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Week of April 20, 2020
 
Alameda County Health Care Services Agency Update
 
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The Health Care Services Agency (HCSA) is now in week 14 of emergency activation for the COVID-19 pandemic. Many are working around the clock on case and contact investigations, pandemic mitigation strategies, surge planning, and guidance for our communities and partners. In this issue we share key updates including:
·     A new Health Officer Order requiring face coverings, 
·     Ongoing results from sheltering in place and the data to determine next steps,
·     Hospital surge planning and predicting hospitalization peak utilization, and
·     Testing, tracing, isolation, and quarantine strategies to keep our residents safe.
 
On Tuesday, the Board of Supervisors approved amendments to the Countywide Eviction Moratorium passed on March 31. The amended moratorium now covers all causes of eviction while the health emergency is in effect and includes certain protections for renters related to the moratorium. The amended action also allows cities to opt out if they have with their own moratorium.
 
The Agency provides regular updates to the Alameda County Board of Supervisors and you will find a link to presentations here.
 
Lastly, we are entering the month-long observance of Ramadan and want to remind our community about the importance of physical distancing and sheltering in place. Similar to our recommendations during the recent Passover and Easter observances, we ask that you find virtual ways to share time together in fellowship.

 

 

Cover Your Face When Leaving Home
Starting April 22, everyone over the age of 12 must wear a face covering when conducting essential activities per aHealth Officer Order issued April 17. Face coverings can be simple and homemade using cloth, fabric, or other soft or permeable material without holes, that covers the nose and mouth. Face coverings must be worn when conducting any essential activities, including:
·     shopping at a grocery store or waiting in line outside,
·     getting take-out from a restaurant,
·     using or waiting for public transportation,
·     riding in a taxi or rideshare,
·     seeking health care, or
·     working at an essential job.
 
Please visit our frequently asked questions in multiple languages for additional information about the order.
 

 

Physical Distancing and Sheltering
Predictive modeling shows that physical distancing is helping Alameda County flatten the curve. Mobility data (lower left graph) shows that we have reduced movement by up to 65 percent and this limits the risk of exposure and more cases.
 
Remember that the currentshelter-in-place orderremains in effect and face coverings are now requiredwhen going out. We need to continue our efforts to reduce the spread of COVID-19 and support fellow community membersin doing the same.
 
 
Testing and Contact Tracing
 
As of April 22, there were 1280 positive cases and 45 deaths in Alameda County, reflecting 2.7 deaths per 100k compared to 3.7 deaths per 100k across California.
 
Our testing positivity rate is 9% which is similar to other Bay Area counties. In the past month approximately 2,200 tests were conducted per week. Our goal is to have 2,500 tests per day and expand testing to all symptomatic individuals.
 
The Public Health Department has formed a COVID-19 Testing Task Force to evaluate testing needs and disparities, further develop our county-wide testing strategy and implement coordinated testing and linkage protocols. The COVID-19 testing sites list posted this week.
In alignment with recently issued state guidance, current testing priorities include:
·     Staff and residents from long term care facilities,
·     Health care personnel, first responders and essential infrastructure workers,
·     People living in congregate settings,
·     People experiencing homelessness,
·     High-risk contacts of cases, and
·     People who are hospitalized.
 
Contact tracing, alongside testing and isolation and quarantine strategies, is critical for managing this pandemic in the long-term. This specific and important tool for infectious disease control is an integral part of our duties and work as a public health department.
·     Over the past several weeks we’ve scaled up our contact tracing team and anticipate training more people to meet increased need as shelter in place orders are modified.
·     We could need upwards of 300 people at peak COVID-19 caseload and are coordinating technology and training with regional partners.
·     Health facilities and other workplaces may conduct investigations and notifications for workplace close contacts per regulations or for HR purposes.  
 
Outbreak Prevention & Isolation and Quarantine
Last week, large scale efforts got underway to decompress congregate living shelters as a way to prevent outbreaks. We transferred people who met criteria to two hotels operating under the Governor’s Project Roomkey initiative.
 
Public Health also issued additional guidance to Long Term Care Facilities (LTCF) including last week’s Order for all Licensed Facilities and Other Agencies to control the spread of COVID-19. We are partnering with the California Department of Public Health, our local hospitals, the Alameda-Contra Costa Medical Association, and the California Association of Health Facilities to support these facilities with infection control, personal protective equipment training, staffing strategies, and outbreak control.
 
Providers who diagnose COVID+ cases are to continue to provide isolation and quarantine orders directly to patients and contacts, and report high-risk cases (people in congregate settings, health care workers, first responders) to ACPHD Acute Communicable Diseaseswithin an hour. Click here to download the isolation orders.
 
Project Roomkey provides hotel rooms for people experiencing homelessness to isolate and quarantine during the COVID-19 pandemic. Governor Gavin Newsom secured FEMA approval for these rooms, including wraparound supports such as meals, security, and custodial services for the first-in-the-nation initiative. Essential behavioral health and health care services are provided by local governments and community partners:
·     Operation Comfort serves people who are homeless and 1) tested positive for COVID-19, 2) are experiencing symptoms of COVID-19, and/or 3) have been exposed to COVID-19. Click here for information on referrals to Operation Comfort.
·     Operation Safer Ground serves people who are homeless and over 65 or otherwise at high risk (medically fragile) or both. Operation Safer Ground is near capacity and is not taking referrals at this time. 
·     Additional hotels are planned with a goal to become available in the next few weeks.  

 

 

Hospital Capacity and Surge Planning
As of April 20, there were 137 hospitalizations (down from 198 on April 14) and 42 ICU patients (down from 71 on April 10) with confirmed or suspected COVID-19. Also on April 20, 28% of the 213 staffed ICU beds and 76% of the on-site 557 ventilators at hospitals across the county were available. 
 
The number of COVID-19 cases in area hospitals has been relatively flat in the past two weeks. We are currently in the conventional phase of surge planning and utilizing existing hospital resources without yet needing to shift equipment and staff.
 
Our latest modeling for hospital surge planning indicates that if we start easing physical distancing in the next 1-2 months, peak hospitalizations would occur in late summer.
·     While we anticipate having enough total hospital beds to meet that peak period, we may have a shortage of ICU beds and we are planning for that possibility.
·     Spaces for isolation of people in high risk situations is a key surge prevention strategy in order to reduce transmission and hospitalizations. We’re pursuing more hotels to provide isolation rooms for people who cannot isolate at home.
Hospitals report that staff recruitment and retention at all levels are the biggest challenge in their surge planning efforts.
 
Of note, the Medical Health Branch of the Alameda County Emergency Operations Center has filled over 94 percent of the more than 1,000 resource requests received since activation on March 18.
  
“switch… more like a dimmer.”

 

Reopening our economy
The governor recently outlined six indicators the state will use in planning for a transition back to opening the economy. He laid out a vision that will be realized at the local level. Considerations for modifying shelter in place orders include the ability to:
·     Monitor and protect communities through testing, contact tracing, isolating, and supporting those who are positive or exposed;
·     Prevent infection in people who are at risk for severe COVID-19;
·     Handle surges with our hospital and health systems;
·     Develop therapeutics to meet the demand;
·     Support physical distancing at businesses, schools, and child care facilities; and
·     Determine when to re-institute certain measures such as the stay-at-home orders if necessary through an early warning system.
 
As a health agency, we are also planning beyond this next phase of opening the economy, to include long-term disease surveillance and containment efforts to help reduce the negative impact of COVID-19 in our communities. The Bay Area has been able to flatten the curvebecause our Health Officers and leaders showed courage and early leadership with sheltering in place. Thank you all for your ongoing support.