CBO COVID-19 CALL NOTES MAY 7, 2020



CBO COVID-19 CALL NOTES MAY 7, 2020New information is in red. Information from the Governor’s Phase 2 Announcement that occurred at noon May 7 is included where applicable.REVIEW OF CA GOVERNOR’S SIX INDICATORS TO OPEN – ASHLEY SWEARENGINThe ability to monitor and protect our communities through testing, contact tracing, isolating, and supporting those positively exposed.Ability to prevent infection in people who are at risk for COVID-19.Ability of hospitals and health systems to handle surgesAbility to develop therapeutics to meet demand.Ability for businesses, schools, and child care facilities to support physical distancing. Ability to determine when to reinstitute certain measures, such as stay-at-home orders, if necessary. See link at OF PUBLIC HEALTH – DAVID POMAVILLE, DIRECTORState Changes and New Guidance ComingOn Monday, the Governor announced some limited retail and some counties may be able to move off the current statewide order.No guidance yet available, maybe Thursday or Friday.We have been on calls with the State throughout the week and hoped to have guidance by now.The big question is how to address restaurants with in-house seating.NEW from Governor Media Conference 5/7/20 – to self-attest to open as part of “county variance” from the State Orders (partial list):No more than 1 case per 10,000 people in last 14 days (means 99 new cases in last 14 days in Fresno Co.)No COVID related death in the last 14 daysAvailability of disinfectant and PPEMetrics that serve as triggers for either slowing the pace through Stage 2 or tightening modificationsGuidelines will be posted on CDPH website next Tuesday, May 12See open, each county needs a Readiness PlanTesting levels to be met.In Fresno County, current estimated number goal is 1,520 per day.Currently, with two new high-volume testing sites open at City College Gym and Sanger Community Center, we are at about 600-700 tests daily.Containment plan.How vulnerable populations will be protected.Some counties don’t have a comprehensive health system and rely on neighboring counties. Think it needs to be a regional approach. Lots of unknowns at this point.NEW from Governor Press Conference 5/7/20 – For the Readiness Plan:Need 1.5 daily testing per 1,000 residents (Note: Fresno Co. population 994,400 = 1,492 daily tests)Containment plan needs 15 contact tracers per 100,000 population (Note: Fresno Co. population 994,400 = 149 trained tracers)Movement on key issues A week ago, we were struggling to get test collection devicesThat has now changed and kits and transport have opened up. More are coming.282892512954000Two new high-volume testing sites have opened up.City College Gym and Sanger Community CenterRegister on-line or by calling Each site can handle 130 tests a day. So far they have done about 100+ daily.Contrary to rumor, there are plenty of openings – as early as tomorrow.We want those who have been working in essential services – such as nursing home staff, grocery clerks, food supply, agriculture – to go in and be tested.General public can also be tested. We want to see levels of asymptomatic persons in the county. Testing sign-up link: in response modeYou are/will see our numbers go up. We are working with nursing homes. When a case is identified, we have gone in and tested and found more, usually asymptomatic. 24860255715Community readiness is important to re-opening. The floor for readiness comes from the State Health Officer. State of emergency orders indicate that the city can’t handle the level needed without additional support and DPH works with them. Some communities have given more directives than the State – such as City of Fresno. Cities don’t have the ability to be less stringent than the State Health Order “floor.” We are working with those who have added directives that do so. Q: Is it true that 1,520 tests per day is the benchmark for Fresno County across all sites? Do we know the number today?DPH: We are unsure of the State benchmark. We are currently at 600-700 per day with the new test sites open. This will likely be a flexible benchmark that will evolve. Also, there is no single repository to get the calculation and some of it needs to be calculated manually. Besides the high-volume sites, hospitals and Federally Qualified Health Centers/Rural Health Centers (FQHC/RHC) provide testing for their patients. We also have a team for smaller communities going out. Q: If someone is tested and is negative, how frequently should they go back? DPH: If it is a high-risk essential worker, such as nursing home staff, he/she should be tested every two to three weeks. We are confident the site setup is safe, no lines, set up in windows of time so that there is little to no waiting. There are special times that we arrange on the backend to keep slots available for health workers/nursing home staff. In May, we are trying to learn how much