PLANNING FOR A FUTURE WITH
COVID-19
Contra Costa Health COVID-19 Transition Plan
January 26, 2023
Contents
Purpose .......................................................................................................................................................................3 Infrastructure Transition Plan as Public Health Emergency Ends ..............................................................................3 Projected State of COVID: It is Here to Stay ...............................................................................................................4 Equity ..........................................................................................................................................................................4 Access to Services for People with Contra Costa Health Plan coverage ................................................................6 Access to Services for People with no health coverage .........................................................................................6 Equity Support to Communities of Focus ...............................................................................................................9 Contra Costa’s Path to Zero ..................................................................................................................................... 11 California’s SMARTER Plan ...................................................................................................................................... 13 Infrastructure Transition Plan ................................................................................................................................. 14 Public Health Testing Services ............................................................................................................................. 14 Public Health Vaccine Services ............................................................................................................................ 14 CCRMC/Health Centers Testing, Vaccine, and Treatment Services .................................................................... 15 State-Funded COVID-19 Test-to-Treat Sites ........................................................................................................ 15 Contact Investigation and Tracing ....................................................................................................................... 15 Public Health Laboratory ..................................................................................................................................... 16 Logistics ............................................................................................................................................................... 16 Health Officer Guidance ...................................................................................................................................... 17 Community Outreach .......................................................................................................................................... 17 COVID Call Center to transition to CCHP Advice Nurse ....................................................................................... 17 Communications .................................................................................................................................................. 17 Long Term COVID Response Plan (FY23/24 and beyond) ....................................................................................... 17 Appendix .............................................................................................................................................................. 19
Purpose
The purpose of this document is to outline Contra Costa Health’s (CCH) strategy and plan for responding to COVID in Contra Costa County for the next 5-10 years. Over the past three years, CCH has ensured that all county residents have had access to testing, vaccines, and treatment. To achieve this, CCH provided an unprecedented level of services to all county residents – touching over 700,000 county residents in one way or another. This has included contact tracing, outbreak management, testing, vaccinations, treatment, and supplies such as antigen test kits and masks. We have been proud to have the 2nd lowest death rate for counties across the nation of populations more than 1 million, and to have been able to save more than 2000 lives through our timely, efficient, and quick response as a local county health department in partnership with other county agencies, community-based organizations, businesses, and residents.
Although COVID testing, vaccines and treatment are now widely available from pharmacies, private vendors, and health care providers, we know that access is often limited initially and the county has been providing services to anyone who comes to us, including those with barriers to accessing other health systems. We have seen this happen time and again throughout the pandemic, and most recently with treatment when our Contra Costa Health Plan made the Advice Nurse Line and provider telephone consultation available to any county resident to ensure universal access to therapeutics before most providers were prescribing them.
We now need to scale back these activities when the Public Health Emergency (PHE) federal declaration ends and rely upon our own existing health department capabilities as well as the health care delivery systems in our county to integrate these COVID activities into their ongoing work.
We have been fortunate that the State has continued to provide services here in Contra Costa including test-to- treat sites. We are anticipating utilizing this resource while it remains available, likely ending when the Public Health Emergency ends if not sooner. Also at the State level, California has outlined metrics for ongoing preparedness and response to COVID in the SMARTER Plan.
With the transition of the current COVID infrastructure, and the integration of COVID services into ongoing health care services across the county, CCH will not be able to meet the demand for COVID services from all county residents nor we will be able to meet the SMARTER Plan metrics.
CCH proposes a two-step approach in this plan:
1. Reduce COVID infrastructure in coordination with the end of the Public Health Emergency, both State and federal
2. Implement a transition plan to fully integrate COVID activities into existing CCH operations by January 1, 2023
Infrastructure Transition Plan as Public Health Emergency Ends
CCH anticipates ongoing waves of significant COVID activity in our county. However, without the staffing required for a large-scale COVID response, and the related ending of funding, we will need to rely on existing health department infrastructure to serve those most vulnerable, including communities hardest hit by the
pandemic, and partner with other health care delivery systems such as John Muir and Kaiser as well as other partners to provide services to county residents.
By the end of this transition, CCH will be able to continue to provide testing, treatment, and vaccination services through existing infrastructure for those residents who are traditionally served by CCH for ongoing health care and developing smaller public testing, vaccination, and treatment sites to ensure access for those who are uninsured. County residents with insurance coverage are being directed back to their regular health care provider for covered services.
