Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Los Angeles County Post Surge
Response Plan
Los Angeles County Department of Public Health
Thursday, June 30, 2022
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
TABLE OF CONTENTS
Metrics to Assess Risk and Assign Appropriate Prevention Measures ................................................................................. 3 CDC Community Levels ................................ ................................ ................................ . 3 TABLE 1: CDC COVID-19 Community Levels ................................ ............................... 3 TABLE 2: Community Safety Protection Measures and Prevention Strategies (Aligned with CDC Community Levels and Community Transmission) ................................ ..... 4 LAC Early Alert Signals and Levels of Concern ................................ ............................... 7 TABLE 3: LAC Early Alert Signals ................................ ................................ ................. 7 Priority Sector Mitigation Measures ................................ ................................ ............. 8 TABLE 4: Priority Sector Response ................................ ................................ ............. 8
LAC Post Surge Preparedness Plan ........................................ 16 TABLE 5: Preparedness Dashboard ................................ ................................ .......... 16 Outbreak Management Preparedness Post-Surge ................................ ...................... 18 Vaccination Preparedness Post-Surge ................................ ................................ ......... 18 Testing Preparedness Post-Surge ................................ ................................ ................ 19 Therapeutic Distribution Preparedness ................................ ................................ ...... 19 Surveillance Preparedness ................................ ................................ .......................... 19
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
As we enter this post surge phase with COVID-19, Los Angeles County (LAC) will utilize both the Centers for Disease Control and Prevention ’s (CDC) community monitoring measures and the California SMARTER plan to guide the realignment of our local public health response. While we welcome our recovery from the initial and dangerous Omicron variant surge, we recognize that post -surge does not imply that the pandemic is over or that there will not be additional unpredictable waves of surges that will require different monitoring metrics and approaches to meet changing mitigation needs.
The role of the LAC Department of Public Health (DPH) post-surge continues to be ensuring an equitable distribution of the resources and opportunities needed to prevent COVID -19 transmission and protect residents and workers from devastating consequences associated with COVID -19 illness. As we have seen over the past two years, the pandemic has illuminated stark inequities in the burden of disease by race/ethnicity and geography, with Black and Brown individuals and those living in under -resourced communities experiencing higher case, hospitalization, and death rates. These disparities did not happen by chance and reflect decades of disinvestment, marginalization, and racism.
The solutions to eliminating the gaps in health outcomes require transforming systems, policies, and practices. Engaging in this work calls for a long-term commitment to centering equity work at all levels, including mitigation efforts post -surge. Calls to ‘returning to normal’ and minimizing public health response activities can have an unintended consequence of e xacerbating inequitable outcomes since the existing health care and social services systems are not yet organized to provide those most vulnerable and marginalized with the necessary resources to mitigate the impact of the virus.
To ensure an equity focused response, LAC DPH will organize post-surge actions to:
• Protect the most vulnerable, including those at risk of experiencing elevated rates of illness and death from COVID-19
• Protect hospitals and health system functioning
• Prevent unconstrained spread and significant illness
• Prepare for future potential challenges presented by the evolving conditions of the virus
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Metrics to Assess Risk and Assign Appropriate Prevention Measures
CDC Community Levels
Los Angeles County (LAC) will use the Centers for Disease Control and Prevention’s (CDC) COVID-19 Community Level Matrix (Table 1) to inform the level of risk across the county and adopt corresponding prevention strategies as described in Table 2. LA County will move to a lower or higher community level after qualifying for the new level for 7 consecutive days.
TABLE 1: CDC COVID-19 Community Levels
New Cases
(Per 100,000
population in
the last 7 days)
Level of
Indicators
Low Medium
High
LA County’s
Current Values
New Cases:
Fewer than
200
New COVID-19
admissions per
100,000 population
(7-day total)
<10.0 10.0-19.9 ≥20.0
Latest values are
updated weekly
and posted on the
DPH Website
Proportion of
staffed inpatient
beds occupied by
COVID-19 patients
(7-day average)
<10.0% 10.0-14.9% ≥15.0%
200 or more
New COVID-19
admissions per
100,000 population
(7-day total)
NA <10.0 ≥10.0
Proportion of
staffed inpatient
beds occupied by
COVID-19 patients
(7-day average)
NA <10.0% ≥10.0%
The COVID-19 community level is determined by the higher of the inpatient beds and new admissions indicators, based on the current level of new cases per 100,000 population in the past 7 days.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
TABLE 2: Community Safety Protection Measures and Prevention Strategies (Aligned with CDC Community Levels and Community Transmission)
The Community Safety Protection Measures and Prevention Strategies below reflect CDC, state, and county mitigation efforts in four areas: indoor masking, testing, vaccination verification, and ventilation. Federal and state requirements are embedded in Table 2 below and will be changed if and when these requirements change.