asymptomatic cases are out in the community, so having the general public test is important. In June or July, the situation may be different. If a site gets overwhelmed, we have the ability to go back to the state and expand further. Q: Is there a cost? Is a doctor referral needed?DPH: When you sign up, they do ask what your insurance is, but if you don’t have any, that is ok. It will be covered for free. No doctor referral is needed.Q: The online site is not easy to navigate. Is there a phone number? DPH: Yes, if CBOs could help people register online, that would be good. There are English and Spanish speaking phone lines, initially with a 20-30 minute wait time. 1-888-634-1123. Q: It would be great to have dedicated time for farmworkers, packing house workers, food supply workers, etc. There is a lot of interest by this group to make sure that these folks can be tested. DPH: Yes. Q: Using City of Clovis as an example, what should we be paying attention to regarding State, County, and City orders. DPH: We have to follow the CDPH orders and we hope people will follow that. There are risks and liabilities with businesses moving too fast. If a school opens early, they are incurring additional liability if it is below the State “floor.” In addition, we have identified certain businesses where cases have emanated from. Contact TracingWe have been doing contact tracing for several weeks. There are now orders from our Health Officer on the website that says you don’t have to be individually notified to be quarantined.The DPH workforce that has been doing the contact tracing needs to come back and do their regular jobs. We are looking to build a new workforce for June 1 to December 2020. Three elements coming:New technology. The State is working with Salesforce and Amazon to develop a platform. It will be deployed by medical providers and/or DPH to keep in touch with individuals. Because we know people cross county boundaries to work, play and reside, this will make tracing a lot easier. Contact tracing trainingUCSF and UCLA have developed a 20-hour training. The pilot starts tomorrow. Workforce embedded with the CommunityWe want to develop a program to embed in the community. Q: How many people do you need to deploy?DPH: 300 is a round estimate. It needs to be refined based on number of cases in a week and other items. My estimate is about 150-200 will be needed. Note: The new CA criteria of 15 tracers per 100,000 population equals about 149 for Fresno County. On May 4, 2020 the Governor stated in a press conference that the first wave of contact tracing workers would be re-deployed State employees. California HR has been identifying appropriate people with the social and demographic characteristics needed for the past several weeks. This is not yet confirmed with Fresno County DPH.Additional DPH questions from ChatAny questions without an answer at this time are being researched and will be shared next week. Are there enough supplies, such as masks and sanitizer, for small businesses to purchase?? How would they access them?? Faith-based organizations are also discussing how to open at the end of May and will be wanting access to these resources.?DPH: Unfortunately, the current limited PPE supply that the Department has access to is disseminated to health care as directed by FEMA. There are vendors that people can reach out to purchase their own PPE.Is there a plan for testing farmworkers?? How will they be afforded quarantine? DPH: is currently conducting surveillance testing in rural towns in partnership with Adventist Health System and Valley Health Team. We recommend people contact their local FQHCs to get tested, as well. Dave Pomaville has been working very closely with the Farm Bureau regarding COVID. The second portion of the question is being researched.Can we expect the “other” category in the racial breakdown to be broken down at one point?? Doesn’t have to be on a daily basis.DPH: Basic information on the “other” category is provided in the “Details” tab underneath the case counts.? The numbers within that category are too small to break out at this time.What proactive testing is occurring at packing houses and industrial warehouses? This is being researched.Are there any sites doing antibody testing for those who may have had the virus and recovered?DPH: Not at this time.?The science is still evolving. The Health Officer was interested in working with OptumServe, which is staffing the two high-volume sites, because they are a statewide group. When antibody testing becomes widely available, they will more easily be able to obtain it.As part of the County analysis of public health impacts, is consideration given to the impact deferred treatment of non-COVID related health issues?? How about anticipated health impacts of COVID-related unemployment and poverty?DPH: We are concerned about people holding off on non-COVID medical treatment, follow