As the Public Health Emergency (PHE) ends, CCH will focus on the following operational imperatives:
• Achieving zero preventable COVID deaths
• Ensuring access to testing, vaccines, and treatment for uninsured and hardest hit communities • Continue core public health activities such as outbreak investigation and variant sequencing • Maximizing use of State resources
• Integrating COVID activities into regular Health Department operations • Addressing the metrics as outlined in the SMARTER Plan as able Projected State of COVID: It is Here to Stay
Although all of us are eager to get back to life “pre-COVID,” we accept the reality that COVID will be with us for a long time, affecting every aspect of daily life. We estimate that COVID will be a priority for our society and the Contra Costa County community for the next 5-10 years.
Although the exact trajectory is unknown, experts anticipate new variants will continue to emerge with unknown levels of protection from vaccines, and combined with waning vaccine immunity over time, will result in future disease waves and outbreaks impacting our communities, health care facilities, schools/childcares, congregate facilities, and other settings and causing spikes in cases, hospitalizations, and deaths. Demand for testing and medical treatments will continue, and access to at-home test kits and PCR testing will be critical for the uninsured and residents with barriers to care. Demand for vaccines and boosters will also continue as new vaccines and vaccine recommendations are released. Vaccine and testing mandates and infection control guidelines will continue to evolve and likely become permanent measures to reduce risk. Possible health order issuance and related enforcement activities may be considered (although unlikely) as CCH monitors trends in disease activity.
The impact of COVID here in Contra Costa, like other significant health issues, will be determined by our ability to continue to respond creatively to ongoing COVID demands, and our ability to align these efforts across the sectors in our county, including our partnerships with health care delivery systems, first responders, county departments, cities, State government, community-based organizations, schools, childcare facilities, private entities and most importantly, our residents.
Equity
We know that COVID has disproportionately affected communities that are already facing other inequities, such as people of color, low-income communities, and older adults, and our plan for continuing to address equity is a critical part of our COVID transition plan. CCH has a clear and ongoing commitment to protect the health of all our residents, particularly those who are most vulnerable and COVID is no exception. CCH will continue to ensure access to COVID services for people with Medi-Cal, our uninsured residents, and the hardest hit communities by institutionalizing this access across our delivery system. CCH, our partner health safety net health agencies (La Clinica, Lifelong, and Brighter Beginnings) and other commercial health systems are responsible for providing healthcare to Medi-Cal residents and will ensure access to COVID services through existing and expanded health delivery mechanisms.
CCH will continue to provide COVID-related services to community members who have Medi-Cal, those who do not have access to health care or coverage, and those who live in those communities who have been hardest hit.
Core strategies to support these community members include:
• Ensuring access to testing, vaccine, and treatment via:
o CCH Health Centers, all located in low Health Places Index (HPI) areas and with expanded hours in the dedicated Immunization clinics
o Contra Costa Health Plan (CCHP) Advice Line for assistance in accessing services – 1-888-243- 8310
o Contracts with community clinics through June 2023.
o Robust mobile clinic capacity to respond to community requests/events • Community Outreach Ambassador Program, to provide community-based services through mid-2024 in partnership with EHSD. The team is currently staffed with nine (9) full-time Adult Ambassadors, two (2) part-time Ambassadors, three (3) coordinators and five (5) Specialty health ambassadors. We are adding two (2) additional coordinators and twenty (20) Workforce Ambassadors through additional funding received from EHSD.
• Daily canvassing of communities that score under the 25th percentile of the Healthy Places Index to identify and support community health needs
• Provide daily outreach services countywide to share updated Contra Costa Health information and inform communities about local vaccination clinics
• Ongoing collaboration with community-based organizations and community partners to organize community events, mobile vaccine clinics, and provide education to the community • Plan, organize, schedule, and provide logistical support for mobile vaccine clinics 2-3 days a week • Ongoing communication including website and dashboard in English/Spanish o Update website as needed, at least once per week
o Provide all information in both English and Spanish, and provide other languages as needed o Maintain a communications tool kit with materials in English and Spanish that can be downloaded and printed for use by the community/public
o Post regularly to social media in English and Spanish, with targeted distribution to geographic and demographic targets
o Provide board of supervisors with communications materials to help inform the public about updates
o Maintain a detailed list of where all members of our community can access Covid services, including testing, vaccine, and access to Paxlovid treatment
o Maintain ongoing relationships with local media, including making subject matter experts who are fluent in Spanish available as we can
o Support text messaging and other direct communications to CCRMC and health center patients regarding availability of services
• Data and epidemiological analysis daily including cases, deaths, test, and vaccine services provided
Access to Services for People with Contra Costa Health Plan coverage There are approximately 242,000 people who are Contra Costa Health Plan members, the vast majority with Medi-Cal coverage. As the largest Medi-Cal managed care plan in Contra Costa with a comprehensive county- wide delivery system, Contra Costa Health Plan has worked with its provider network to ensure easy access to COVID services for CCHP members. These services will continue to be provided including reimbursing members for home test kit purchases, ensuring providers are reimbursed for testing, vaccine, and treatment services provided to members and 24/7 Advice Nurse consultation for COVID treatment options available.
