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Sonoma County Health department outlines new, diminished response to COVID
The Press Democrat - 6/25/2022
Jun. 25—They were the proverbial boots on the ground during Sonoma County's never-ending battles against COVID-19, temporary county health workers whose ranks fluctuated almost in concert with each pandemic surge over the past two years.
They've been celebrated as heroes, essential troops in a now historic public health campaign that no one wants or expects to go on forever.
This week, that temporary workforce of about 60 staff with the County Department of Health Services — known by many as DHS — will be reduced by a third. It's a direct response to the evolving nature of the pandemic and just days ahead of a June 30 deadline when millions of dollars in government pandemic funding is set to run out.
County health officials said everyone knew this time was coming. For weeks, however, many temporary workers, as well as the county's health partners, have been left in the dark about details of the department's plans to continue its COVID-19 response and vaccinations beyond June 30.
The confusion caused by what they say has been a lack of clarity about the plans comes on the heels of a searing report from the Sonoma County Civil grand jury, which pointed to deep-rooted problems in DHS's pandemic response.
On Thursday, during an interview with The Press Democrat, Health Services Director Tina Rivera and Public Health Division Director Gabriel Kaplan expressed sympathy for departing temporary workers and thanked them for their contributions during the pandemic.
But they insisted everyone knew the county's emergency pandemic response would scale back at the end of June.
"Some of them were notified this week, but most of them were notified sooner than that," Rivera said. "Many had already resigned weeks ago, and a month ago, because they knew that come June 30, the COVID response was being demobilized."
However, some local providers who operated clinics and other COVID-19 services said they didn't know until last week whether they would continue to be part of the county's vaccination program after June 30.
A party tinged with uncertainty
All agree these partners have been invaluable links in the public safety chain during the pandemic. After a bumpy start, Sonoma County has achieved high rates of COVID immunization. Currently, 83% of the county's eligible population is fully vaccinated.
With that sort of progress as the pandemic wore on, the focus turned to populations that proved stubbornly hard to reach. They included homebound residents with disabilities, the unsheltered and undocumented workers. The county referred to this as equity work, and small clinics played an oversized role in closing the gap.
One of them, Fox Home Health, which operates the vaccine clinic at Roseland Community Center, recently hosted a party for frontline health staff. At the event, county health workers shared "war stories" about the pandemic. Many expressed thanks for the help they received from Fox and other community-based organizations.
The celebration, at the Luther Burbank Art and Garden Center on Yulupa Avenue in Santa Rosa, took place a week before the county would begin notifying a number of contract workers whether they would still have jobs in July. Beneath the air of celebration and gratitude was an unmistakable undertone of uncertainty.
Some of the county staff attending the event said they did not know what the county's post-June 30 pandemic plan was. Two temporary workers spoke to The Press Democrat anonymously for fear of retribution, since at the time they still didn't know if they would have jobs.
"We've known that this has been coming for a while," said one worker. "But the actual decision to make the change, letting people go, figuring out what this going to look like, what our capacity is going to be going forward, those things are literally being discussed now. It's kind of stressful."
Ed Sawicki, the county's vaccine mission manager, was among those who expressed their thanks to Fox Home Health owner Cheryl Fox and her staff on June 17. When asked if the county had a plan, he said, "We're finalizing it as we speak."
Those whose jobs were potentially at risk say ongoing deliberations over the county's future COVID-19 plan should have taken place months ago, not a week or two before funding was set to run out.
Rivera and Kaplan strongly rejected any suggestion that a post-pandemic plan was being crafted at the last minute. They said it's been months in the making.
They shared details the county's "COVID Demobilization Plan," a process that hinges on a belief that COVID-19 no longer poses the threat it did a year ago, or two years ago.
Rivera said the coronavirus has entered an "endemic phase." Though ever-present, it can be managed without an emergency response, she said.
Kaplan said the available budget for county COVID-19 infection control and vaccine programs is currently $5 million for the fiscal year beginning July 1. That's a fraction of the roughly $25 million to $30 million in federal and state COVID-19 emergency funds the county received in the previous fiscal year, officials said.
Under the plan, the county will move workers to other departments and reduce vaccine services, among other alterations.
"Our response is going to evolve and we need to narrow our focus," Kaplan said. "We can't sort of continue to try to be all things to all people."
Tina Rivera, Sonoma County's newly appointed Health Services director, middle, meets with her vaccine team, from right clockwise, Brad Silvestro, Steve Burchell, Ed Sawicki and Timmy Jeng, Friday, Feb. 16, 2022 in Santa Rosa. (Kent Porter / The Press Democrat) 2022
Key foot soldiers leaving
No one in DHS, including Health Officer Dr. Sundari Mase, is claiming the pandemic is over. But for weeks, officials have pointed out that the current COVID-19 surge looks very different than previous surges, where case spikes were usually followed by significant increases in COVID hospitalizations and deaths.
"It's not a surprise that certain jobs are not continuing now that we're in an endemic phase," said Board of Supervisors Chair James Gore. "If something changes and we have to surge with federal and state funding, then we will."
Officials said that of the 60 temporary health workers, 41 will remain after June 30. It's unclear for how long.
This week, Fox Home Health learned it will continue to be involved, and the county-supported clinic in Roseland will remain functional. That allowed Cheryl Fox to breathe a sigh of relief on behalf of the community she serves.
"It's a time to reach the unserved or underserved within our community," Fox said. "Putting on the brakes because it's looking like an endemic, it's not the time to decrease those services."
Another nonprofit organization that has aided the county's equity drive, the CURA Project, appears more vulnerable.
CURA, which has received $10 million through the DHS to connect Latino, Indigenous and low-income residents to financial assistance and COVID services, will now work with the Department of Human Services rather than Health Services, and is expected to get "a bit less" to work with, Rivera said.
"That's not the amount going forward," she explained. "And that's not the demand.'
Sawicki and planning section chief Timmy Jeng, two key leaders in the county's COVID-19 campaign, will remain in place in the short term, they learned only a few days ago. Both are contract workers, and those contracts were extended for three months.
But many of those who worked in COVID-related positions will be gone on July 1. Perhaps the most notable is Dr. Urmila Shende, who was hired as the county's vaccine chief just a few weeks into the immunization campaign.
Rivera said she wouldn't call Shende's departure "a casualty," but rather part of the county's transition to endemic response. Still, she acknowledged the huge role the pediatrician has played in getting this county protected against the coronavirus.
Some of the displaced temporary employees worked directly with vaccination clinics and had expertise that will be hard to replicate, people familiar with those roles insist.
"I joke that it's like planning a mini wedding," said Diane Kopes, whose DHS job in advance planning for vaccine clinics will end June 30.
"You need providers, you need infrastructure for lines, tables and all that," she said. "You need relationships with community-based organizations and with medical providers. You also need to build relationships with people who control the spaces where you're setting up clinics."
Kaplan acknowledged that "a lot will fall on our health care partners" after this transition. Kopes isn't convinced providers are ready for it.
"My doctor's office is a family practice, so they have kids coming in, and they have no refrigeration capacity to handle vaccine in their office," she said.
"They can't even take possession of vaccine at this point. All these steps are far more complex than the average person knows about. You would think the managers of Health Services Department would have tried to understand this sooner."
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