*Note: When there is circulation of an emerging COVID-19 variant of concern that shows potential evidence of vaccine avoidance, these recommendations and requirements will be modified.
CDC Community Level1: LOW CDC Community Level1: MEDIUM
CDC Community
Level1: HIGH
Community Transmission:
Weekly Case Rate
<25/100K 25-50/100K >50/100K <25/100K 25-50/100K >50/100K All Transmission Levels
Indoor Masking
Note: Employers must
offer well-fitting medical
masks and respirators to
employees working
indoors in close contact
with other workers
and/or customers at all
sites where masking is
optional
All individuals, regardless of
vaccination status
Individual
preference3,
unless required
by site
Strongly
recommended
Strongly
recommended
Individual
preference3,
unless required by
site
Strongly
recommended
Strongly
recommended
Required indoors in all
public spaces and
businesses
Individuals at elevated risk2 Strongly
recommended in
higher risk
settings
Strongly
recommended
Strongly
recommended
Strongly
recommended in
higher risk
settings
Strongly
recommended
Strongly
recommended
Required
For those exposed,
regardless of vaccination,
for 10 days after last day of
exposure
Required Required Required Required Required Required Required For those confirmed positive Required to
isolate for up to
10 days; mask
strongly
recommended
for those who
test negative on
day 6-10
Required to
isolate for up to
10 days; mask
strongly
recommended
for those who
test negative on
day 6-10
Required to
isolate for up to
10 days; mask
strongly
recommended
for those who
test negative
on day 6-10
Required to
isolate for up to
10 days; mask
strongly
recommended for
those who test
negative on day
6-10
Required to
isolate for up to
10 days; mask
strongly
recommended for
those who test
negative on day
6-10
Required to
isolate for up to
10 days; mask
strongly
recommended
for those who
test negative
on day 6-10
Required to isolate for up
to 10 days; mask strongly
recommended for those
who test negative on day
6-10
Indoor spaces at K-12
schools
Individual
preference3,
unless required
by site
Strongly
recommended
Strongly
recommended
Strongly
recommended
Strongly
recommended
Strongly
recommended
Required in all indoor
spaces at K-12 schools
and in public and
business settings
All healthcare settings,
correctional and detention
facilities, public transit,
Required Required Required Required Required Required Required
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
CDC Community Level1: LOW CDC Community Level1: MEDIUM
CDC Community
Level1: HIGH
Community Transmission:
Weekly Case Rate
<25/100K 25-50/100K >50/100K <25/100K 25-50/100K >50/100K All Transmission Levels transportation hubs,
congregate care facilities,
and homeless and
emergency shelters
Testing
Routine screening testing in
workplaces
Individual
preference3,
unless required
by site or sector
Individual
preference3,
unless required
by site or sector
Individual
preference3,
unless required
by site or sector
Individual
preference3,
unless required by
site or sector
Strongly
recommended for
unvaccinated/not
fully vaccinated at
sites with
individuals at
elevated risk2
unless required by
the site or sector
Strongly
recommended
for everyone
regardless of
vax status
unless required
by site or sector
Strongly recommended
for everyone regardless
of vaccination status
unless required by site or
sector
For those exposed Required Required Required Required Required Required Required For those
symptomatic/confirmed
positive
Required to exit
isolation at day
5; otherwise
Isolate for 10
days
Required to exit
isolation at day
5; otherwise
Isolate for 10
days
Required to exit
isolation at day
5; otherwise
Isolate for 10
days
Required to exit
isolation at day 5;
otherwise Isolate
for 10 days
Required to exit
isolation at day 5;
otherwise Isolate
for 10 days
Required to exit
isolation at day
5; otherwise
Isolate for 10
days
Required to exit isolation
at day 5; otherwise
Isolate for 10 days
Before gathering socially
with those at elevated risk
Individual
preference3,
unless required
by site
Individual
preference3,
unless required
by site
Strongly
recommended
Individual
preference3,
unless required by
site
Strongly
Recommended
Strongly
Recommended
Strongly Recommended
Vaccination/
Negative Test
Verification
For healthcare workers,
employees at healthcare
facilities, and employees at
high-risk congregate care
settings and homeless
shelters
Required Required Required Required Required Required Required For visitors indoors at
healthcare facilities,
including congregate care
sites
Strongly
Recommended
unless required
