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SMC Health COVID-19 Plan & Metrics

Overview

SMC Health VACCINE PLAN & Metrics
To Stop Spread of Covid-19 and Reduce Disparate Impacts

Introduction/Background

Newly available safe and effective vaccines are one of the most important ways to end the COVID-19 pandemic. Access to these vaccines must be equitable. 

The COVID-19 pandemic has worsened pre-existing disparities affecting low-income residents and communities of color in San Mateo County. For example, members of the Latinx community represent 24% of population, but 41.6% of COVID-19 cases as of June 2021. Full recovery from COVID-19 requires we do everything we can to address not only the public health impacts, but economic recovery, community infrastructure, education and child care. While we know addressing these inequities fully is a long-term effort, we must start now with a pandemic response that targets the most impacted communities with tailored, culturally responsive approaches to overcome vaccination barriers.

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) using a data set called the Healthy Places Index . With the introduction of vaccines, we expect the State will establish new metrics to assure the equitable distribution of vaccines. If we are successful, there will be no difference in rates of COVID-19 cases or vaccinations between different communities within San Mateo County.

How are we doing?

Metric Goal Status

Gap between COVID-19 positivity for the lowest HPI census tracts and countywide positivity rate

0% difference between neighborhoods

0.3% gap reported  6/7/21

For additional detail, please see our data dashboards which outline the vaccination rates in various communities here

San Mateo County Equity Principles to Guide our Vaccination Effort

Safety, equity and transparency: We are committed to being transparent, careful, and above all equitable in providing COVID-19 vaccines to everyone who needs and requests vaccination. While the federal and state governments directly guide and supply many vaccinations through large health care systems and pharmacies, County Health coordinates vaccinations for those not already connected to vaccines and provide a safety net assuring no one is left behind. Our focus is to increase accessibility for low-income residents and communities of color and partner with trusted members of these communities to understand and remove barriers. 

 We are using these principles to guide our effort :

  1. Provide transparency in the science, data, and vaccination process. 
  2. Prioritize those that shoulder the most risk.
  3. Acknowledge explicitly the negative and painful history of health care in the US in communities of color and current health inequities that have led to distrust in healthcare, research, and government.  
  4. Engage our community to better understand their concerns and needs and respond as much as possible. 
  5. Communicate effectively in culturally sensitive ways through trusted partners.
  6. Overcome as many barriers to accessing the vaccine as possible – geographic, linguistic, cultural, physical, technological, documentation, mistrust, and more.
  7. Learn and improve as we go.

More about our vaccine equity work here  

Our Vaccine Plan: Two strategies to stop spread and reduce inequities

San Mateo County Health’s pandemic response plan involves custom approaches for different at-risk community groups. The work to ensure equitable distribution of vaccine builds on strategies we have used throughout the pandemic and will be informed by the newly expanded Vaccine Communication Equity Working Group comprised of over 100 members and convened as part of the San Mateo County Recovery Initiative.

The very complex and dynamic vaccine roll out is changing every day. County Health plays a key coordination role between the federal and state government and our community. The federal government approves and creates guidance which the state of California further details. The State then gives vaccine doses to counties and large multi-county health care organizations like Kaiser, Sutter/Palo Alto Medical Foundation, Dignity/Sequoia and AHMC/Seton Medical. County Health supports smaller health care organizations to sign up to be vaccinators and gives doses to them to vaccinate patients, prioritizing underserved groups. Additionally, we act as a safety net by arranging vaccine access for residents who cannot access it through their employer or healthcare provider. County Health monitors data to be sure there are no disparities in access within our community.

Strategy 1: Improve communication to build trust, engagement and participation in vaccine efforts

Our first strategy addresses multiple concerns, namely:

  • Distrust of government, research, and health care as a result of painful and shameful history of health experimentation on people of color
  • Current health inequities in healthcare and beyond
  • Misinformation
  • Safety concerns
  • Confidentiality and immigration status concerns
  • Linguistic barriers
  • Knowing when and how to receive vaccine, especially for those who are not digitally connected

What we are working on:

Engagement: The San Mateo County Recovery Initiative Vaccine Communication Equity Working Group allows for an ongoing dialog between the County and our most impacted communities. This group allows us to better understand the needs and concerns of our communities and get direct feedback on our plans. It also helps community partners get up to date information about the vaccine roll out at all levels to be able to share that knowledge with the communities they represent and serve. Community leaders can use this forum to share feedback with the State on their prioritization and planning efforts through a partnership set up with the California Pan Ethnic Health Network – a statewide health equity advocacy organization that serves on the State Community Advisory Committee.

In addition, our Health Equity Initiatives supported through San Mateo County Health’s Office of Diversity and Equity continue to provide vaccine discussion forums to serve as venues for two-way engagement between the County and impacted communities.

Communication: With the assistance of the SMC Recovery Initiative Vaccine Communication Equity Working Group, residents of the most impacted neighborhoods will receive accurate and effective information about the COVID-19 vaccine, the vaccination process, and how to stay healthy before and after vaccination by focusing on other protective behaviors. This group develops COVID-19 vaccine communication and outreach plans specifically designed for the most vulnerable communities in San Mateo County and provides feedback on the countywide vaccine communications plan. To ensure consistent, accurate, and timely information these communication efforts align with other efforts at federal, state, and local levels.

