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Significant disparities exist in San Mateo County affecting our low-income residents and communities of color.  Deep and longstanding social/economic factors are at the root of these issues, yet COVID-19 has exacerbated these inequities. 

While there is more we need to understand, it is clear that our pandemic response must continue to target all low-income residents and communities of color with a tailored, culturally competent approach.

Our Plan: Two strategies to reduce spread and inequities

San Mateo County Health’s plan to contain the spread of the virus is designed to have customized approaches for different at-risk community groups, tailored to meet their specific needs. The plan focuses on two strategies: 

Strategy 1 

Improve Communication to Build Trust, Engagement and Participation in Protection Efforts

Strategy 2

Enhance Targeted Strategies for at-Risk Communities

Our Ultimate Measure of Success

How will we know if we are making progress? California requires each county to reduce overrepresentation of low-income and/or minority groups in its COVID-19 positive cases. The way this is measured is by comparing rates of positive cases in different neighborhoods (or census areas). In order to move into less restrictive tiers, the lowest ranking neighborhoods on the Healthy Places Index need to meet certain thresholds.

How are we doing?

Metric   Status

Percentage COVID-19 positivity
(7-day average, 7 days lagged) for the lowest quartile HPI census tracts


1.1% reported by State 1

What we are working on: We have appointed a new Public Health Equity Officer to coordinate our public engagement related to this plan. The details of the plan are outlined below.

Strategy 1: Improve Communication to Build Trust, Engagement and Participation in Protection Efforts

Two reasons we are struggling to reduce the spread and disproportionate impact of COVID-19 are:

  • Poor adoption of the protective behaviors that most prevent the spread (vaccination, face coverings, hygiene, social distance, no gatherings); and
  • Lack of trust in government and engagement in Public Health protection efforts.

In response to these, our plan is to improve communication with our community by prioritizing these actions:

A. Expand targeted, culturally competent communications to reinforce core messaging on protective behaviors

While we have communication efforts for the general public, there is great value in our ability to tailor information for specific groups to most effectively meet their needs. Farmworkers on the coast need different information (in different ways) than young adults in East Palo Alto. When we have a spike in cases in a particular neighborhood there is enormous benefit in being able to quickly provide information they need to stay safe, in the language and format that works best. We do this work through partnerships within the County and with community-based organizations.

How we are doing:

Metric Goal Status
# outreach events per month 1 event per month  October: 7 outreach events
# of digital media and radio impressions 100,000 impressions per month

October: 2,060,861 media impressions

# Social Medial Impressions (WeChat, Twitter, Instagram, Facebook) 50,000 impressions per month October: 70,282 social media impressions
# active ads running (billboards, newspapers, bus shelters, digital ads) 1 ad/month (in multiple languages) October: 24 active ads

What we are working on: We are selecting from a group of community partners who have responded to our request for assistance in outreach and education in their communities. In addition, we continue to work with our community-based organizations led by and serving those most impacted groups.

B. Maintain public dashboards and in-language resource information

Information is the most powerful tool we have to slow the spread of this virus. The dashboards and resource information created for our communities are key ways we share important information and build trust.

How we are doing:   

Metric Goal Status
Visitors to SMC Health website per month 100,000 96,000
Followers on SMC Health Facebook at monthly point in time 22,000 24,748
Followers on SMC Health Twitter at monthly point in time 5,300 7,267

C. Conversations with At-Risk Communities: Creating opportunities for dialog with impacted groups

We are in this together, and it is a two-way conversation. Our plan is to continue supporting interactive activities (forums, town halls, focus groups, live streaming social media events) that target key groups (faith groups, parents, neighborhoods, etc.) within our community. These allow for critical dialog where we can learn from and share with each other.

How we are doing:

Metric  Goal Status
# of supported interactive activities 2 per month

12 completed in October 2021

What we are working on: Given the overwhelming impact on the Latinx community, the Public Health Equity Officer will convene a Latinx advisory committee to review the learnings and offer input to the continued public health response as well as support other interactive activities.

D. Promote Following Core Behaviors (face coverings, social distancing, etc.) and Health Equity within our Partnerships with Community Stakeholders

The County is not alone in working to slow the spread of the virus in our community. Our plan includes ongoing partnerships with trusted leaders within key sectors to prioritize health equity as they make decisions and develop plans.