by site
Strongly
Recommended
unless required
by site
Strongly
recommended
unless required
by site
Require visitors
who are not up to
date with COVID
vaccines to be
tested (PCR or
Antigen) prior to
indoor visitation
Require visitors
who are not up to
date with COVID
vaccines to be
tested (PCR or
Antigen) prior to
indoor visitation
Require visitors
who are not up
to date with
COVID vaccines
to be tested
(PCR or
Antigen) prior
to indoor
visitation
Require all visitors,
regardless of COVID
vaccination status, to be
tested (PCR or Antigen)
prior to indoor visitation
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
CDC Community Level1: LOW CDC Community Level1: MEDIUM
CDC Community
Level1: HIGH
Community Transmission:
Weekly Case Rate
<25/100K 25-50/100K >50/100K <25/100K 25-50/100K >50/100K All Transmission Levels
Vaccination/
Negative Test
Verification
(Cont’d)
Outdoor mega events and
indoor portions of bars,
lounges, nightclubs,
distilleries, wineries, and
breweries
Strongly
recommended
unless required
by site
Strongly
recommended
unless required
by site
Strongly
recommended
unless required
by site
Strongly
recommended
unless required by
site
Strongly
recommended
unless required by
site
Strongly
recommended
unless required
by site
Strongly recommended
unless required by site
Indoor mega events Strongly
recommended
unless required
by site
Strongly
recommended
unless required
by site
Strongly
recommended
unless required
by site
Strongly
recommended
unless required by
site
Strongly
recommended
unless required by
site
Strongly
recommended
unless required
by site
Strongly recommended
unless required by site
For staff in homeless
shelters: unvaccinated staff
at homeless and emergency
shelters to test weekly, as
required by the State HOO.
Required
Required Required Required
Required Required
Required
Environmental
Mitigation
Ventilation throughout
indoor spaces
Ensure and
maintain
improved
ventilation
throughout
indoor spaces
Ensure and
maintain
improved
ventilation
throughout
indoor spaces
Ensure and
maintain
improved
ventilation
throughout
indoor spaces
Ensure and
maintain
improved
ventilation
throughout indoor
spaces
Ensure and
maintain
improved
ventilation
throughout indoor
spaces
Ensure and
maintain
improved
ventilation
throughout
indoor spaces
Ensure and maintain
improved ventilation
throughout indoor
spaces
1CDC recommends use of COVID-19 Community Levels to determine the impact of COVID-19 illness on health and healthcare systems and the prevention measures to use for individuals, households, and communities. The CDC Community Level can be Low, Medium, or High and is dete rmined by the higher of the new COVID-19 admissions and inpatient beds occupied by COVID-19 patients metrics, based on the current level of new cases per 100,000 population in the past 7 days.
2Individuals at elevated risk include: elderly, unvaccinated, those with underlying medical conditions, immunocompromised indi viduals, and communities in high poverty. This means that a person with one or more of these conditions who gets very sick from COVID -19 (has severe illness from COVID-19) is more likely to: be hospitalized, need intensive care, require a ventilator to help them breathe, or die. See CDC website for more details on the underlying medical conditions associated with elevated risk of severe COVID-19 illness. 3Individual preference means that no person can be prevented from wearing a mask as a condition of participation in an activit y or entry into a business.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
LAC Early Alert Signals and Levels of Concern
Public Health will monitor the following signals to provide early indication of concerning trends that can result in future high rates of transmission and/or increased illness severity. The signals in Table 3 below include three (3) community-wide measures (variants of concern, Emergency Department COVID -19 visits, cumulative case rate in high poverty communities) and four (4) sector specific measures (outbreaks at Skilled Nursing Facilities [SNFs], outbreaks at kindergarten through 1 2th grade schools, outbreaks at settings assisting persons experiencing homelessness [PEH], clusters at worksites). Alerts in any community wide measure that reaches the threshold for medium or high concern will trigger an in-depth review of contributing factors and the possibility of modifications to community prevention strategies. Sector specific alerts that reach the threshold for medium or high concern will result in action steps outlined in Table 4: Mitigation Measures for Priority Sectors.