up and waiting on seeing a doctor if they are not feeling good (non-COVID related.) We are going to be doing messaging to encourage people to still contact their doctor for any non-COVID medical issues and not wait. Is the criteria the same who gets tested consistent across all sites?? Or do people get preference if they can pay? Why are so many sites shown on the State website for Fresno County in North Fresno?DPH: The two sites at City College and Sanger Community Center use the same criteria and there is no preference related to payment.? Hospitals and clinics accept insurance, and will also still provide testing if the person has no insurance.? Private sites, like the Herndon and Blackstone Urgent Care Center, may charge fees if a person does not have insurance.? That site also does not accept Medi-Cal.? Many of the sites listed on the CDPH website to find a testing site in Fresno County are Quest Lab locations. They require a doctor referral and most are in north Fresno. Is testing registration provided in other languages? ?Any chance the website can be put into Spanish?? Sanger has a lot of monolingual residents. ?Is there a phone option?DPH: Yes, the phone line is 888-634-1123.? The phone line has a Spanish option (press 8).? The website is in English. We don’t know if the company will put a Spanish version up.? We will pass on the request, if possible. What are the hours in Sanger for testing? ??428625372110DPH: Sanger hours begin at 7 AM and the last appointment is 6:30 PM. Face masks are required for both City College and Sanger sites. They need to bring their Patient ID number received when registering. Flyers for Sanger and City College are being translated and will be sent out next week.I have a co-worker who has symptoms and the online info told her to stay home.? Who is supposed to be tested? For those who may have COVID, but were told to stay home, it is assumed they are not counted in the affected numbers? ??Who will be qualified to do contact tracing?? Will they need to be DPH staff or trained by DPH staff?? Is there consideration of sub-contracting tracing to CBOs?We need to make sure the “new workforce” is reflective of the community.? How can we ensure pathways for immigrant community members who have the cultural and linguistic skills that are assets? What is considered an adequate sample of people tested to estimate how many people have been contaminated in Fresno County?Are there any special directions for young children who might need to be tested? Information on the new flyer for the City College and Sanger testing sites indicate to call to set up child appointments. With the heat in Fresno, will the disposition of the virus spread or its presence in the community change? Internal chat response – the Town Hall on Healthy Fresno County Facebook that took place on April 24 touched on that subject. Q for group: Is there anyone to help senior citizens obtain access to registration for testing? Many elderly seniors do not have computers or smart phones to register online for testing. There is a phone option at 1-888-634-1123. Hours by phone are available 5 AM – 8 PM Pacific Time (the recording states 7 AM – 10 PM CENTRAL Time). Q: Can someone address the Governor’s Executive Order (posted 5/6/20) authorizing Worker’s Comp claims and benefits for essential workers “catching” COVID-19 on the job and how that affects CBOs providing essential, direct services to the community? [Note: This is retroactive to March 19 and is through July 5, 2020. There is a lack of clarity if it applies to teleworking.]NEW: Nicole Linder of Marjaree Mason Center forwarded webinar information for May 19, 11-12:30, through California Farm Labor Contractor Association. Free to CFLCA members and $25 for others. Register Link: : Pandemic EBT Availability and Application. P-EBT card issuance will begin May 8 to all automatically eligible families. These include current Cal-Fresh, Medi-Cal, or Foster Care recipients.? If a family believes themselves to be eligible for P-EBT but has not received a P-EBT card by about May 25, they should apply online.? This includes if their child is eligible for Free or Reduced Lunch and their school is closed due to COVID-19, even if they are receiving “pick-up” meals from the school. The card is good for one year. The CDSS will administer the P-EBT online application, developed in partnership with Code for America.? The online application will be available through a dedicated P-EBT URL and will include an “information page” where families can learn more about P-EBT.? The application will be user-friendly and available in English, Spanish, and Chinese. The application will launch on May 22. ? Eligible families can access the P-EBT information page here beginning now: ? Eligible families can apply for P-EBT here beginning on May 22: (not yet operational)? DPH Answers to April 30, 2020 QuestionsWho are they wanting to do