Access to Services for People with no health coverage
Since early in the COVID-19 pandemic, federal legislation has provided State and Local Fiscal Recovery Funds/American Rescue Plan Act funding to provide reimbursement to providers for the costs related to providing COVID testing, treatment, and vaccines to uninsured individuals, regardless of their immigration status. The funding has allowed uninsured Contra Costa County residents to access these services at no cost to them at many locations across the county. The federal funding for these programs is coming to a point of depletion, with no agreement by the U.S. Congress to extend it.
As federal funding winds down, it is critical for individual health and the health of our community to ensure that everyone, including people with no health insurance, can continue to easily access COVID services. There are an estimated 57,000 uninsured residents in the county as of the 2020 census. Of this, approximately 15,000 may be eligible for Medi-Cal – including adults with income levels up to 138% of the federal poverty level (FPL) with an additional unknown number of uninsured children living in households with up to 266% of FPL. The remaining 42,000 residents, although currently uninsured, may be eligible on the health insurance marketplaces for federal subsidies to support reduced monthly insurance premiums through Covered California healthcare plans. The ability to provide essential COVID-19 healthcare services while connecting eligible individuals to healthcare coverage is a key pathway to ongoing health and access.
In California, currently, undocumented residents who are income-eligible and under 26 years and 50 years and older qualify for Medi-Cal. Low-income undocumented individuals between 26 and 49 years are currently eligible for the Contra Costa CARES program and will become eligible for Medi-Cal in January 2024. Therefore, CARES bridges the transition, eliminating additional barriers to care for this vulnerable population. La Clinica, Lifelong and Brighter Beginnings are contracted providers for Contra Costa CARES, and there is a robust community outreach effort to reach this group and enroll them in CARES.
A key goal of the CCH COVID-19 Winddown plan is to ensure that uninsured individuals continue to have the same access to COVID-19 services as access granted to insured individuals. To support this, CCH will work to continue to provide services and access for uninsured individuals to COVID-19 testing, treatment, and vaccine services through the following tactics:
Call Center
• Access to treatment through the Contra Costa Health Plan (CCHP) Advice Line (1-877-661-6230) • Access to schedule testing and vaccine appointments through the CCH Appointment Unit (1-800-495- 8885) or the COVID Call Center (1-833-829-2626).
• The COVID Call Center will remain operational through the PHE. As the PHE end date approaches, a transition plan will be established based on current needs.
Testing
More information available at Get Tested | Coronavirus (cchealth.org) • At home test kit distribution. CCH distributes at home test kits as requested to the following agencies:
o Home visiting and case management programs
o Health Care for the Homeless and CORE street outreach/services o Homeless Shelters
o Local libraries and Community-based Organizations
o Board of Supervisors offices
o Police department and city offices
o CCH Health Centers and Behavioral Health Clinics
o Community members upon request
• Walk-in testing available Monday through Friday for uninsured at CCH Health Centers, all located in low Health Places Index (HPI) areas:
o Antioch Health Center, 2335 Country Hills Drive, Antioch, CA 94509, 8:00 – 11:30 am o Bay Point Health Center, 215 Pacifica Avenue, Bay Point, CA 94565, 8:00 – 11:30 am o Brentwood Health Center, 171 Sand Creek Road, Suite A, Brentwood, CA 94513, 1:00 – 4:30 pm o Concord Health Center, 3052 Willow Pass Road, Concord, CA 94519, 1:00 – 4:30 pm o Martinez Health Center, 2500 Alhambra Avenue, Martinez, CA 94553, 8:00 am – 4:30 pm o Miller Wellness Health Center, 25 Allen Street, Martinez, CA 94553, 1:00 – 4:30 pm o North Richmond Center for Health, 1501 Fred Jackson Way, Richmond, CA 94801, 7:45 am – 4:45 pm
o Pittsburg Health Center, 2311 Loveridge Road, Pittsburg, CA 94565, 8:00 am – 4:30 pm o West County Health Center, 13601 San Pablo Ave, San Pablo, CA 94806, 1:00 – 4:30 pm • Expanded contracts with community clinics (e.g., La Clinica) to provide no-cost testing o Tuesdays, 9:00 – 11:00 am; La Clinica Monument, 2000 Sierra Rd Concord CA 94518 o Wednesdays, 9:30 – 11:30 am; La Clinica Oakley, 2021 Main St Oakley CA 94561 o Fridays, 9:30 – 11:30 am; La Clinica Pittsburg, 2240 Gladstone Dive Pittsburg CA 94565 • Expansion of on-demand services of the Equity Mobile Team for community-based pop-up testing clinics • Ongoing communication and promotion of free and low-cost testing services available to uninsured individuals at health centers and select pharmacies. Locations in California are posted to the https://myturn.ca.gov website with many conveniently located CVS, Walgreens, and grocery store locations, with evening and weekend operating hours.