TABLE 3: LAC Early Alert Signals
Indicator
Thresholds
Low
Concern
Medium
Concern
High
Concern
LA County’s
Current Values
Percent of specimens sequenced that are
identified as a new Variant of Concern*
(including subvariants) (based on the
World Health Organization’s designation)
Less than 10% of
sequenced
specimens
10%-20% of
sequenced
specimens
More than 20% of
sequenced
specimens
Latest values are
updated weekly and
posted on the DPH
Website
7-day average of the percent of
Emergency Department (ED) encounters
classified as coronavirus-related
Less than 5% of
ED encounters
Between 5% and
10% of ED
encounters
More than 10% of ED
encounters
7-day cumulative crude case rate for the
lowest income areas
(30-100% area poverty)
Case rate is <100
per 100,000
Case rate is 100-200
per 100,000
Case rate is >200 per
100,000
Number of sewer systems with a two-fold
or greater increase in wastewater SARS-
CoV-2 concentration
(10 day rolling average)
0 1-2 ≥ 3
Number of new outbreaks in
skilled nursing facilities over the
past 7 days
≤10 new
outbreaks in past
7 days
11-20 new
outbreaks in past 7
days
>20 new outbreaks in
past 7 days
Number of new outbreaks in
TK-12 school classrooms over the
past 7 days
≤7 new
outbreaks in past
7 days
8-14 new outbreaks
in past 7 days
≥15 new outbreaks in
past 7 days
Number of new outbreaks in PEH settings
over the past 7 days
≤10 new
outbreaks in past
7 days
11-20 new
outbreaks in past 7
days
>20 new outbreaks in
past 7 days
Number of worksite cluster reports
in the past 7 days
< 100 worksite
cluster reports in
past 7 days
100-300 worksite
cluster reports in
past 7 days
> 300 worksite
cluster reports in
past 7 days
*If a Variant of Concern is also designated a Variant of High Consequence, it will result in immediate designation at the level of “High Concern.”
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Priority Sector Mitigation Measures
During post-surge, detailed below are both general mitigation measures and additional measures that vary depending on the threshold for concern for each priority sector.
TABLE 4: Priority Sector Response
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
SNFs*
*The measures
in this table are
general
information for
the public.
Healthcare
facilities must
follow specific
LAC DPH
guidance and
CDPH and CMS
requirements.
• Increase vaccination and
booster coverage for those
eligible (required for SNF
employees).
• Require masking indoors at all
healthcare settings.
• Ensure adequate testing
capacity to meet routine and
response testing requirements
as defined by the state’s All
Facility Letters (AFLs) and
county HOOs.
• Ensure access to therapeutics.
• Optimize indoor ventilation
where possible.
• Continue aggressive
management of outbreaks and
expanded infection control
measures.
• Continue to provide
consultation, education, and
information on optimal
infection control practices.
• Test all symptomatic staff
and residents.
• Conduct contact tracing
and assure proper
isolation of cases and
quarantining of close
contacts based on the
county HOO.
• Test contacts within
facility as required after
exposure.
• Require masking indoors
at all healthcare settings.
• Conduct regular screening
testing of staff who are
not up to date with COVID
vaccines as required by
state and county
guidance.
• Report all cases among
staff and residents to DPH.
• Test all symptomatic staff
and residents.
• Conduct contact tracing
and assure proper
isolation of cases and
quarantining of close
contacts based on the
county HOO.
• Test contacts within
facility as required after
exposure.
• Require masking indoors
at all healthcare settings.
• Conduct regular screening
testing of staff who are
not up to date with COVID
vaccines as required by
state and county
guidance.
• Require visitors who are
not up to date with COVID
vaccines to be tested (PCR
• Test all symptomatic staff
and residents.
• Conduct contact tracing
and assure proper
isolation of cases and
quarantining of close
contacts based on the
county HOO.
• Test contacts within
facility as required after
exposure.
• Require masking indoors
at all healthcare settings.
• Require N95 respirators
for all staff during the
entire time while in the
facility.
• Conduct regular screening
testing of all staff and
residents as required by
state and county guidance.
• Require all visitors,
regardless of COVID
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
• Prioritize DPH assistance with
outbreaks.
or Antigen) prior to
indoor visitation.
• Limit communal dining
and activities as required
by state and county
guidance.
• Report all cases among
staff and residents to
DPH.
vaccination status, to be
tested (PCR or Antigen)
prior to indoor visitation.
• Pause communal dining
and group activities.
• Report all cases among
staff and residents to DPH.
K-12 and Early
Childhood
Education
(ECE)
• Ensure adequate testing
capacity at K-12 schools and
ECE settings.
• Continue offering group
contact tracing option to
schools as an alternative to
individual contact tracing in
TK-12 schools.
• Recommend that all eligible
staff and students receive
their vaccines/booster dose;
vaccination requirements are
determined by the state or
school districts.
• Prioritize DPH assistance with
outbreak management. During
an outbreak, the Public Health
outbreak response team may
require changes in safety
protocols. This may include
more stringent guidance on
masking, testing, and
• Require masking indoors
for asymptomatic staff
and students with an
exposure.
