Our COVID-19 Yearbook

INTRODUCTION

The coronavirus disease (COVID-19) pandemic and our response changed our lives forever. We’ve had many unforgettable experiences and learned many important lessons. As the course of the disease evolves, we continue to leverage those lessons to keep Marin County residents healthy and safe. We feel fortunate to be part of a community that has worked successfully together to fight this disease and win. Thanks to you all. We will maintain our diligence and commitment as long as needed and use all available resources to inform, educate and support our community.

As the Marin Department of Health and Human Services director, I owe a debt of gratitude to the residents of Marin County, the Board of Supervisors, fellow County Department Heads and staff, frontline healthcare professionals, first responders, essential workers, community-based organizations, businesses, and most of all, to the awesome and fabulous professionals in Health and Human Services. In the wake of a worldwide pandemic, they all stood up, did their part, and provided outstanding support and services then and continue to provide outstanding service and support now.

Benita McLarin Director Marin HHS

During a 15-month period, we all worked collaboratively to develop an impressive emergency response to the pandemic by partnering with more than 1,300 county employees as disaster service workers and countless community workers and volunteers. Some were asked to assist in responsibilities related to their regular employment. In contrast, others were assigned tasks unrelated to their positions, like assisting at vaccination centers and helping to house and quarantine infected people in hotels.

The severity, novelty, and unpredictability of the virus created many challenges, but the innovative measures taken by our staff saved untold lives. Their stewardship resulted in fewer hospitalizations and deaths than in similar counties nationwide. The vaccine and the public’s willingness to embrace it were game changers. This led to Marin having one of the highest vaccination rates in the country, a trend that continues today.

This publication is a retrospective review of the COVID-19 pandemic and its impact on our department and community. It intends to capture Marin HHS’ response to the pandemic as told by its leaders, staff, supporters, and the residents we serve.

In the following pages, you’ll meet the people of the Marin HHS divisions as they tell their stories – sometimes funny, sometimes sad – of perseverance, triumph, and personal loss. You’ll also meet some of the community organizations that partnered with Marin HHS. Without their help and assistance, much of this success would not have been possible.

And then there are the residents of this county. With nearly a quarter-million first-dose vaccinations, Marin County led the nation in administering the vaccine. This commitment by the people of Marin helped to keep our citizens safer and our economy open. Lockdowns and mask mandates became all too familiar behaviors that disrupted everyday life as we knew it. Once again, the majority of people living in Marin met the challenge. Their efforts saved lives.

COVID-19 overwhelmed the globe in 2020. The Marin Department of Health and Human Services responded by living up to its mission to Promote and Protect the Health, Well-Being, Safety, and Self-Sufficiency of its residents.

I’m so grateful, humbled, and blessed to have served our community during this historic period alongside some of the world’s most talented, intelligent, dedicated, committed, and outstanding professionals.

Thank you again for all you have done and all you have sacrificed and given.

This book is dedicated to YOU!

ADMINISTRATION

The COVID pandemic was a historic event and posed unprecedented challenges for our county and communities. It impacted the lives and livelihoods and the social and emotional well-being of residents across the county. But in the face of those challenges, we also saw a great spirit of resilience rise up and our sense of community shine bright.

When the pandemic first hit in 2020, it was hard to imagine the road ahead. We navigated “sheltering in place” and periods of surge. We came to a new understanding of essential services and appreciation for the essential workers who keep our communities and county functioning. Indeed, it was during the hardest times that our community came together the most and excelled.

This document is just a small glimpse into the past two years of pandemic response in Marin County through the lens of staff and community partners. It helps to memorialize the strength, dedication, bravery, and vulnerability of our staff during this most challenging time. Most of all, it serves as a great reminder of who we are as a community and what makes Marin County great.

On behalf of the Board of Supervisors, I want to thank our staff, community partners, and residents for stepping up and shining so brightly throughout the COVID-19 pandemic. Through our individual actions, our collective effort, and our commitment to community, we modeled partnership and collaboration and what a successful, compassionate community looks like.

Sincerely,

I am writing to express my sincere thanks to the hundreds of HHS employees who have stepped up when our community needed us most. The value and dedication of our staff throughout the COVID-19 pandemic cannot be underestimated. The circumstances were extraordinary, and our county pulled together in a profound way to save lives. Our employee’s commitment to service was exemplified in our daily interactions with our community as this emergency changed on a day-to-day basis.

This Yearbook presents an opportunity to display, through photographs and narrative stories, the courage, sacrifice, and hard work that our employees and partners showed during the pandemic. Let this serve as a reminder that, as public servants, we take our duty and responsibility to heart. I am proud of your resilience and of the shining example of dedication that our employees displayed every single day.

Once again, I want to sincerely thank staff for serving as an inspiration to myself and our community.

With Appreciation,

Katie Rice

President Marin Board of Supervisors

Matthew Hymel Chief Administrative Officer Marin County

COVID-19 rocked the world in March 2020. On March 16th, Marin County joined with five other Bay Area counties and issued a “shelter in place” order to combat COVID-19. We gave this fourweek order with the goal of “flattening the curve” and returning to normal by Spring Break. This is not what COVID had in store for us. Instead, we had to double down on our efforts to protect our community’s most vulnerable residents and Marin’s critical infrastructure.

With limited information, scarce resources, and no vaccine, it would take a collective effort to fight the virus. It would also take humility, perseverance, and sacrifice to adapt to the everchanging COVID landscape – our “new normal.” Our Marin HHS team and a contingent of county colleagues, municipal employees, community partners, volunteers, essential workers, first responders, healthcare providers, and elected officials had to navigate unprecedented and unimaginable challenges and demands. Fortunately, in Marin County, we found helpers around every corner, ready to go above and beyond the call of duty.