Vaccine
More information available at Get Vaccinated | Coronavirus (cchealth.org)
• Walk-in vaccination available Monday through Friday for uninsured at CCH Health Centers, all located in low Health Places Index (HPI) areas.
o Antioch Health Center, 2335 Country Hills Drive, Antioch, CA 94509, 1:00 – 4:30 pm o Bay Point Health Center, 215 Pacifica Avenue, Bay Point, CA 94565, 1:00 – 4:30 pm o Brentwood Health Center, 171 Sand Creek Road, Suite A, Brentwood, CA 94513, 8:00 – 11:30 am o Concord Health Center, 3052 Willow Pass Road, Concord, CA 94519, 8:00 – 11:30 am o Martinez Health Center, 2500 Alhambra Avenue, Martinez, CA 94553, 1:00 – 4:30 pm o Miller Wellness Health Center, 25 Allen Street, Martinez, CA 94553, 8:00 – 11:30 am o North Richmond Center for Health, 1501 Fred Jackson Way, Richmond, CA 94801, 7:45 am – 4:45 pm
o Pittsburg Health Center, 2311 Loveridge Road, Pittsburg, CA 94565, 8:00 – 11:30 am o West County Health Center, 13601 San Pablo Ave, San Pablo, CA 94806, 8:00 – 11:30 am • Dedicated Immunization clinics open to all individuals without access to other health care, located at four county location. Online scheduling available at Vaccine Scheduling (cchealth.org):
o Brentwood Health Center, 171 Sand Creek Road, Suite A, Brentwood, CA 94513, Mondays 1- 5pm
o Pittsburg Health Center, 2311 Loveridge Road, Pittsburg, CA 94565, Tuesdays 1-5pm o Concord Stanwell Building, 2355 Stanwell Circle, Concord, CA 94520, Thursday 1-5pm o West County Health Center, 13601 San Pablo Ave, San Pablo, CA 94806, Fridays 1-5pm CCH will be expanding the above Immunization clinics to include weekend/evening hours when the PHE ends.
• On-demand services of the Equity Mobile Team for community-based pop-up vaccination clinics • Expanded contracts with community clinics (e.g., La Clinica) to provide no-cost vaccinations o Tuesdays, 2:30 - 4:30 pm (Moderna 6 months thru 5 years and Moderna Bivalent for 18+), La Clinica Monument, 2000 Sierra Rd Concord CA 94518
o Fridays, 2:30 – 5pm (Pfizer 5-11, Pfizer 12+, Pfizer Bivalent 5+), La Clinica Monument, 2000 Sierra Rd Concord CA 94518
o Wednesdays, 2:00 - 4:00 pm (Baby Moderna, Pfizer 5-11, Pfizer 12+, Pfizer Bivalent), La Clinica Oakley, 2021 Main St Oakley CA 94561
o 2nd and 4th Thursdays from 2:00 – 5:00 (Pfizer Bivalend 6 months+, Pfizer 5-11, Pfizer 12+ and Moderna 6 months+, Moderna Bivalent 18+). La Clinica Pittsburg, 2240 Gladstone Drive, Pittsburg CA 94565
• Transportation assistance to vaccine appointments available through MyTurn.ca.gov • Ongoing communication and promotion of free and low-cost vaccine services available to uninsured individuals at health centers and select pharmacies. Locations in California are posted to the https://www.vaccines.gov/ and https://myturn.ca.gov/ websites. In Contra Costa County, there are over 50 locations listed (as of 10/5/22) with many conveniently located CVS, Walgreens, and grocery store locations, with evening and weekend operating hours.