• Improve ventilation.
• Monitor for symptoms
and test immediately if
symptomatic.
• Assure proper isolation of
cases based on the county
HOO. Require test to
return for shortened
isolation period.
• Promote group tracing in
schools.
• Require response testing
for persons with an
exposure at school/ECE
sites within 3-5 days after
the last exposure, who are
remaining on or returning
to site before day 10.
• Require masking indoors
for asymptomatic staff
and students with an
exposure.
• Strongly recommend
masking indoors for staff
and students.
• Improve ventilation.
• Monitor for symptoms
and test immediately if
symptomatic.
• Assure proper isolation of
cases based on the county
HOO. Require test to
return for shortened
isolation period.
• Promote group tracing in
schools.
• Require response testing
for persons with an
exposure at school/ECE
• Require masking indoors
for asymptomatic staff and
students with an exposure.
• Strongly recommend
masking indoors for
staff and students;
require masking as
feasible for high-risk
indoor activities
including indoor
medium and high
contact sports, large
events, singing, and
band/orchestra in TK-12
schools.
• Improve ventilation.
• Monitor for symptoms and
test immediately if
symptomatic.
• Assure proper isolation of
cases based on the county
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
quarantine and isolation
periods.
• Strongly encourage school-
based vaccine clinics to enroll
as COVID-19 vaccine
providers.
• Consider surveillance
testing in a TK-12
school/district sample to
monitor for trends, only if
staffing and test capacity
allows (e.g., 10%+ of
school population with
cadences of weekly,
biweekly, monthly based
on school need/capacity).
• Report all cases and
outbreaks among staff
and students to DPH.
sites, within 3-5 days after
last exposure, who are
remaining on or returning
to site before Day 10.
• Strongly recommend
weekly testing of those
not fully vaccinated in
TK- 12 schools.
• Report all cases and
outbreaks among staff
and students to DPH.
HOO. Require test to
return for shortened
isolation period.
• Promote group tracing in
schools.
• Require response testing
for persons with an
exposure at school/ECE
sites, within 3-5 days after
the last exposure, who are
remaining on or returning
to site before Day 10.
• Strongly recommend
weekly testing of all
students and staff in TK-12
schools if resources allow.
• Report all cases and
outbreaks among staff and
students to DPH.
PEH • Recommend that all eligible
residents and staff receive
their vaccine and booster
dose(s).
• Require unvaccinated staff at
homeless and emergency
shelters to test weekly, as
required by the State HOO.
• Ensure capacity for
asymptomatic screening and
diagnostic testing of residents
• Require staff at homeless
and emergency shelters to
wear well-fitting medical
masks or respirators.
• Require all residents at
homeless and emergency
shelters to wear masks
while indoors.
• Offer high-quality masks
to all residents.
• Test all symptomatic
persons for COVID-19
• Require staff at homeless
and emergency shelters
to wear well-fitting
medical masks or
respirators.
• Require all residents at
homeless and emergency
shelters to wear masks
while indoors.
• Offer high quality masks
to all residents.
• Require staff at homeless
and emergency shelters to
wear well-fitting medical
masks or respirators.
• Require all residents at
homeless and emergency
shelters to wear masks
while indoors.
• Offer well-fitting medical
masks or respirators to all
residents.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
at shelters using point-of-care
or other tests.
• Ensure access to therapeutics.
• Improve indoor ventilation
where possible.
• Continue to provide
consultation, education, and
information on optimal
infection control practices.
• Prioritize DPH assistance with
outbreak management.
• Continue aggressive
management of outbreaks and
expanded infection control
measures.
regardless of vaccination
status.
• Required to conduct
weekly screening testing
of all shelter staff who are
not fully vaccinated (per
state and county HOOs).
• Strongly recommend
conducting weekly
screening testing of 10%
of unvaccinated residents,
as capacity allows with
point-of-care or other
tests.
• Assure proper isolation of
cases and quarantining of
close contacts based on
the county HOO.
• Report all cases among
staff and residents to DPH.
• Test all symptomatic
persons for COVID-19
regardless of vaccination
status.
• Required to conduct
weekly screening testing
of all shelter staff who are
not fully vaccinated (per
state and county HOOs).
• Strongly recommend
conducting weekly
screening testing with
point-of-care or other
tests for all shelter staff
and residents who are not
up to date with
vaccinations.
• Assure proper isolation of
cases and quarantining of
close contacts based on
the county HOO.
• Report all cases among
staff and residents to
DPH.
• Test all symptomatic
persons for COVID-19
regardless of vaccination
status.