Every county department supported Marin Public Health — the Marin County’s Sheriff’s Office of Emergency Services coordinated the Emergency Operations Center; the Department of Public Works supported logistics; the Community Development Agency assisted with advance planning; Cultural Services opened their doors; Parks and Recreation staffed our testing sites; Marin Fire and paramedics vaccinated; Librarians helped contact tracing, and much, much more. In times filled with fear and uncertainty, disaster service workers (DSWs) countywide readily and willingly accepted “other duties as assigned.”

We have deep gratitude for all the individuals, businesses, and organizations that helped Marin Public Health’s response to COVID-19. Childcare workers came to work every day so essential workers could do their jobs. Our direct care workforce provided in-home supportive care, and long-term care facility staff kept residents safe and the facilities open. Our all-hands-on-deck approach kept our critical infrastructure intact and protected our most vulnerable residents.

When COVID-19 breached our long term care facilities, Marin Public Health partnered with our three hospitals — Kaiser, Marin Health, and Sutter — to deploy a mobile assessment and triage team. Doctors, nurses, and staff went onsite during active outbreaks to test residents and staff and provide infection prevention and control guidance. They tirelessly worked endless days and countless nights to ensure treatment aligned with residents’ and patients’ goals of care. They prevented hospitalizations and saved lives.

As we enter the recovery phase of the pandemic, we have significant challenges ahead of us. Substance use and mental health disorders significantly increased across all age groups. Remote learning detrimentally impacted children and adolescents, and many students struggle to “catch up,” improve their social-emotional skills, and build resilience. While we forged and fortified our commitment to racial equity during our response, our essential workforce, disproportionately people of color, women, and immigrants, continue to earn non-living, low wages without protections or benefits.

We offered “blood, toil, tears, and sweat” and led the nation in preventing and controlling the spread of COVID. There were silver linings at every turn (and pivot) in our pandemic response. Your compassion, generosity, dedication, creativity, and endurance have inspired and buoyed us. We must stay galvanized, apply lessons learned to new and ongoing threats, maintain positive momentum, and seize the opportunity to achieve our vision where All in Marin Flourish.

Thank you for all you do each and every day.

Matt Willis, MD, MPH Public Health Officer

Lisa Santora, MD, MPH Deputy Public Health Officer

TIMELINE INTRODUCTION

What is going on?

Officials worldwide exhaled as a busy year of crises and protests took center stage and occupied the media spotlight in 2019. In the U.S., events like the U.S.- China trade war, the Central American migrant exodus, and the U.S. House impeachment of President Donald Trump dominated the news cycle.

In Marin, the county avoided an end-of-year catastrophe with the quick response of its fire department. The Muir Fire, Marin County’s most significant of the year, was first reported on October 24th, at 10:45 a.m., in a remote area along the Pacific Ocean. The fire was just north of Muir Beach and south of Stinson Beach in a sparsely populated place. Luckily, no one was injured, and no structures burned.

Jason Weber, Marin County fire chief, said, “I urge residents and visitors to use caution.” These prophetic words of caution would be uttered to Marin residents repeatedly by their public health officials in the coming months regarding a deadly yet unknown virus that would change their lives forever.

How it all started.

Pneumonia cases with an unknown cause were first reported in the Hubei province of China at the end of December 2019. Patients described symptoms including fever and difficulty breathing, and early reports suggested no evidence of human-to-human transmission. Or so it was thought.

China tightened travel restrictions and enforced isolation measures in the hardest-hit areas to contain the virus’s early spread. The World Health Organization (WHO) endorsed this strategy, and countries worldwide implemented similar quarantine measures.

The timeline begins1.

The following timelines are a chronological listing of events and milestones documenting the spread of the virus from its origin in Wuhan, China in 2019 to its emergence in Marin County in March 2020. The timelines memorialize 26 months of action captured by point-in-time headlines, quotes from individuals, or statements from governing bodies that describe the challenges and victories faced by Marin HHS.

And so, it began.

On January 17, 2020, the CDC begins screening passengers on direct and connecting flights from Wuhan, China, to San Francisco, New York City, and Los Angeles, and plans to expand screening to other major airports. On the same day, the CDC deploys a team to Washington state to assist with contact tracing efforts in response to the first reported case of 2019-nCOV in the U.S.

JANUARY 2020

On January 20, 2020, the first U.S. laboratoryconfirmed case of COVID-19 in the U.S. from samples taken on January 18th in Washington state is validated by the CDC.

On January 7, 2020, Chinese authorities identify and isolate a novel coronavirus as the causative agent of the outbreak. The Centers for Disease Control and Prevention (CDC) publish information about the novel coronavirus on its website around the same time.

On January 31, 2020, the same day the WHO International Health Regulation Emergency Committee reconvenes and declares the coronavirus outbreak a Public Health Emergency of International Concern, U.S. Secretary of Health and Human Services, Alex Azar, declares the SARS-CoV-2 virus a public health emergency. The White House 2019 Novel Coronavirus Task Force announces the implementation of new travel policies to be effective at 5:00 p.m. EST on February 2nd, 2020.

FEBURARY 2020

On February 29, 2020, the CDC updates its Criteria to Guide Evaluation and Testing of Patients Under Investigation (PUI) for COVID-19 to any patients with a severe respiratory illness, even in the absence of travel history to affected areas or known exposure to another case, to prepare for possible additional person-to-person spread.

The CDC’s National Center for Immunization and Respiratory Diseases (NCIRD) activates a center-level response to investigate this novel pneumonia of unknown etiology.

On March 1, 2020, the CDC creates COVIDNET by modifying existing respiratory virus surveillance networks that monitor influenza-associated hospitalizations and Respiratory Syncytial Virus (RSV) for hospitalizations related to COVID-19.

MARCH 2020

COVID-19 Strikes Marin County

MARCH 27TH:

MARCH 9TH: The first case of COVID-19 is reported in Marin County.