Treatment
• Access to the Contra Costa Health Plan (CCHP) Advice Line for treatment services and referrals • Communication and promotion of free and low-cost treatment services available to uninsured individuals at health centers and select pharmacies. Testing and Vaccine locations in California offering treatment services are posted to the https://myturn.ca.gov/ websites.
Healthcare Coverage
• As uninsured individuals access testing, vaccine, and treatment services through any of the CCH- provided operations listed in this section, CCH will screen everyone for Medi-Cal eligibility. If eligible to apply for coverage, CCH will refer the individual to assistance with completing an application to allow the individual to have continued access to healthcare services • The Center for Human Development (CHD) in Contra Costa County currently operates a Medi-Cal Enrollment Navigator program to aid individuals in applying and retaining Medi-Cal benefits. The Ambassador Outreach team will work to utilize this resource when supporting uninsured individuals in the community.
Housing for Isolation Support
• Isolation support can be accessed through the COVID Call Center, which will transition to a hotel voucher program coordinated by Public Health.
• Unhoused individuals can access isolation housing services at Delta Landing through the Contra Costa COVID Call Center. These services will end within the next six months and individuals will be directed to a hotel voucher program as described above.
Equity Support to Communities of Focus
CCH is also providing targeted support to the following populations:
Staff and Incarcerated Individuals in Detention facilities - Mandates for vaccination of congregate setting staff are currently in effect. Vaccinations are provided for incarcerated individuals by onsite health services teams.
These teams continue to provide COVID-19 testing at intake for all persons booked at the facility, maintain isolation rooms for incarcerated individuals who test positive, and surgical masks are readily available for incarcerated individuals upon request. As of August 2022, we are targeting to vaccinate 1,428 inmates and 50 staff by 6/30/2023.
Unhoused individuals - Vaccination outreach efforts continue in addition to required vaccinations to stay at shelter facilities. The CCH Health Care for the Homeless (HCH) program provides outreach and street medicine teams who administer vaccinations in the community. This team works closely with shelter and CORE outreach staff to ensure unhoused patients have the necessary vaccinations required to access beds and services. The HCH program also provides clinical services in all shelters ensuring access to booster vaccinations. Unhoused individuals are currently able to access isolation housing services at Delta Landing through the Contra Costa COVID Call Center. As of August 2022, teams are targeting to vaccinate 540 individuals in this population by 6/30/2023.
Lowest Vaccine Equity Measure (VEM) Quartile - Using census data from areas scoring low on the Healthy Places Index (HPI), CCH identifies neighborhoods with low vaccination rates to host mobile vaccination clinics.
Contra Costa Health Ambassadors support this effort by canvasing door-to-door to encourage vaccinations.
Targeted neighborhood marketing campaigns include distributing flyers, social media posts, and partnering with local CBOs to promote the planned events. This effort is targeting to vaccinate 1,071 individuals and boost 3,629 individuals by 6/30/2023. It is estimated that 13.7% of this population is not yet fully vaccinated.
African American/Black Population - Mobile Vaccination Teams administer COVID-19 vaccines at community churches and neighborhood events. Healthcare partner La Clinica also hosts pop-up clinics and provides
vaccinations at their community health center clinics. CCH Ambassadors provide door to door canvassing and community-based outreach services to encourage vaccination. Culturally targeted communication campaigns have been developed to address hesitancy in the black community. As of August 2022, we are targeting to vaccinate 6,643 individuals and boost 7,717 individuals in this population by 6/30/2023. It is estimated that
27.8% of this population are not yet fully vaccinated.
Latinx Population - Vaccination on site with Mobile Vaccination Team at community locations including culturally appropriate grocery stores, churches, and community events. La Clinica hosting pop-up clinics and other community health center clinics. A key partnership is with Hijas Del Campo to provide vaccinations through farms and agricultural businesses. As of August 2022, we are targeting to vaccinate 20,147 individuals and boost 26,687 individuals in this population. It is estimated that 27.6% of this population are not yet fully vaccinated.
