time for employees to get tested with their primary care provider or other local testing sites.
Creative Partnerships:
• Fostering working relationships with business leaders to engage in COVID-19 outreach programs such as the current partnership between the County of Sonoma Communications unit and The Engine is Red for a digital advertising campaign. The Engine is Red is providing its services for free to the county while the County financing the mobile ad buys.
Encouraging businesses to model best practices in their workplaces to reduce transmission:
• Utilizing best practices in Appendix A/Exposure, which lives on the EDB website and has been shared numerous times through digital communications and word of mouth.
• Make it clear that there will be no retaliation for employees who have COVID-19 - and that they will be allowed to return to their jobs after taking time off to properly isolate.
• Establish testing programs for employees and/or partner with Sonoma County Public Health for onsite testing.
• Enhance worker education and share resources with employees: Provide COVID safety information for employees. Businesses with Latinx and Indigenous community employees are encouraged to partner with the COVID-19 Urgent Response and Aid (CURA) Project to connect their employees to additional community resources.
Strategy Improvement 5: Isolation / Quarantine Support
Hotel Accommodations and Wrap-around Services
One of the additional barriers to prevent the spread of COVID-19 amongst low-income communities is the capability to safely isolate and quarantine within the household. The hotel accommodation program, and additional wrap around services, will expand upon this work and provide additional lodging options to the most vulnerable populations.
DHS is working to identify local available lodging via hotel accommodations for positive individuals who cannot safely isolate in their own home. Currently, we are anticipating a block of 25 rooms could be available in Sonoma pending successful negotiations of an agreement. Further, DHS is working with the state to provide temporary hotel housing options for essential farm and food processing employees who are either COVID-19 positive or exposed. The county will coordinate with the state to book hotel rooms and provide data so the state seeks FEMA reimbursement.
Strategy Improvement 6: Communication, Promotion Campaign
To promote the County’s new strategies focused on inequities highlighted by the State’s Health Equity Metric, the County Communications team has launched a Health Equity Marketing and Outreach campaign with targeted messaging focusing on:
● Expanded opportunities for testing
● Financial support available for low-income COVID-19-positive individuals in key census tracts.
● Encouraging residents to avoid large gatherings and to follow safety protocols this holiday season.
Aspects of campaign underway include:
● Public service announcements on Spanish and English radio for eight-week campaign from Oct. 26 - Dec. 21 including on KZST, KFGY, KSRO, KXTS, KJOR, KSRT and KBBF.
● In partnership with the integrated creative agency The Engine is Red of Santa Rosa, development of a two-month e-marketing campaign targeting mobile phone-using audience within key census tracts. These digital ads will promote County messaging with click-throughs to SoCoemergency.org page on testing information.
● Series of half-page and quarter-page print ads published in The Press Democrat, North Bay Business Journal, Sonoma Index Tribune, Petaluma Argus-Courier, La Prensa and Sonoma County Gazette for eight weeks beginning the week of Sunday, Oct.26. Campaign also to include digital ads across SMI platforms.
● Development of new graphics/promotion ads for social media and other platforms featuring local families modeling COVID safety protocols.
Aspects of campaign that are in progress:
● Creation of 30-second Spanish-language TV ads for Telemundo and/or Univision (30 days/twice daily) for November and December.
● Development of new Latinx supermarket videos at rate of 28 spots per day at 18 Latinx markets throughout Sonoma County, for a total of 532 spots per day through November and December.
● Digital billboard placement on northbound and southbound for 10 weeks in Rohnert Park for holidays.
● Social Media push (Facebook and Instagram) during holidays
● Photo shoot and videos featuring local families, modeling COVID safety protocols, in progress.
Ongoing LatinX Outreach:
Beginning in October, nonprofit organizations began distribution of 20,000 COVID-19 door hangers and other materials in targeted neighborhoods. Material includes information in English and Spanish on COVID-19 safety measures and contacts for resources as well as information about the expanded testing opportunities for residents of key census tracts. Community-based organizations also are distributing materials by tabling in locations frequented by members of the LatinX community such as local grocery stores, strip malls, parks etc. The community-based organizations include:
● Hispanic Chamber of Commerce of Sonoma County
● La Luz
● Latinos Unidos
● Windsor Wellness Project
Outreach Efforts/Materials:
● Development of new SoCo Emergency web page for better accessing of resources and information about COVID-19 support
● Creation of flyers/posters for businesses to inform employees about testing options in Sonoma County including popup testing sites.
● Creation of flyer/poster showing businesses how to host testing on site for employees as well as provide resources for employee COVID education
● Initiated outreach to local businesses to highlight in "Community Champions," a social media campaign acknowledging businesses with best COVID-19 safety practices
● Working closely with On the Move to support the CURA Project, with local community partners.
Prior Board Actions:
On July 27, 2020, during Budget Workshops, the Board approved a plan to allow for a sustainable COVID-19 response through June 30, 2021 to continue the County’s COVID-19 Response efforts.
On September 1, 2020, the Board of Supervisors approved the Department of Health Services COVID-19 Emergency Plan allowing for the continuation of the COVID-19 Response plan and authorizing the Director of Health Services to obtain necessary resources, services, supplies, equipment and for the temporary COVID-19 Unit to be established.
On October 20, 2020, the Board of Supervisors authorized the Director of Health Services, or designee, to execute the Enhanced COVID-19 Response Strategies and to execute agreements, and to obtain necessary resources, services, supplies, equipment, and such other properties to be lacking or needed for the protection of life and property, and to bind the county for the fair value thereof not to exceed the appropriations authorized by the Board in this item. The Board of Supervisors also approved redirecting within fiscal year 2020-2021 $4 million Coronavirus Aid, Relief, and Economic Security (CARES) Act assigned to COVID-19 response activities led by the Department of Health Services to finance the initial phase of Enhanced COVID-19 Response Strategies.
Fiscal Summary
|
Expenditures |
FY 20-21 Adopted |
FY 21-22 Projected |
FY 22-23 Projected |
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Budgeted Expenses |
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Additional Appropriation Requested |
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Total Expenditures |
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Funding Sources |
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General Fund/WA GF |
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State/Federal |
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Fees/Other |
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Use of Fund Balance |
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Contingencies |
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Total Sources |
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Narrative Explanation of Fiscal Impacts:
DHS will continue to monitor the level of response needed to address the COVID-19 pandemic and come back in December to request additional appropriations that will be commensurate with the level of response needed based on conditions existing at that time. DHS will continue to refine its COVID-19 Response plan and Enhanced COVID-19 Strategies based on efficacy and finite resources. Additional resources will be needed to support community-based partners prior to and after December 31, 2020 as that is when current funding for the program subsides. DHS will return to your board with an update on the effectiveness of these improvement strategies to reduce the transmission and prevalence of COVID-19 in our communities and to seek direction from your board on how to address the need for additional investments should the need for these investments continue.
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Staffing Impacts: |
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Position Title (Payroll Classification) |
Monthly Salary Range (A-I Step) |
Additions (Number) |
Deletions (Number) |
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Narrative Explanation of Staffing Impacts (If Required):
N/A
Attachments:
None
Related Items “On File” with the Clerk of the Board:
None