• Required to conduct
weekly screening testing
of all shelter staff who are
not fully vaccinated (per
state and county HOOs).
• Strongly recommend
conducting, at
minimum, weekly
screening testing of all
shelter staff and
residents, regardless of
vaccination status. If
resources allow,
conduct screening
testing twice a week for
shelter staff and
residents, regardless of
vaccination status.
• Assure proper isolation of
cases and quarantining of
close contacts based on
the county HOO.
• Report all cases among
staff and residents to DPH.
Worksites
• Ensure information regarding
vaccinations, testing, and
therapeutics to employees.
Worksites with 3 or more
cases within exposed group
Worksites with 3 or more
cases within exposed group
Worksites with 3 or more
cases within exposed group (as
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
• Encourage worker vaccination.
• Investigate workplace
outbreaks; require employers
to implement safety measures
that limit transmission.
• Continue to provide
consultation, education, and
information on optimal
infection control practices.
(as defined by Cal/OSHA ETS)
during a 14-day period:
• Implement indoor
masking for exposed
group for a minimum of
14 days from last positive
case.
ALL WORKSITES:
• Employers required to
offer well-fitting medical
masks and respirators to
employees working
indoors in close contact
with other workers and/or
customers.
• Strongly recommend
masking indoors for
workers at elevated risk
with significant contact
with the public or other
workers.
• Require symptomatic
workers to isolate and
test.
• Workers who are exposed
to a COVID-19 case must
test as soon as possible
and wear a well-fitting
(as defined by Cal/OSHA ETS)
during a 14-day period:
• Implement indoor
masking for exposed
group for a minimum of
14 days from last positive
case.
ALL WORKSITES:
• Employers required to
offer well-fitting medical
masks and respirators to
employees working
indoors in close contact
with other workers
and/or customers.
• Strongly recommend
masking indoors for all
workers.
• Require symptomatic
workers to isolate and
test.
• Workers who are exposed
to a COVID-19 case must
test as soon as possible
and wear a well-fitting
mask while indoors
around others.
• Optimize ventilation at
worksites.
defined by Cal/OSHA ETS)
during a 14-day period:
• Implement indoor masking
for exposed group for a
minimum of 14 days from
last positive case.
• Consider remote work
where operationally
feasible, especially for
workers at elevated risk.
ALL WORKSITES:
• Employers required to
offer well-fitting medical
masks and respirators to
employees working
indoors in close contact
with other workers and/or
customers.
• Strongly recommend
masking indoors for all
workers.
• Require symptomatic
workers to isolate and
test.
• Workers who are exposed
to a COVID-19 case must
test as soon as possible
and wear a well-fitting
mask while indoors around
others.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
mask while indoors
around others.
• Optimize ventilation at
worksites.
• Employers required to
report to DPH if 3 or more
COVID-19 cases are
known or reported at a
worksite within a 14-day
period.
• Increase risk messaging to
high-risk worksites such
as manufacturing and
warehousing.
• Encourage physical
distancing in communal
areas, such as
breakrooms and
cafeterias.
• Employers required to
report to DPH if 3 or more
COVID-19 cases are
known or reported at a
worksite within a 14-day
period.
• Optimize ventilation at
worksites.
• Increase risk messaging to
high-risk worksites such as
manufacturing and
warehousing.
• Recommend physical
distancing in communal
areas such as breakrooms
and cafeterias.
• Employers required to
report to DPH if 3 or more
COVID-19 cases are known
or reported at a worksite
within a 14-day period.
Highly
Impacted
Communities
• Increase vaccination and
booster coverage.
• Ensure access to vaccinations,
testing and therapeutics in
communities hardest-hit by
COVID-19.
• Continue investment in
community-based
organizations (CBOs) and
faith-based organizations
(FBOs) working in
communities hardest hit
to provide resource
linkages, conduct COVID-
19 outreach and
education, and facilitate
access to vaccination
opportunities.
• Continue Public Health
Councils program to
provide critical support to
low-wage essential works;
• Prioritize community and
workplace outreach and
vaccination efforts in
communities showing
increased rates of
transmission.
• Begin to assess
quarantine and isolation
(QI) housing capacity if
rates of transmission
and/or illness severity
continue to increase.
• Expand PH Council
outreach in essential low-
wage worker industries.
• Continue to prioritize
community and workplace
outreach and vaccination
efforts in communities
showing increased rates of
transmission and/or illness
severity.
• Promote enhanced and
targeted outreach by CBOs
and other partners to
support growing demand
for education resources.
• Explore increased QI
housing capacity, if
necessary.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
consider broader efforts
to support other essential,
low-wage worker
industries not previously
included in the pilot
program.
disproportionately
impacted by outbreaks.