American Indian, Alaska Native Populations - Contra Costa Health Ambassadors provide door to door canvassing and outreach services to encourage vaccination of this community with traditionally low vaccination rates. Education and outreach services are provided at community and cultural centers. As of August 2022, we are targeting to vaccinate 36 individuals and boost 260 individuals in this group by 6/30/2023. It is estimated that 6.4% of this population are not yet fully vaccinated. 50+ y/o population - Contra Costa Health Ambassadors provide door to door canvassing and outreach services, mobile vaccination teams travel to homebound individuals, and mobile teams provide vaccination clinics at senior centers and assisted living facilities. The public can request in-home and facility-based vaccinations through an online form on the CCH website. As of August 2022, we are targeting to vaccinate 1,081 and boost 23,362 individuals in this age population by June 2023. It is estimated that 1.1% of this population are not yet fully vaccinated.
Skilled nursing facilities staff and patients - Mobile vaccination teams travel to skilled nursing facilities (SNF) to provide vaccinations to residents. In addition to vaccinations, Communicable Disease and Infection Control staff provide education and technical assistance to these facilities. CCH maintains a county-wide SNF contact list to communicate regular updates and host town hall events to answer questions and support facilities. Residential facilities can request onsite vaccination services through an online form posted to the CCH website. As of August 2022, CCH has reached the target of 95% of this population fully vaccinated and will continue to provide vaccination services to new staff and new patients upon request.
School-Aged Children – The CCH Mobile Equity Vaccination team hosts pop-up vaccination events at schools throughout the year. A care coordination unit has also been established to assist parents in obtaining vaccinations through streamlined scheduling processes with the Public Health Immunization Clinics and CCH Pediatric Clinics. COVID vaccines are also provided at school-based health centers at Kennedy High School in Richmond, and Meadow Homes elementary school in Concord.
Contra Costa’s Path to Zero
In recognition of the changing COVID landscape, including the advent of both vaccines and treatments to reduce mortality, CCH has launched the Contra Costa Path to Zero with the aim of zero preventable COVID deaths here in Contra Costa. This strategy outlines the areas of activity needed to achieve this aim, including • Preventing infection (Shots, Testing, Masks, Readiness, Education) • Increasing survival when infected (Rx)
• Advancing equity
• Increasing outreach, engagement, education, and information (Awareness)
California’s SMARTER Plan
In addition to our Path to Zero, the SMARTER Plan (Shots, Masks, Awareness, Readiness, Testing, Education, Rx) released by the State of California in May 2022 outlines the tools necessary to move towards the next phase of the COVID pandemic and future emergency situations. Contra Costa is aligning with this Plan and will be using the same measurement goals as outlined in the table below.
SMARTER
Plan California State measurement Contra Costa County
measurement
CCH Path to Zero
supporting strategies
Shots
Ability to administer at least 200,000
vaccines per day on top of existing
pharmacy and provider infrastructure
Ability to administer at
least 4,000 vaccines per day on
top of existing pharmacy and
provider infrastructure
• Easy and ongoing access
to testing and vaccination
Masks
Maintain a stockpile of 75 million high
quality masks and the ability to distribute
them as needed
Maintain a stockpile of 1.5
million high quality masks and
the ability to distribute them as
needed
• Maintain PPE supply
including masks
Awareness
Maintain ability to promote vaccination,
masking, and other mitigation measures in
all 58 counties. Support engagement with at
least 150 community-based organizations
Maintain ability to promote
vaccination, masking, and other
mitigation measures in the
county. Support engagement
with at least 10 community-
based organizations
• Reduce misinformation
through trusted
messengers
• Educate providers on
interventions
• Normalizing mask wearing
• Partner with community-
based organizations and
schools
• Presence in hardest-hit
communities
Readiness
Maintain wastewater surveillance in all
regions and enhance respiratory surveillance
in the healthcare system while continuing to
sequence at least 10% of positive COVID-
19 test specimens. Ability to
add 3,000 clinical staff within 2 – 3 weeks of
need and across various healthcare facility
types
Ability to add 60 Surge staff
within 1 week of need
• Maintain personnel surge
capacity
• Enact sick leave policies
Testing
Maintain commercial and local public health
capacity statewide to perform at least
500,000 tests per day (PCR and antigen)
Maintain commercial and local
public health capacity to
perform at least 10,000 tests
per day (PCR and antigen)
• Easy and ongoing access
to testing and vaccination
• Tracking of variants
through sequencing
• Ensure at-home tests
available to every
household
• Wastewater surveillance
Education Expand school-based vaccination sites by
25% as eligibility expands
Expand school-based
vaccination sites by 25% as
eligibility expands
• Partner with community-
based organizations and
schools
Rx Ensure local entities can order effective
therapeutics within 48 hours
Ensure local entities can order
effective therapeutics within 48
hours
• Make therapeutics easily
available within 48 hours
To achieve the metrics outlined in both the CCH Path to Zero and the SMARTER Plan, CCH must maintain a COVID response without the expansive infrastructure that we have built over the past three years, and instead rely on our existing capabilities, partnerships, and particularly existing health care delivery systems.