The vaccine communication approach is built on our existing strategies by continuing to:

  • Provide targeted, culturally and linguistically appropriate communications to reinforce core messaging
  • Maintain public data dashboards and in-language resource information
  • Facilitate conversations with at-risk communities and impacted groups
  • Develop partnerships with trusted messengers, community leaders and key sectors (business, education, child care) to promote health equity as the vaccine roll out

The County will continually acknowledge the mistrust in our communities of color because of current and past health inequities they have experienced, as we work to overcome them. In addition to County communication strategies, we are engaged with all large local health care organizations to better coordinate communications.

Partnership: The most significant way we will move the needle is by partnering with trusted community-based organizations in our most impacted communities. Leaders in these communities have built trust over many years, understand effective outreach strategies, and will be important messengers once they have confidence in the vaccine and vaccination process themselves.

Through the Office of Community Affairs, the County partners with over 30 organizations providing vaccine information to our most vulnerable neighborhoods. We also host nine Health Equity Initiatives to ensure dialogue in racial/ethnic, LGBTQ+, and spirituality affinity groups about the vaccine. We plan to expand partnerships to support trusted messengers in their outreach, as we learn directly from their expertise and community learnings.  

The State is has a notification and scheduling system called MyTurn allowing all California residents to learn if they are eligible to receive a vaccine, and if not yet eligible, to register to be notified by text or e-mail when it is their turn. 

Given that many of our hard to reach residents do not have access to or use technology, we are enlisting local partners, leaders and media to publicize key updates. 

  • Where/How: Many San Mateo County residents will receive vaccination from their health care provider or local pharmacy. 

How we will know how we are doing:

Metric Goal Status
# of interactive vaccine related community sessions  Average 3 per month  April: 7 Sessions 
# of population-specific messaging and outreach campaigns

5 ethnically/linguistically  targeted campaigns

6 geographically targeted campaigns

38 in May
# of resourced partnerships with community based organization to support vaccine outreach  30+ partnerships  30+

Strategy 2: Enhance targeted vaccination strategies to ensure equitable distribution to at-risk communities

Our second strategy addresses additional barriers that include:

  • Geographic distance, physical limitations, and lack of access to transportation
  • Access for people who are homebound or reside in congregate care settings
  • Access to technology for scheduling, accessibility and proving eligibility

What we are working on:

Community-based strategies: Building on lessons from our efforts to ensure access to COVID-19 testing, our vaccination plan includes working with local partners to identify vaccination sites in vulnerable neighborhoods. Our plans involve working with local partners like pharmacies, community clinic sites, and vendors willing to establish mobile neighborhood-focused locations. In addition, our Mobile Health Van and Street and Field Medical Teams actively engage our homeless and farmworker population for vaccination.  

Congregate care strategies: Older and disabled adults living in congregate care facilities of all types have been among those San Mateo County residents most impacted by the pandemic. The federal Centers for Disease Control has contracted with Walgreens and CVS to provide on-site vaccination for the majority of long-term care facilities. This program is well underway in San Mateo County, and County Health has arranged with Safeway Pharmacy to help this effort in our community.

High-volume countywide strategies: In order to reach our goal to vaccinate 90% of adult San Mateo County residents (557,100 people) by the end of June 2021 with two doses of a vaccine, we will need 185,700 vaccinations per month, or more than 6,190 per day. To meet this ambitious goal, all health care systems and pharmacies in San Mateo County will need to pull out all the stops. 

We expect to need at least one mass vaccination site that can vaccinate thousands of people each day. While large vaccination sites will not be right for everyone, one or more sites will greatly expedite our progress in vaccinating residents. The County organized pilot events at San Mateo County Event Center in January that demonstrated what is possible, and large systems (Sutter/PAMF and Kaiser) are actively pursuing mass vaccination sites to serve their patients/members. We hope to be able to allow patients of smaller systems to these mass vaccination options. We are exploring arrangements with other entities to create this capacity.

Accessibility to registration and appointment-setting: Many members of our community lack access to internet connectivity and/or devices, cannot use online systems that are not offered in their language, experience challenges navigating web resources, and/or are not comfortable sharing personal information online. The County prioritizes access and will work to make registration to any County-led vaccination process as easy as possible to navigate, require the least personal information and documentation necessary, be available in languages other than English, and offer alternatives to online registration where possible.

How we will know how we are doing:

Metric Goal Status
# of alternatives to online vaccine registration methods supported by the County 2-3 3
# of community-based vaccination strategies as alternatives to high-volume sites 3 3

Additional Data

Please see our vaccine related data dashboards here

Post

PLAN FOR PREVENTING SPREAD OF COVID-19 IN SAN MATEO COUNTY AND REDUCING DISPARATE IMPACTS

Introduction/Background

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. For example: in San Mateo County members of the Latinx community represent 24% of population, but 41.6% of COVID-19 cases (as of June 2021).

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 Goal Status

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

< 2.2% to qualify for yellow tier

0.7% reported by State 6/7/21

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 (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
# canvassing events per month 1 canvassing event per month  May: 23 outreach events
# of media impressions in target communities per month 4.5 million media impressions in target communities per month

May: 4,784,951 media impressions

# visitors to SMC Health COVID resource webpage per month To maintain at lease 1,000 views per month  May: 360 views
# masks distributed by Mask Mobile per month 2,400 per month (dependent on supplies) May: 7,184 masks

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 100,000 204,000
Followers on SMC Health Facebook at monthly point in time 22,000 24,747
Followers on SMC Health Twitter at monthly point in time 5,300 7,049

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

7 completed in April 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 58% 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

566/100,000 population per day for period as of 6/7/21

# neighborhood  testing events                

Average at least 16 neighborhood testing events per month

59 events in May

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 62%
% of Bilingual contact tracers 40% 47%

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

May: 146 referrals

TOTAL: 5,372 referrals (since August)

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.