MARCH 16TH:

Marin County launched the first in a series of emergency “pop-up” childcare centers for children of essential workers.

MARCH 16TH:

Dr. Matt Willis and six other public health officers issue a legal order directing their respective residents to shelter at home for three weeks.

Marin County records its first death from COVID-19.

Dr. Lisa Santora, Marin HHS

“This is a heartbreaking development in our work to limit the impact of COVID-19 locally. This unfortunate death further shows how serious this virus is and how necessary it is for our community to continue to shelter in place and take bold measures to mitigate the spread of COVID-19 in Marin.”

MARCH 11TH:

On March 11, 2020, the WHO declares COVID-19 a pandemic. Their statement reads:

Statement from the WHO

“Amid the rising spread of the 2019 Novel Coronavirus (2019-nCoV), the World Health Organization (WHO) has declared the virus outbreak a public health emergency of international concern (PHEIC).”

Marin Public Health led the state and nation by opening a referral-based drive-thru test site at the Marin Center.

MARCH 23RD:

Marin Public Health Officer

Dr. Matt Willis tests positive for COVID-19.

More than two years after COVID-19 disrupted life globally, public health officials in Marin County can reflect on the virus’s trajectory.

APRIL 17TH

A new health order requiring face coverings begins. Children aged 12 years or younger are exempt.

MAY 20TH: A rapid rise in CalFresh registration echoes the economic hardship experienced by lower-income residents.

Kari Beuerman, Marin HHS “We want families to know that Marin HHS is ready to help them access essential nutrition supports, such as CalFresh.”

APRIL 2020 JUNE 2020 MAY 2020

MAY 1ST: Marin hospitals and public health combine forces to provide on-site support to senior residential facilities in the prevention, early detection, and control of COVID-19.

Dr. Elizabeth Lowe, MarinHealth “It’s inspiring to be working alongside doctors and nurses from across the county. We’re all one team fighting this together.”

JUNE 18TH: A public health guided return to site-based classroom instruction is issued by Marin Public Health and Marin County Office of Education.

JULY 22ND: Marin and 29 other counties are placed on the state’s monitoring list due to elevated disease transmission rates. The school year will begin with distance learning.

Mary Jane Burke, Marin County Superintendent of Schools

“While this information is disappointing, we are prepared for safe return of students and staff to the classroom where they belong.”

JULY 2020

2020 2021 2022

Dr. Matt Willis, Marin HHS “The goal is to see children and staff return to the classroom and to do that as safely as possible.”

AUGUST 2020

MARCH 2020

SEPTEMBER 3RD: Waiver applications for TK through sixth-grade school reopening are approved by Marin’s public health officer.

Dr. Matt Willis, Marin HHS “We’re at a critical juncture, and our ability to get kids back into school is up to all of us. It’s not time to relax our protective measures.”

SEPTEMBER 2020

AUGUST 28TH:

The county can reopen indoor shopping centers, hair salons, and barbershops beginning August 31st at 25% capacity.

OCTOBER 27TH: Steady progress against the virus prompts new guidelines and pushes Marin to Tier 3 COVID-19 status.

OCTOBER 2020

September through early November is a critical period for vaccinations.

OCTOBER 12TH:

2020 2021 2022

To avoid the flu-COVID “twindemic,” Marin doctors strongly recommend seasonal influenza vaccinations as soon as possible.

Schools have been closed to classroom teaching since March.

COVID-19 statistics from Marin County Public Health as of November 13, 2020.

NOVEMBER 13TH: Public Health tightens restrictions on high-risk indoor environments to contain the virus’s spread.

DECEMBER 4TH: Marin County, along with the counties of Alameda, Contra Costa, Marin, San Francisco, Santa Clara, and the City of Berkeley, jointly announced they will implement the state’s Regional StayHome Order on Dec. 6th.

Dr. Matt Willis, Marin HHS “This couldn’t come soon enough. Vaccinating our front-line healthcare workers will protect them as they manage surges in cases.”

NOVEMBER 2020 DECEMBER 2020

NOVEMBER 17TH: Free on-site testing and at-home FDA-approved testing kits are available for county residents. Getting

DECEMBER 16TH:

First doses of vaccine arrive in Marin. Marin Public Health partners with Kaiser, MarinHealth, Sutter, and the Marin Medical Reserve Corps to vaccinate residents in Marin’s long term care facilities for the elderly (LTCF). Hospitals begin to vaccinate staff as ICU capacity dwindles.

2020 2021 2022

The first shipment of the Pfizer doses to be received in Marin

JANUARY 25TH: The Stay-Home Order is lifted as improved forecasts prompt the state to move Marin County from “deep purple” to purple status.

FEBUARY 3RD: Short supply of doses means more focus on seniors as Bay Area public health leaders urge vaccination prioritization.

FEBUARY 21ST: Drive-through vaccinations are slated for Marin beginning Sunday, February 21st. Marin Public Health prioritizes vaccinating educators and school staff to support reopening all schools in Marin for full-time, in-person instruction.

JANUARY 2021 FEBRUARY 2021

2021 2022

JANUARY 15TH: The county expands COVID-19 vaccine access from hospital and LTCF staff and residents to priority populations.

JANUARY 29TH: Health officials cite supply challenges for slow vaccination pace: less than 500 doses per day are available in Marin through February 6.

Dr. Matt Willis, Marin HHS “Everyone in Marin will have their turn.”

Dr. Matt Willis, Marin HHS

“Three out of four COVID-19 deaths in Marin are among residents aged 75 or older. A vaccine offered to a resident above age 75 is 300 times more likely to save a life than a vaccine offered to someone under the age of 50.”

Employees from healthcare industries are receiving the COVID-19 vaccine now in Marin County. 1/15/21

MARCH 18TH:

As of Tuesday, March 16th, all Marin County schools have reopened for some degree of in-person learning as the COVID-19 pandemic shows more signs of easing.