Infrastructure and staffing will be challenging to maintain when the Public Health Emergency ends. We are concerned that we will not be able to meet these metrics with the reduction in our COVID response.
Infrastructure Transition Plan
The current CCH COVID Operational structure is aligned with the Incident Command System (ICS) and includes the necessary components to continue our equity efforts, implement the Path to Zero and support the State’s SMARTER plan. With the reduction in staffing due to attrition and the end of the Public Health emergency, we will significantly reduce the COVID Operational structure to gradually close the large-scale testing and vaccination sites over time and focus our services on those who we traditionally serve. Details of the proposed changes are outlined in the section below.
Public Health Testing Services
CCH closed two community based COVID-19 Testing sites on October 1, 2022, directing community members to a variety of other testing resources including home-based tests, pharmacies, regular health care providers, and the State test-to-treat sites. Of COVID-19 tests performed at CCH community-based testing sites during the last six months of operation, 63% of individuals receiving tests had private insurance and 37% of patients were covered by Medicare, Medi-Cal, CCHP, or were uninsured.
Public Health Vaccine Services
By the time the Public Health Emergency ends (projected to be April 15, 2023, and possibly sooner depending on demand, CCH will close three community-based COVID-19 Vaccine sites and transition services to existing Public Health Immunization clinics provided at four health center locations. These four immunization clinics serve individuals without access to other health care on a first-come, first-serve basis. Once the site closures are implemented, CCH will have no surge capacity to support anticipated new vaccines or surge in cases from new variants. If needed, CCH would have to contract out services, if available, to support any surge capacity.
Community sites to close by the time the PHE ends
• Oak Grove COVID-19 Vaccine – 1034 Oak Grove Rd, Concord • Richmond Auditorium COVID-19 Vaccine - 25th St and Nevin Ave, Richmond • Nick Rodriguez Community Center COVID-19 Testing – 213 F St, Antioch
Public Health dedicated Immunization clinics open to individuals without access to other health care • Brentwood Health Center, Mondays 1-5pm
• Pittsburg Health Center, Tuesdays 1-5pm
• Concord Stanwell Building, Thursday 1-5pm
• West County Health Center, Fridays 1-5pm
Mobile COVID-19 Testing & Vaccine Team to continue through June 2023 • The COVID-19 Vaccine and Testing Mobile Team will continue to operate in current capacity until June 30, 2023.
• The Mobile team will focus on access to COVID-19 testing and vaccinations for the uninsured Contra Costa populations and the below populations:
o Equity clinics for vaccinations
o Homebound vaccinations
o Facility vaccinations
o Facility Outbreak COVID Testing
o Business/Events/School Vaccinations
o Vessel/ Cargo Ship Vaccinations
CCRMC/Health Centers Testing, Vaccine, and Treatment Services CCRMC and Health Centers will continue to offer testing, vaccination, and treatment services to people with CCHP as well as those who are uninsured. Individuals without insurance can access COVID-19 testing and vaccine services through walk in hours at all clinic locations. The department will also maintain infection control standards, screening protocols, remote visit options, and provide acute care treatment for hospital patients. The CCH Health Centers align to community health services through the following pathways:
• People with health insurance should go to their healthcare provider, or to commercial testing and vaccination sites, including State sites.
• People without insurance can access the CCH Health Centers for COVID-19 services as a walk-in patient. • People with CCHP/Medi-Cal/Medicare can schedule COVID-19 services through MyChart or by calling 800-495-8885.
State-Funded COVID-19 Test-to-Treat Sites
State-funded COVID-19 testing sites, operated via contract with OptumServe, will continue to operate on a month-by-month basis until the demand decreases and/or the State ceases funding. When CCH closes their testing sites in San Ramon and Richmond, community members seeking testing services will be directed to these State testing sites, ensuring that we take full advantage of the State resources. • Pleasant Hill – 321 Gold Club Rd, Pleasant Hill
• Antioch – 4703 Lone Tree Way, Antioch
Contact Investigation and Tracing
The Contact Tracing and Investigation unit has already begun to map and align workflows with the Public Health’s Communicable Disease program, given the monkeypox outbreak. Case Investigation and Contract Tracing services supporting Schools, Residential Care Facilities, Laboratory Result Reporting and Location (Business) will continuously decrease as staff exit employment. Efforts will focus on developing a more sustainable, scalable, and responsive CD unit for all future disease tracking and responses.