• Expand access to PPE and
screening testing in
priority sectors and
communities.
• Support access to PPE and
screening testing in
priority sectors and
communities
• Tailor CBO/FBO
messaging for
communities of concerns.
• Support targeted PPE and
screening testing access in
priority sectors and
communities.
• Amplify CBO/FBO
messaging for
communities of concern;
convene CBO/FBO
partners to discuss
strategies and resources to
mitigate the spread of
COVID-19.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Sector
General Mitigation
Measures
Low Concern Medium Concern
High Concern
Hospitals and
Health
Systems*
*The
measures in
this table are
general
information
for the public.
Healthcare
facilities must
follow specific
LAC DPH
guidance and
CDPH and CMS
requirements.
• Require masking at all
healthcare settings.
• Increase booster coverage for
those eligible (required for all
health care personnel).
• Continue option for modified
isolation and quarantine
requirements only where
needed to accommodate
severe staffing shortages.
• Coordinate with MHOAC to
safeguard regional capacity for
essential pre-hospital (EMS)
and hospital services and
ensure surge capacity.
• Continue to provide
consultation, education, and
information on optimal
infection control practices.
• Require masking at all
healthcare settings.
• Test all symptomatic staff
and patients.
• Conduct contact tracing
and assure proper
isolation of cases.
• Assure vaccination
requirements for all
applicable staff are
adhered to.
• Report all cases among
staff and patients to DPH.
• Require masking at all
healthcare settings.
• Test all symptomatic staff
and patients.
• Conduct contact tracing
and assure proper
isolation of cases.
• Assure vaccination
requirements for all
applicable staff are
adhered to.
• Report all cases among
staff and patients to DPH.
• Require respirators for all
staff when in direct
contact with
residents/patients.
• Test all symptomatic staff
and patients.
• Conduct contact tracing
and assure proper
isolation of cases.
• Assure vaccination
requirements for all
applicable staff are
adhered to.
• Report all cases among
staff and patients to DPH.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
LAC Post Surge Preparedness Plan
Much of the post -surge plan depends on our ability to focus resources on response actions and preparedness activities. Response actions include addressing increasing levels of community risk and early alert signals that may be sector specific. Preparedness activities are f ocused on strategies that consistently allow the County to respond to changing conditions.
TABLE 5: Preparedness Dashboard
Preparedness Actions Needs
Improvement Adequate Outstanding LA County’s
Current Values
Access to vaccines: Number of mobile
vaccination sites per week Less than 200 200-300 More than 300 Latest values are
updated weekly
and posted on
the DPH Website
Access to vaccines: Number of fixed
vaccination sites Less than 900 900-1,100 More than 1,100 Access to vaccines: Percentage of
eligible homebound residents referred
to DPH who received their vaccine
within 2 weeks from date of referral
Less than 60% 60%-75% More than 75%
Access to vaccines: Percentage of
eligible residents 12+ in the most
vulnerable communities1 who have had
1+ additional dose/booster
Less than 45% 45%-60% More than 60%
Outbreak management: Percentage of
high-risk worksite outbreaks 2 that have
had at least one site visit by DPH
Less than 75% 75%-85% More than 85%
Testing access for the Public: Average
wait time across all County-run
testing sites
More than
1 hour
Between 30-60
minutes
Less than 30
minutes
Testing access at Schools: Percentage
of TK-12 public schools that have
capacity for response testing
Less than 80% 80%-90% More than 90%
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Preparedness Actions Needs
Improvement Adequate Outstanding LA County’s
Current Values
Testing access at SNFs:
Percentage of Skilled Nursing Facilities
(SNFs) that have capacity for routine
response testing
Less than 90% 90%-99% 100%
Access to therapeutics:
Number of sites in the most vulnerable
communities1 that dispense
therapeutics3
Less than
150 sites 150-250 sites More than 250
sites
Access to therapeutics:
Percentage of eligible residents using
the call center who received
recommended therapeutics
Less than 80% 80%-90% More than 90%
Surveillance – Sequencing:
Number of positive case specimens
that are sequenced per week
Less than 300
300-1,200
More than 1,200
Surveillance –Wastewater:
Number of Service Planning Areas
(SPAs) represented in wastewater
collection and testing 3X/week
Less than 5 5-7 8
Surveillance – EDs:
Percentage of EDs reporting COVID-like
illness data
Less than 80% 80%-90% More than 90%
1 The “most vulnerable” communities are classified based upon at least 11 community characteristics, including economic, housing, environment, social, education, transportation and health care compiled in the California Department of Public Health Vaccine Equity Metric or by having a fully vaccinated population coverage less than the overall Los Angeles County estimate.