MARCH 2021

MARCH 5TH: Marin County residents who have been unable to make their own appointments via the internet can call the newly launched Access Service Center to get assistance from a real live human being.

MARCH 30TH: Vaccine eligibility expands in Marin: all residents over 16 are expected to qualify for COVID-19 shots by mid-April.

APRIL 6TH:

Health officials urge vaccinations and face coverings as the B.1.617.2 (Delta) COVID-19 variant is detected in Marin.

APRIL 2021

2021 2022

APRIL 19TH:

Access to federal vaccine supplies mitigates local shortages, as community clinics and public health partners assist in vaccinating Marin’s most vulnerable.

Mark Shotwell, Ritter Center

As Marin heads into April, there are still about 100,000 county residents remaining to vaccinate against COVID-19

“Our partnership with the county is a natural extension of Ritter Center’s mission to provide access to primary health care to people who have historically and systematically been underserved, including those who have been disproportionately impacted by the pandemic.”

MAY 7TH: Marin is poised to vaccinate 12 to 15-yearolds as distribution teams anticipate authorization.

“Vaccinating our adolescents is a high priority and will be critical to our pandemic progress.”

MAY 2021

MAY 20TH:

MAY 28TH:

Marin Center vaccine site closing ended on a high note, with two mass vaccination locations alone delivering nearly 120,000 doses.

Dick Daley, Marin Center POD “We did everything we could to make it a quick and convenient visit for people getting their shots.”

JUNE 9TH:

Marin launches a vaccine incentive program and encourages all to participate in the state’s lottery “Vax for the Win” as California prepares to reopen fully.

Dr. Lisa Santora, Marin HHS

“We hope the chance to become a millionaire or even just the opportunity receive help with groceries, will help nudge that number even higher so we can obtain wider community immunity in the weeks ahead.”

JUNE 2021

2021 2022

A recent COVID-19 death illustrates that local cases are overwhelmingly among unvaccinated residents and bolsters confidence in the vaccine’s protection.

JUNE 3RD: Health officers from around the Bay Area support a full in-person school for fall 2021.

JUNE 14TH:

For the first time in more than a year, Marin County hospitals have zero confirmed COVID-19 patients requiring hospitalization, demonstrating the vaccine’s efficacy.

The Larkspur Ferry Terminal likely will be a location for COVID-19 vaccinations for kids aged 12-15 if authorization comes through to provide doses to that age group. 5/7/21

JULY 16TH: Bay Area counties recommend indoor masking for everyone as Marin sees an uptick in cases and hospitalizations.

AUGUST 20TH: Marin to require vaccine verification for first responders, while unvaccinated staff will require weekly testing.

JULY 2021 AUGUST 2021

2021 2022

Those who are fully vaccinated against COVID-19 are well protected already. 9/24/21

SEPTEMBER 2021

Since June 1, 12 people have been hospitalized in Marin for COVID-19; all but one were unvaccinated. 7/12/21

SEPTEMBER 24TH: Healthy residents are advised to wait while elderly and high-risk categories are prioritized as Marin readies for COVID-19 booster shots.

OCTOBER 19TH: Health leaders declare full protection of vaccines as critical for preventing serious illness; older adults are urged to get COVID-19 booster shots.

DECEMBER 10TH:

Marin leads California in COVID-19 vaccines for 5-11-year-olds, lauds its partnerships as a formula for success, and encourages parents of unvaccinated children to make appointments.

Dr. Matt Willis, Marin HHS

“This is a historic moment in our fight against COVID-19.”

MARCH 2020

OCTOBER 2021

NOVEMBER 2021

NOVEMBER 12TH:

DECEMBER 2021

DECEMBER 17TH:

“With the holidays approaching, getting a COVID-19 booster will allow us to safely spend time with friends and loved ones.”

With more than 3,000 children vaccinated and additional appointments becoming available, pediatric vaccinations ramp up across the county.

The first Omicron case is detected in Marin, raising concerns, and underscoring the role of booster vaccines.

Dr. Lisa Santora, Marin HHS

“This holiday season, the Omicron variant is an invisible, uninvited guest that may crash your holiday gathering. A holiday gift to yourself and your loved ones is to not let your guard down when engaging in activities outside of your home.”

Dr. Laura Eberhard Kaiser Permanente

2022

JANUARY 18TH: The federal government provides every household with four free rapid tests as of January 18.

FEBRUARY 25TH: Twenty-four virus deaths between January and February 12th reinforce the need for vigilance.

JANUARY 2022MARCH 2022

FEBRUARY 2022

FEBRUARY 9TH: Marin issues a new mandate for first responders that requires full vaccination and boosters.

MARCH 3RD: Marin aligns with the state on mask recommendations for schools and childcare settings, although individual facilities may choose additional restrictions.

County

responders were first eligible for the COVID-19 vaccine in December 2020.

Marin

first

20022

APRIL

MAY 2022

Fast forward. The timeline ends.

As flags flew at half-staff in front of the Marin County Civic Center and other federal buildings across the U.S. following President Joe Biden’s order, the nation commemorated the one-millionth death in America due to COVID-19.

On May 12, 2022, at the second global pandemic summit, President Biden spoke solemnly of the once unthinkable death toll in the U.S. and said,

“Today, we mark a tragic milestone here in the United States: one million COVID deaths, one million empty chairs around the family dinner table — each irreplaceable. Irreplaceable losses, each leaving behind a family, a community forever changed because of this pandemic.

MARCH 2020

APRIL 2022

And here we are.