What we are working on:

  • Business Community: Partner with SAMCEDA and other business organizations to increase education about how to prevent spread; specifically focusing on improved safety for at-risk workers in construction, food service, and custodial/maintenance.
  • Education: Partner with the County Office of Education to provide technical and subject matter expertise and other supports as they work to meet the needs of their students and families.
  • Childcare: Partner with First5 and Child Care Coordinating Council to support outreach and technical assistance to childcare providers. 
  • Health Plan: Partner with the Health Plan of San Mateo to monitor and support the 18% of San Mateo County residents that are their members; specifically focusing on older adults in care facilities (who have been 35% of San Mateo County deaths) and the staff and caregivers who work in these settings.
Metric Goal Status
# Schools supported/approved for safe in-person learning See San Mateo County Office of Education Website San Mateo County Office of Education Website

Strategy 2: Enhance Targeted Strategies for at-Risk Communities

In addition to lack of trust and not following recommended behaviors, two additional factors contribute to increased spread of COVID-19 and create disproportionate impacts:

  • Lack of testing among certain communities with high positivity rates; and
  • Inability for frontline and low wage earners to safely isolate due to economic impacts.

In response, our plan is to enhance targeted strategies for at-risk communities by prioritizing these actions:

A. Ensure Easy Access to Testing for At-Risk Populations

Providing convenient, no-cost testing to all residents when, where and how they need it is crucial to our ability to identify and stop the virus. Our plan expands neighborhood testing sites and outreach supported by trusted community partners. Making testing easy and transparent builds trust and connection. We strive to eliminate all barriers to testing. See more detailed testing plan

How we are doing:

Metric Goal Status

# tests / 100,000 population

308 tests/100,000 population

769.7/100,000 population per day for period as of 11/1/21

# neighborhood  testing events                

Average at least 16 neighborhood testing events per month

41 events in October

What we are working on: See more detailed testing plan

B. Ensure Effective (timely, responsive and culturally competent) Contact Tracing

What happens if you test positive for the coronavirus? Ideally, you connect immediately with a contact tracer and through that relationship are able to safely isolate.  Contact tracers are heroes of the pandemic.  Not only do they serve every person who tests positive but they also work to identify, notify and support every person who was exposed. This is a big job, with a big impact. We need to have enough people, with the right skillsets to be able to effectively engage with the community.

What we are working on:

  • Maintain sufficient staffing of contact tracers
  • Ensure contact tracers can connect in the resident’s preferred language

How we are doing:

Metric  Goal Status
% of Covid-19 cases outreached to within 1 day by contact tracers TBD 74%
% of Bilingual contact tracers 40% 48%

C.  Provide Culturally Competent Support to Remove Barriers to Safe Isolation

There are countless challenges to being able to safely isolate, and we are committed to doing everything we can to make doing the safe thing the easiest thing. People diagnosed or exposed to coronavirus are often unable to safely isolate because of their living situation, need to go to work for income, access to food, etc. Our Public Health Support Program connects these people with a case worker from Mental Health Association who works with them to understand and meet their specific needs. The more trusting and comfortable the relationship is with the case worker, the more effectively they are able to identify and remove barriers.

What we are working on:

  • Housing: Partner with Housing and Human Services to provide hotel and other housing options
  • Food: Referrals to Second Harvest (for all) and the Great Plates Delivered initiative (for older adults)
  • Health Coverage: Connecting to medical and behavioral health care coverage through our Health Coverage Unit. Not only do we connect people to coverage programs, but we also make policy changes to expand/extend coverage and advocate for those members of our community who are not receiving adequate coverage
  • Other County support: The County and private entities have supported Rental Assistance, Landlord Assistance, and the Immigrant Relief fund as well as childcare.

How we are doing:

Metric Goal Status
% Bilingual case managers  75% 100%
# Referrals per month >250 referrals per month

September: 212 referrals

TOTAL: 6,751 referrals (since August 2020)

D. Continue Safety Net Healthcare and Supportive Services

In parallel to these public health strategies, Health continues to provide culturally competent healthcare and supportive services for the lowest income residents of our community. Our direct services meet the health and wellness needs of our community through our hospital and clinics, behavioral health and recovery services, mobile clinics and street medicine teams who bring healthcare directly where people are.

Additionally, our role in the community includes partnering with all local hospitals to monitor the potential for surge demands and coordinate regarding use of alternate care resources.

How we are doing:

Hospital Capacity to Meet Surge 

This dashboard provides information on the number of hospitalized patients with confirmed or suspected cases of COVID-19, as well as current occupancy and availability of intensive care unit beds, acute hospital beds and ventilators across San Mateo County. These data are provided by hospitals and may vary greatly day to day as discharges, transfers, and deaths of patients occur throughout the day.