2 Under post-surge level, high-risk worksite outbreaks are defined as 1) manufacturing or warehousing work settings with at least 50 employees; 2) airline/airport setting; or 3) any industry with 5 or more epidemiologically linked cases. High-risk worksite outbreak definitions may change at higher levels of community transmission and/or when number of outbreaks exceed local investigation capacity. 3 Therapeutics include oral and injectable medications used to prevent infection or disease progression among those with infection.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
The lessons we have learned from navigating more than two years of the pandemic will inform preparedness activities for LA C ounty. The five focus areas identified below include: preparedness for outbreak management, vaccine distribution/information dissemination, testing, therapeutic distribution, and surveillance.
Outbreak Management Preparedness Post-Surge
Worksites are required to report clusters of three (3) or more cases within 14 days to DPH as part of a broader strategy to ensure workplace safety and protect employees when there is spread of an infectious agent. Post-surge worksite outbreak management strategies will include the following:
• Contact will be made with all worksites reporting an outbreak to provide information about employer responsibilities and recommendations/requirements for mitigation of additional spread. • Sites experiencing outbreaks m ay be required by DPH to implement mitigation measures, such as indoor masking, routine testing, distancing, and other infection control measures, to limit the spread of COVID-19 among workers at a worksite.
Vaccination Preparedness Post-Surge
Vaccinations provide the most powerful personal and community protection from COVID-19. Increasing coverage by ensuring access and addressing concerns regarding vaccine efficacy and safety remain priority activities. The following actions are essential components of the preparedness plan:
• Increase vaccination and booster coverage among those at elevated risk for severe illness and those working/living with those at elevated risk.
• Maintain a network of at least 300 mobile teams per week that can provide access to vaccines in low- coverage communities and at schools.
• Maintain an extensive fixed vaccination clinic network to provide access across the entire county. • Increase numbers of medical providers offering vaccines to their patients through their routine services. E mphasize pediatricians incorporating COVID -19 vaccination into routine vaccination practice.
• Increase participation of health plans in ensuring homebound residents have access to vaccinations and boosters.
• Maintain homebound services to provide vaccination s and booster to those at elevated risk for severe illness.
• Increase the number of residents trained as community ambassadors, parent ambassadors, and student ambassadors.
• Increase funding for CBOs and FBOs to support dissemination of vaccination informati on and promote access to vaccine clinics.
• Transition at least 3 Public Health vaccination sites to provide multiple COVID -19 services including vaccination, testing, resources and mental health services.
Los Angeles County Post Surge Response Plan (Revised 6/30/2022)
Testing Preparedness Post-Surge
• Testing may continue to be required by businesses, local or state HOOs, Cal/OSHA or state AFLs in high-risk settings (e.g., SNFs, shelters, correctional facilities, health care facilities, schools), for entry into Mega Events for those not fully vaccinated, and for outbreak management. • Access to free and accessible testing for those with symptoms, exposures, exiting isolation or quarantine, or complying with travel and return to work/school requirements, is important. While there are requirements that health plans provide reimbursement to their members for testing, not everyone is insured and there is neither sufficient supply of tests nor ability for all members to purchase tests. Community testing sites that provide free and accessible testing to residents will remain essential over the upcoming months.
• Distribution of antigen test kits continues to be needed i n high-risk settings and communities with high case rates, where testing remains an essential strategy for protecting workers and community members/residents.
Therapeutic Distribution Preparedness
There is a need to ensure that those with less access to health care can receive appropriate therapeutics.
This includes the following:
• Ensure a vast network of providers with information, supply of therapeutics, and prescribing ability across the county, with emphasis on deep penetration in hard hit and low-resourced communities. • Ensure a vast network of distribution sites (including pharmacies and community clinics) that can distribute oral medic ations with no barriers with deep penetration in hard hit and low -resourced communities.
• Provide a call center where residents can get more information about therapeutics and how to access therapeutics; provide culturally and linguistically appropriate inf ormation and information on accessing free medications.
• Consider using telehealth platforms at public health clinics or other community clinics to augment sites that can prescribe and distribute oral therapeutics in low-resourced communities.
Surveillance Preparedness
To maintain an early alert system that can track the presence of emerging variants of concern, the following is required:
• Capacity to sequence approximately 10% of positive specimens. • Ability to expand wastewater surveillance to all areas of the county. • Expanded sentinel surveillance capacity to detect changing patterns in community rates of respiratory illness that might indicate the emergence of a new variant.