After more than two and a half years of advances in science, human rights, and public health investment, we have achieved remarkable success against the COVID-19 pandemic. Progress on this scale is only possible when countries and communities work together towards a common goal. Although the virus may never be defeated, the advances that have been made will only be sustained by avoiding the threat of an apathetic approach by our national and local leaders and by remedying deep-seated inequalities that affect the most vulnerable of those in our midst. The president concluded his comments by saying,

“So, thank you for responding to this fight. And most especially, thank you to all the doctors, nurses, community health workers, scientists, aid workers, and anyone and everyone on the frontlines fighting this pandemic, saving lives every single day.

We owe you.”

28TH: COVID-19 antiviral treatments are available for high-risk Marin residents.

meaning may have changed throughout time, but during the COVID-19 pandemic , held close to the following definition and were easy to identify.

Marin’s h eroes

A real-life ever yday h ero coura ge. and

A h ero’s sel flessn ess, braver y, compassion,

is much like a literar y hero: a person who puts oneself before others for a good cause. They typically exhibit characteristics of

DIVISIONS IN ACTION

The professionals of Marin’s HHS Divisions were the heroes that worked around the clock to protect us from the virus and its deadly effect. They were the doctors, epidemiologists, nurses, social workers, administrators, contact tracers, volunteers, essential workers, and more that sacrificed so much.

As the world waited for a vaccine, the scientific community banded together to provide the antidote. When the fears and misinformation of some attempted to overshadow the science, they stood their ground and respectfully spoke the truth. Although they wore goggles, gloves, gowns, and masks during their shifts, Marin’s superheroes were not immune from the virus and the fear of spreading it to their families. That showed real bravery.

Their strength and heroism will not go unrecognized by our community and communities worldwide. They served as an inspiration to all of us by working the frontlines to end this pandemic while putting their own lives at risk. History will remember them fondly.

These public servants of Marin continued to protect our county, cities, and communities with selflessness and humility during COVID-19. They earned the title of Hero.

Public Health

Marin Public Health was our community’s first line of response when the COVID-19 outbreak began. Officials worked to control the spread in Marin by putting into action emergency operations and response plans by working closely with guidance from the Centers for Disease Control and Prevention (CDC), the California Department of Public Health (CDPH), and our regional and local partners.

During COVID-19, the work of implementing educational programs, recommending policies, administering services, and conducting research continued. The pandemic reminded us that we must prioritize solutions to health disparities by promoting healthcare equity, quality, and accessibility.

Overcoming barriers to health equity have become an important goal.

Achieving high vaccination rates equitably requires a simultaneous focus on building trust while removing barriers to vaccination. Marin County Public Health advanced COVID-19 vaccine equity together with strategic precision.

Vaccine Equity

Marin Public Health developed a strategy for achieving vaccine equity for COVID-19 based on earlier shortcomings with its vaccination history.

Before COVID-19, the county had some of the lowest vaccination rates in California. Only 75 percent of incoming kindergarteners were fully vaccinated, and Marin had the highest rates of personal belief exemptions against required vaccinations in the Bay Area.

As a result, there were record numbers of whooping cough cases. Then in 2015, during California’s measle outbreak, Marin gained a national reputation as the poster child for affluent, highly educated communities with low vaccination rates. The comedian Jimmy Kimmel teased, “Those people in Marin County are more afraid of gluten than they are of smallpox.”

Taffy Lavie and Jessica Middleton, PHNvolunteers at the first vaccine clinics at skilled nursing facilities.

Seeing preventable outbreaks of diseases that are more common in the developing world fueled some soul-searching as a community, and new forms of dialogue regarding vaccination policy and access began.

Currently, 95 percent of our children entering kindergarten are fully vaccinated, and the county has some of the nation’s highest vaccination rates against COVID-19. Approximately 90 percent of children ages five to 18 are fully vaccinated, as Marin moved from being a vaccine-hesitant county to a vaccine-friendly community.

Community Response Teams

Marin County Public Health focused on bringing information to families in cities and communities throughout the region.

The strategy used in Marin was to form four community response teams (CRT) in the four hardest-hit communities by COVID-19. With financial support through the CARES Act, a lead agency in that community rallied and recruited other community partners to become vaccine champions and address specific concerns in their communities. Those teams were supported by Public Health using three primary strategies.

Local Data for Local Action

To close gaps, you need to see them. Marin Public Health’s epidemiologists constantly looked at the data in meaningful ways, whether that was census tract, gender, race/ethnicity, or age, to determine where the gaps were.

The CRTs were clear about the goals they were trying to accomplish. The primary objective was that no community or town would be more than 10 percent behind the county average vaccination rate. This approach allowed for an equity focus because the emphasis was constantly on the tailing end. We didn’t worry about those ahead because it wasn’t an equality approach. It was about shepherding everyone along at the same rate.

Communicating for Impact

The second strategy was communication. This process was our most important strategy for establishing trust. The path of trusted vaccine information started at the federal level (e.g., FDA, CDC), moved to the state (e.g., CDPH), and finally to the local level, where we could directly engage in real dialogue with people in households. Conversations were started at the local level, where we could hear, listen, adapt, and say, what does this mean to us as a community? How will we roll this out? How can we be responsive to people’s concerns?

Another important aspect of communication was to have a weekly structure with key sectors like schools, elected leaders, volunteers, the CRTs, hospitals, clinics, and long-term care facilities. The goal was twofold: to provide them with key messages that were aligned so that families are encircled by the same vaccine-positive messaging no matter where they go; and to manage the countervailing influence of misinformation.

A daily email with public health status updates that went out to approximately 50k subscribers was complemented by short video updates, press releases, the Marin HHS website, social media, and never saying no to any request for interviews

Emergency meal box deliveries at Marin County Housing Authority Nov. 2020.

That rethinking led to a much-improved vaccination rate outcome.

by the media. This strategy inspired trust. A randomized Community Assessment for Public Health Emergency Response (CASPER) survey in Marin County indicated that 92 percent of respondents Strongly Agreed or Agreed with the statement, These results demonstrated trust in our community and how we responded to the pandemic.

