County of Santa Clara Public Health Department’s COVID Response

Source: County of Santa Clara Public Health Department (February 2022)

COUNTY OF SANTA CLARA PUBLIC HEALTH DEPARTMENT’S COVID RESPONSE

Bay Area residents all remember where they were when their lives changed on March 16, 2020. It was the day that six counties issued a shelter-in-place order that closed all but essential businesses and activities to slow the spread of the novel coronavirus, SARS COV-2. It was the beginning of a years-long battle against COVID-19 that is still being fought today.

The County’s COVID response program activated hundreds of County employees as Disaster Service Workers while simultaneously calling on more than 500 representatives from community partner organizations, including volunteers and employees from the California Department of Public Health (CDPH), students, ethicists, and city employees. It was a huge operation that included data monitoring and analysis, case and contact investigations at an unprecedented scale, outreach and education, strategic planning, detailed logistics, and round-theclock emergency response communications, while utilizing the full legal authority of the Public Health Officer in unprecedented ways given the threat to health and safety.

In the 32 months since then, the program has slowly transitioned from an all-hands-on-deck emergency response to a sustainable COVID Prevention and Control Program housed within the County of Santa Clara Public Health Department’s (SCCPHD) Infectious Disease & Response Branch. This transformation has involved creating and maintaining dedicated teams focused on Disease Investigation, Education and Outreach, Data and Surveillance, as well as the continued deployment of the Mobile Response Team to reach marginalized groups with little access to healthcare. The program has formed lasting partnerships with schools, higher education and universities, skilled nursing facilities, places of worship, and other stakeholders in the community through this process.

SCCPHD has needed to remain agile and flexible to respond to rapid changes throughout the COVID-19 pandemic. This effort involves trying to meet current needs while simultaneously anticipating what needs might look like three months to a year from now. Input from healthcare providers has been invaluable during the pandemic, providing SCCPHD with real-time stories from the frontline that have helped inform their response, serve the community, and address health disparities and inequities.

Public Health strives to arm healthcare providers with the tools, resources, and information they need to serve patients directly. A patient’s own medical provider is often the most important person in their health decision-making. SCCPHD aims to give physicians a variety of tools to help their patients fight COVID, including vaccine delivery to provider locations, information about vaccination that they can share with patients,

updated guidance on boosters and treatments, and information on what to anticipate in the coming months with variants and other infectious diseases that often peak in the fall and winter.

COVID Communications

In addition to working directly with providers, SCCPHD also routinely updates the media and provides current, local guidance on its website covid19.sccgov.org. The County’s COVID site often expands beyond what is offered by CDPH or the Centers for Disease Control and Prevention (CDC), including:

• Patient education material in non-English languages • Local infection and vaccination statistics • Local wastewater data • Public health orders that are unique to the County

The website also has a section dedicated to healthcare providers at publichealthproviders.sccgov.org. This site provides comprehensive and accessible tools and resource guides for

Source: County of Santa Clara Public Health Department (December 2022)

SCCPHD provides multiple dashboards that the public can easily access to find data about COVID infections; vaccination status by age, gender, and race; and more. healthcare providers to support their patients with vaccination information, testing locations, guidelines for isolating when exposed to COVID, and referrals to community services.

Frequently asked questions from community health providers:

• How does the local public health department’s guidance differ from CDC and CDPH? • What are the reporting requirements for providers with patients who test positive for COVID? • How can I access treatments and medications for my patients? • How can I order vaccines for my own practice?

Answers to these questions and others can be found on Public Health’s COVID webpage for providers: publichealthproviders. sccgov.org/diseases/covid-19

Ensuring Equity for All

Beginning in 2020, SCCPHD provided support services to people in quarantine, such as meal delivery, laundry service, transportation to medical services, and rental assistance if needed. Additionally, the County worked diligently with the jail and custody systems to reduce the incarcerated population to minimize person-to-person contact and with businesses with COVID outbreaks to slow the spread of the virus. SCCPHD also partnered with community residents and cross-sector partners to provide outreach and education to build awareness and dispel myths, fear, and misinformation. Drive-through and athome vaccine clinics were established to support people with disabilities, and clinics were offered in places where people felt most comfortable and safe, such as churches, schools, community service sites, and workplaces. SCCPHD continues to provide residents with essential resources, for example, hotel placements for COVID-positive unhoused people who need support to isolate to avoid spreading COVID.

The Future of COVID

As much as everyone would like it to be over, COVID and its evolving variants will remain with us for years, to come. In addition to relying on its strong relationships with the provider community, SCCPHD will also continue developing new partnerships, methods, and tools to reduce the harm that COVID has caused.

Wastewater Monitoring

One innovative approach SCCPHD has used for staying informed is through wastewater monitoring. Working with Stanford and the four water treatment facilities in Santa Clara County, SCCPHD has developed one of the most robust systems in the country to monitor wastewater for levels of COVID transmission and track the prominence of new variants. These data have allowed the department to see a surge or emergence of a new variant days, or even weeks, ahead of when reported case data would show the same. And, given that many people are now using home antigen tests rather than PCR tests, many cases are unreported so the wastewater trends provide a more accurate indication of level of virus circulating in the community and attendant exposure risk.

Source: County of Santa Clara Public Health Department (December 2022), covid19.sccgov.org/wastewater

The Changing Nature of COVID

Persistent waves of COVID continue to ebb and flow within the local community. It’s challenging to continually ask the community to adjust to changing recommendations and protocols, which is why healthcare providers play such an important role. Though SCCPHD makes data-driven recommendations across the entire population, healthcare providers have direct conversations with their patients and can consider an individual’s health history, work circumstances, family care needs, and other factors that may influence how strictly they need to comply with those recommendations. Healthcare providers have the opportunity to take general guidelines and apply them in a more nuanced way with individual patients.

Long COVID

The Lancet recently released a study with a foreboding statement about Long COVID: “After recovery from acute COVID-19, a substantial proportion of patients continue to experience symptoms of a physical, psychological, or cognitive nature. These long-term sequelae of COVID-19 have been described as the next public health disaster in the making.”1

Moreover, the CDC estimates that as many as 1 in 5 people who get COVID will suffer from Long COVID effects ranging from brain fog and a loss of smell to gastrointestinal distress and cardiac problems. Some patients seem to improve after time while others end up so disabled that they can no longer work.

We still have much to learn about Long COVID and how they it will affect Americans one, five, and ten years into the future. Since COVID-19 continues to evolve, often unpredictably, healthcare providers can help by keeping SCCPHD updated on what they are encountering in their practice, sharing questions they are receiving from their patients, identifying what services patients are having difficulty accessing and what information gaps are still prevalent.

Footnote: 1. “Persistence of somatic symptoms after COVID-19 in the

Netherlands: an observational cohort study - The Lancet”