The Case & Contact Tracing Unit currently is responsible for the following activities:
• Outbreak management at workplaces, schools, other locations, and events • Ongoing receipt of case reports
• Collaborating with providers to ensure treatment is offered • Consultation with the public on best practices and latest recommendations • Test result texting campaigns, surveys of positives and callbacks
Public Health Laboratory
The PH Laboratory will continue to operate services but will have a reduction in demand of processing COVID-19 specimens as sites close. The Public Health Laboratory will continue to process Mobile unit COVID-19 specimens, Whole Genome Sequencing from CCRMC patients, sequencing from samples across the county, as well as wastewater sampling.
Logistics
The CCH Logistics branch of the COVID-19 Response will begin to shift most functions of operations back to existing processes.
The Logistics Branch currently oversees the following activities:
• Act as State liaison to the Medical Health Operational Area Coordination (MHOAC) program as designees of the County Health Officer
• Request staffing support from State
• Order, inventory management and distribution of home test kits, masks, personal protective equipment (PPE) and other supplies to internal and external health care providers as well as community-based organizations
• Storage and distribution of professional COVID-19 rapid tests for local health care providers • Distribution of home test kits to community partners
• Contract development and monitoring, and invoicing/POs for sites/supply vendors • Remote technical support for field-base staff and sites • Distribution of therapeutics (Paxlovid, Paxlovid (Renal), and Molnupiravir) • Establishing, relocating, and demobilizing County and State COVID-19 vaccination and testing sites • Inventory management of supplies and equipment removed from sites closed • Track active DSWs and TEWs
After the PHE ends, Logistics will transition services so that contracts, Purchase Orders, supply ordering and invoicing will be managed by individual divisions within CCH for COVID-19 operations. Inventory management of pandemic supplies will shift to the CCH Health Emergency Response Unit. Services remaining within the Logistics Unit until completed include:
• Distribution of COVID-19 Therapeutics
• Antigen test ordering and distribution to community
• Request staffing support from State
• Distribution of PPE to community, while State provides supplies and staff • Personnel and Site demobilization
Health Officer Guidance
As part of our health department regulatory responsibilities, our Health Officer will continue providing recommendations and guidance.
We will continue to monitor data for real-time situation status as well as predictive modeling for cases, hospitalizations and deaths, and testing and vaccine demand.
Community Outreach
Community outreach, engagement and education will continue via our Equity Team as well as our Ambassador Program. These staff will focus on communities that are hardest hit, including providing vaccine and testing services at health fairs and other events and connecting with community-based organizations serving historically marginalized communities. Our Ambassador Program will continue to provide community outreach through 2023 as it has been funded through a partnership with the Employment and Human Services Department. In addition, CCH received a State grant to hire Specialty Ambassadors from the developmentally disabled community.
CCH will also continue to partner with at least 10 community-based organizations through the Historically Marginalized Community Group through both meetings as well as ongoing email communications.
COVID Call Center to transition to CCHP Advice Nurse
When the Public Health Emergency ends, or when the vaccine sites close, CCH will close the COVID-19 Call Center.
Contra Costa Health Plan will provide advice nurse line capacity as well as telephone consultation for COVID for those who qualify and refer residents with access to health care back to their regular providers. They will continue distributing information to their providers and holding educational sessions about COVID vaccine and treatment options.
Communications
Our Communications team will continue to ensure we are providing timely and clear communication with the most up-to-date information through the website and social media outlets, and by continuing to respond to media inquiries.
Long Term COVID Response Plan (FY23/24 and beyond)
The ongoing CCH COVID response will be limited and designed to support public health infrastructure development that will be critical to respond to other infectious disease outbreaks and emergencies. This final structure will support infection control oversight and education, communicable disease surveillance and response planning, mobile testing and vaccination teams, and other public health modernization and
improvement projects to enable the department to effectively respond to future pandemics or emergencies in an efficient, equitable and scalable manner.
All COVID response staff will be informed of the transition plan and provided appropriate resources for applying for ongoing County positions in collaboration with support and recommendations from the County’s Human Resource Department.
Appendix
1 EHSD Report of Health Insurance Analysis Post-COVID, 10/11/2022