Building Partnerships

The last element was building partnerships. This approach was essential for rural areas. We approached this by asking families two fundamental questions: where do you go every day and whom do they trust? The overlap between those two was the most natural partner for vaccine messaging and locations offering vaccines. The West Marin CRT organized meetings at various community sectors providing vaccine-positive messaging at schools, food banks, businesses, churches, libraries, health clinics, and community services. This method was an example where people received messages and vaccinations from trusted and regularly accessed agencies.

By partnering with schools to host vaccine clinics, 40 percent of Marin County’s five to 11-year-olds were vaccinated within two weeks of eligibility. Most of those children were vaccinated in schools.

Partnerships outside of healthcare were essential for vaccine equity. By August of 2021 in West Marin, 98 percent of Latinx residents were fully vaccinated, decreasing the disproportionality in cases. In 2020, Latinx residents were seven times more likely to be infected than their white counterparts. In 2022, that number has been normalized to one-to-one.

What changed in Marin County between 2015 and 2020 was a difference in the approach to the vaccine conversation itself. Marin Public Health helped change hearts and minds by stepping out of their offices, getting into the communities, and doing more listening. We recognized that vaccine decision-making is less about what public health officials think and more about what the community thinks.

We recognized that no one makes changes in their mind when they are feeling defensive. We delivered frequent and consistent messaging across sectors and built partnerships starting with existing circles of trust, especially in rural areas, for access, messaging, and operations.

Marin’s Public Health employees and its volunteers have earned a debt of gratitude from their colleagues and the community they served during the pandemic. Over the past two years, the work has been challenging. It has not been easy. Thank you for making a difference.

Community Resource Teams

In response to the COVID-19 pandemic, Marin Public Health created community response teams (CRT) in communities with the county’s highest case rates. This outreach approach targeted community-based organizations (CBO), non-profits, schools, community health clinics, the business community, faith-based organizations, and city and county representatives.

Volunteers from across the county helped in spreading the word regarding vaccination information.

DSW workers assigned to assist with the coordination of administering vaccines to Marin residents..

“I trust the information supplied by Marin County Public Health.”

Working with Marin Public Health, CRTs identified and liaised with community partners to optimize outreach and communication strategies. They leveraged their organizational strengths to collaborate on building the partnerships’ capacity to prepare and respond to COVID-19. Marin County Voluntary Organizations Active in Disaster (VOAD) enhanced the CRT work through coordination and technical assistance.

Senior Program Coordinator Randi B. Lachter of Marin’s Community Response and Outreach Program worked closely with the CRTs and had this to say,

“Funding lead agencies to form Community Response Teams and to focus on the unique needs of their geographic areas (versus the entire county) was critical for COVID response. The lead agencies were trusted sources of information, open-minded, and willing to collaborate with representatives from many parts of the community and with Public Health. This effort helped strengthen relationships between public health and CBOs and successfully let CBOs take the lead in shaping outreach and education in their communities.”

Health Preparedness Program

The Healthcare Preparedness Program (HPP), a federally funded program supporting regional healthcare system preparedness, was part of the response. HPP promotes a sustained national focus to improve patient outcomes, minimize the need for supplemental state and federal resources during emergencies, and enable rapid recovery.

The HPP coalition provided a safe space for sharing best practices, relationship building, and generally improving Marin’s emergency preparedness level. The program goals included:

CRT volunteers providing assistance at a Marin Public Health vaccination site.

Marin County’s Sheriff’s Office of Emergency Services helped to coordinate activities at the Emergency Operations Center.

Southern Marin Community Response Team member delivering COVID test kits.

• To maintain effective coordination among healthcare partners, Marin County Medical Health Operational Area Coordinator (MHOAC), and the Office of Emergency Services (OES).

• To maintain a coordinated communications plan for large-scale incidents in healthcare delivery.

• Practice emergency communications, situation reporting, information gathering, resource requesting, and sharing through collaborative and ongoing drills and exercises.

• Work together to meet or exceed the preparedness goals set forth by the State and Federal governments.

Marin Medical Reserve Corps:

Marin’s Medical Reserve Corps (MMRC) — a reserve list of non‐medical, medical, public health, and mental health professionals, such as physicians, nurses, pharmacists, emergency medical technicians, dentists, veterinarians, epidemiologists, infectious disease specialists, administrative assistants, machinists, retired military personnel, and security officers — worked tirelessly with public health during COVID-19. Their assistance to local hospitals and Marin Public Health to augment personnel needs during the pandemic surge was invaluable.

MMRC volunteers.

MMRC volunteers with appreciation shirts.

I’m smiling, I swear.

The best way to describe quarantine: outward smiles and inward screams.

If you would have told me a year ago that we’d all be wearing face masks, I wouldn’t have believed you.

Marsha Grant receives her vaccination.

Management Staff at the Super POD (Left front to back: Michael Finnigan, Karrie Groves, Allison Nygaard, Melissa Holzapfel, Marsha Grant. Right front to back: Todd Overshiner, Michael Giannini, and Richard Daley.

Outside the Americorp Suite at 1600 Los Gamos (left to right): Diane Ayers, Danielle Hiser-Honda, Lindsey Termini and Dr. Lael Duncan.

Crews who swab together stay together - some of the drive through test site staff. (photo by Maureen de Nieva Marsh)

BEHAVIORAL HEALTH AND RECOVERY SERVICES

In January 2020, the Division of Behavioral Health and Recovery Services (BHRS), their public health partners, and other county medical directors started hearing about the coronavirus and imagining its potential impact on their clients and services. It didn’t take long for that reality to set in.

COVID-19 brought many changes to our daily lives. The uncertainty and worry about the physical effects of the virus equaled the emotional suffering individuals dealt with regarding information overloads, worries and pressures regarding finances, and job insecurity, not to mention the overwhelming effects of social isolation.