all these tests on? ?Are there truly that many ill people? (We keep hearing hospitals are empty.) Or is the idea to test those of us in the general population that are well? Yes, we have enhanced our testing capacity and now able to test who ever would like to get tested at the new Fresno City College high throughput testing site. The site is providing tests for asymptomatic and symptomatic people.? Folks can schedule their appointment at the Fresno City Testing location by going online to lhi.care/covidtesting There are also FQHC, medical providers, and other clinics throughout the County providing testing. ?When people are talking about “hospitals are empty”, hospitals have not been as busy because elective surgeries were not allowed until recently. ?Do institutions in Fresno still need antigen or serology tests? Science is still evolving.?Nothing out is reliable for antibody testing yet.Do we still have problems with false reads on tests? What is percentage of error? Still researching.How are other infectious diseases being monitored, especially with the closure or reduced services of some FQHCs?? Thinking specifically about STI.? Syphilis is the only STI the Department investigates and we have been able to continue doing Syphilis investigations.? For the remaining STIs, since prior to COVID we receive reports and manage them through the State surveillance system.? We have data to provide on the other STIs but we don’t investigate.? During the initial response other infectious diseases (ID) had seen a longer response time than normal.? Other ID are always prioritized based of level of infectiousness and impact to the community with the workload that we are experiencing at the time.? For example, we will immediately prioritize an E coli case over a Campylobacter.?HOSPITAL COUNCIL, NORTHERN & CENTRAL CALIFORNIA – DAVID BACCI, REGIONAL VPleft191770Their focus is on collaboration, working with DPH, and developing a regional approach. A sustained effort will be needed for at least the next year.-28575154241500Q [unseen/unanswered]: For hospitals, we have heard from the Punjabi and Spanish-speaking communities that they are having trouble navigating care, prevention, and discharge instructions.? Are there plans for investment in culturally and linguistically concordant patient navigators? ??What is the process that any patient can request a patient navigator resource? ?This is being researched.?Q: Are we going to start screening for gastrointestinal symptoms (GI)? HC: Recently CDC updated symptoms. We have seen some presenting only GI symptoms who have been positive for COVID-19. Yes, we have it on the radar. left22098000VALLEY HEALTH TEAM – SOYLA REYNA-GRIFFIN, CEO AND DR. RON DOMINGUEZ, ASSOC. MEDICAL DIRECTORPatients tend to stick with a provider or health center. They instituted universal screening, monitoring employees 2x/day, and now are able to test daily from 3-5 pm.Anyone coming to a clinic receives a mask.There is a constant need for PPE. Identified clusters in Firebaugh and Mendota.They don’t have a formal contact tracing program, but that’s a logical next munity members are notified by letter if someone was identified positive while they were within the clinic. They will continue screening activities as the County moves away from Shelter in Place. Point of care testing so that they could get immediate test results would be beneficial. Now it takes 2-3 days to get test results and it can be difficult to track them down to notify them or to keep people quarantined when they don’t know the results. CBO ROLE/CLOSING – LINDSAY CALLAHAN, CEO, UNITED WAY2-1-1 is taking calls for Public Health over the weekend, so has all the information as well. While a few CBOs have been open, many are now looking at how to re-open. We need to find a way to help each other. We should tackle that in the next week or so. We also need to figure out a new, better normal. We would like to bring speakers back in the future around that. RESOURCES PROVIDED THROUGH CHATFresno Metro Black Chamber is doing a survey of the impact on COVID-19 on our small businesses. Please feel free to share the following link with your networks. La Salud is supporting grocery and supply deliveries to Latina immigrant elders. Please let Genoveva Islas know if you have any contacts that need support. 559-927-5761.Lori Olivero - Anthem Blue Cross Medi-Cal - Lori.olivero@anthem - 559-573-1733 – Available for informational presentations (via Zoom, WebEx, Conference Call, etc) - to help you understand Medi-Cal and Anthem’s extended benefits - information that can help you help your clients/patients utilize their benefits: Transportation, Online Urgent Care, Case Management and our CA.R.E. Line at 1-800-227-3238California Telephone Access Program. Contact Pa Kou Cha for information or a presentation at pcha@ or 559-477-4674. ................
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