Symptoms of stress, anxiety, depression, and insomnia rose in the county. Some increased the use of alcohol and drugs as a coping mechanism. These warning signs signaled the beginning of the challenges BHRS was to face. Things got off to a rocky start.

BHRS staff members were deployed into new roles while continuing to fulfill existing casework and balancing their personal lives. It was stressful, and some considered leaving. Several reported challenging experiences with their new assignments due to the lack of training, and others voiced concerns about being placed in unsafe situations.

Resources were scarce. Occasionally, there were times when gloves, masks, gowns, and other personal protective equipment (PPE) were hard to find. Staff reported the need for interpreter services and cited one instance when a Spanish-speaking COVID-19-positive mom and her newborn showed up for help with isolation and quarantine. There was no one available to assist with their follow-up care effectively. Situations like these forced BHRS to make some changes.

These and other obstacles early in the pandemic led the division to rally around its mission, organize protective gear, and muster the courage to maintain access while other services went virtual. The division had to quickly develop telehealth and virtual clinic capabilities to adjust and provide the full menu of options that were required. There was a renewed commitment to partnerships and a great deal of collaboration and support for others. Telehealth administration was given to front desk staff, while contract administrators worked overtime to support social services programs like the Great Plates Program.

They adapted to a model of constant risk-benefit analysis in deciding when clients needed in-person versus virtual services. They also had to fill in gaps for other types of services. By adapting and being nimble in response to the pandemic, BHRS was constantly evolving and stayed focused on its objective of serving those who were in need. The medical team maintained a physical presence at their sites throughout the pandemic, and the requirements of their clients for crisis services, injectable medications, on-site assessment, and mitigating problems related to the use of virtual tools were constant.

Some positive things did come out of the pandemic. A renewed sense of importance regarding and respect for public health and public mental health missions might have been the most important, followed by the rapid build-up and mobilization of BHRS’ telehealth capacity and the use of new and enhanced communication tools. Many staff members also commented on how rewarding it was to be a part of the vaccination distribution process as a disaster service worker and observe the relief people felt when accessing vaccines.

Mid March 2020, at the EOC before we started wearing masks. Here’s the beginnings of a soon to be massive Care and Shelter branch: Ashley Hart McIntyre, LaToya Webb and I with Lynn Murphy.

Benita McLarin getting vaccinated at the VA.

BHRS services never closed the doors to treatment throughout the pandemic, including in-person work at the Crisis Stabilization Unit, Mobile Crisis Response Team, Jail Mental Health, and virtual and hybrid work throughout our outpatient clinics. Substance Use Services, including Recovery Coaches, provided field-based services and an outstanding level of innovation and creativity to adapt to a continuously changing landscape. BHRS staff were incredibly resilient and coped with the stress and quick changes they encountered daily. They looked after each other and were supportive of one another. They persevered through tough times but acknowledged that they couldn’t have accomplished it without the help of their partners.

MarinHealth and its Emergency Department assumed the COVID-19 testing and clearance for every CSU patient before they came onto the unit. Additional partners included the Multicultural Center of Marin, Ritter Center, Buckelew Programs, BrightHeart Health, and Center Point, to name just a few.

The COVID-19 pandemic significantly changed the lives of the residents of Marin and the staff members of BHRS. The direct and indirect suffering brought on by the pandemic was challenging to witness. Increased isolation from family and support systems were symptoms felt by many. By maintaining a physical presence in the community while other vital services went virtual, BHRS stayed connected with its most vulnerable clients. BHRS continued essential services during the height of the pandemic, and the sacrifices made by so many within their ranks, in so many unspoken ways, will sustain them as they continue to battle COVID-19.

BHRS Staff

More than 40 percent of BHRS staff served as disaster service workers at various points during the pandemic. They were stationed in the Project Roomkey motels, the isolation and quarantine sites, vaccination clinics, and the emergency operations center. BHRS staff actively and intentionally engaged the community regularly in person, using virtual means, through the media and radio, often setting aside their own fears and personal safety to ensure the Marin community received the best care possible.

A client of Marin Center for Independent Living’s Powered and Prepared program receives a battery to ensure readiness in the event of power outages and emergencies.

Celebrating Grant Welling being named Volunteer of the Year award for MMRC at the Northgate POD.

Margaret Todd Drive Through Meals Feb. 2021.

SOCIAL SERVICES

COVID-19 disrupted the social safety net here in Marin and across the U.S. Individuals experienced unemployment, gaps in health coverage, homelessness, and an array of additional issues that required the assistance of social services organizations.

Marin HHS’ Division of Social Services faced the daunting task of trying to help maintain the foundation of social services support for the county’s most vulnerable residents. At the onset, leaders established their pandemic response by trusting various sources, including national health organizations, the state, and Marin’s public health agency, and, most importantly, relying on their internal expertise in dealing with these complex issues.

The pandemic disproportionately affected Marin families, who were most at risk. Food insecurity was a primary example. In March 2020, applications for food assistance benefits from the State of California’s CalFresh program increased by more than 3,000 clients in Marin. The rapid rise in CalFresh registration was directly related to the COVID-19 pandemic and the resulting economic hardship experienced by lower-income residents.

The county partnered with local restaurants to provide meals through the Great Plates Delivered initiative. Twenty restaurants fed more than 700 seniors aged 60 and older at a high risk of COVID-19 breakfast, lunch, and dinner Monday through Friday. This FEMA-sponsored program stimulated the economy by bringing employees back to work from the restaurant, hospitality, and transportation industries.

Other social service programs saw a sharp increase as COVID-19 infections increased. Medi-Cal enrollment soared to more than 51,000 beneficiaries, referrals to Adult Protective Services increased by 10 percent, and referrals to Children and Family Services decreased by 20 percent. This drop in referrals was perhaps the most concerning as children transitioned to distance learning, and mandated reporters did not have eyes on their students. However, this wasn’t the only challenge social services faced.

Balancing disaster services work with the division’s daily work may have been their biggest challenge. Because their daily work had dramatically increased, it became a nearly impossible task to serve two constituencies with the high level of service they had always provided. Vacancy rates were on the rise, and worker fatigue set in. In future crises, division leadership can reflect on the staffing lessons learned to avoid staff attrition and workforce burnout.

The old saying, “It is a marathon and not a sprint,” was driven home by COVID-19. Knowing the need to pace ourselves, be mindful of self-care, and be equitable in the division of labor so as not to burn out the best and brightest, and always meet the client’s and community’s needs to the best of our ability was the lesson of the day.

Most wouldn’t have believed it possible to assemble and operate a Public Assistance call center remotely before March 2020. However, that’s precisely what they did without the luxury of a strategic plan and a comfortable go-live timeline. As the need for benefits increased, so did the commitment of staff who stepped up, met the moment, and dealt with various complex client needs with kindness, patience, and compassion. Colleagues supported each other professionally and personally in remarkable ways. Everyone had to figure out a new work-life balance, a way to do self-care, and how to help their workforce through the new normal. The division’s performance during the COVID-19 pandemic has left an indelible mark on its response to the pandemic.

The pandemic has lasted much longer than anyone ever predicted however, the commitment of the Division of Social Services to the residents of Marin County is forever. Our outstanding personnel is our strength, and they will continue to achieve remarkable feats during any crisis and beyond.

MCPH-HHS First Vaccination Clinic at a Long-Term Care Facility: Tamalpais Marin’s Executive Director, Wes Bard, with Dr. Lisa Santora, MCPH Deputy Director, 12/17/20.

Heather Graves was one of our key staff at Isolation and Quarantinehere she’s training someone new at Inn Marin.

Kristen excited to receive her first dose of the COVID-19 vaccine!

WHOLE PERSON CARE

Long before the coronavirus put a grip on the health of Marin residents, another preexisting health crisis confronted the county: Homelessness. These two unique health challenges coalesced here in Marin with the onset of COVID-19. The job of Marin’s HHS Whole Person Care (WPC) Division became just a bit more demanding as they now went to battle on two fronts.

Knowledge of the virus became known by WPC staff members as they attended to their daily work routines and activities. Some heard about COVID-19 from news reports, while others received the gravity of the information firsthand. One staff member said, “I was on a team presenting at the management forum at Kerner when our presentation was cut short by Dr. Santora. She gave everyone an update about this “COVID thing” we kept hearing about.” A few days later, on March 12, 2020, that same staff member was reassigned — as hundreds of other county employees would also be in the days to come — to the emergency operations center (EOC).

Everyone on the WPC team received new assignments to the EOC. The move came at a cost, as almost all of the division’s work was put on hold. Luckily, WPC’s primary consultants filled the void during the early months. Nonetheless, some staff were grievously impacted by the high stress, demanding workload, the constant state of change, and the confusion they faced. Much rebuilding needed to be done as staff slowly returned to their positions in the late summer of 2020.

The aftermath of these reassignments lingered on. One staff member said, “Being part of the COVID-19 response was quite traumatizing, in ways I still find difficult to describe. It was exciting! I used so many of my skills and felt meaningful and connected – I can’t say I regret doing it. But it took years off my life. It was so stressful and difficult.”

Ironically, COVID-19 brought out the best in some. One shared sentiment was that working with intelligent people who care was beautiful. It was what they already loved about their jobs. Working directly with the community was great, and retrieving old skills from mothballs, like speaking Spanish, was fun! Existing partnerships strengthened, and new relationships were launched.

The lessons learned were plentiful about how to self-manage and support the clients. The staff who knew how to set limits as a self-preservation tool quickly saw that strategy crumble under the spotlight of challenging projects. One team member said, “I love to lead significant, complex, mission-critical projects. COVID taught me that there is such a thing as a project that’s too big and complex for me to feel I can master. That was humbling.” The work was hard.

There were many barriers for clients. They kept getting sicker after they checked into a designated motel for isolation and quarantine. There was urgent staff runs for life-saving medication, late-night consultations with hospital social workers, calls to 911, and all without sufficient medical support. At times it felt so scary. That’s how it felt to work on the frontlines and lead a big part of Care and Shelter. The clients of WPC contended with many challenging issues, including loss of support and resources, isolation, community criticism, and more.

The social isolation of COVID-19 impacted everyone, but for people experiencing homelessness, this impact was even more severe. The unhoused were cut off from their usual sources of interactions, case management ceased or went virtual, libraries closed, and access to technology and its

Charis Baz & Benita McLarin: On my last day in charge of Isolation and Quarantine Benita McLarin unexpectedly came to say goodbye and give me this beautiful flower arrangement as a thank you.

Marsha Grant and Amber Davis on Hawaiian Day.

Sending you a virtual hug!

“I came for a day. Was gone from my desk and sucked into the void for months and months.”

power source disappeared. Deaths of despair seem to increase in this community, rivaling the number of COVID-19 deaths in Marin.

The California Health Care Foundation reports that more than 150,000 people experience homelessness on any given day in California. In Marin, as of July 2022, that number is 1,121. Fortunately, the county avoided dramatic increases during the pandemic due to its proactive approach through investments and a system transformation of county and community partners to support and house our most vulnerable community members.

The upside of COVID-19 has to be the introduction of the HomeKey funding source. The county applied for and was awarded funds for three HomeKey projects increasing the number of permanent supportive housing units in Marin County by 130, plus expanding our scattered site housing slots by an additional 71 beds. Since the onset of the pandemic, the monthly rate of housing people has increased by 56 percent, and more than 281 persons were relocated to permanent housing.

Although COVID-19 tested our staff to its limits, we are proud of the many accomplishments of our team and the many lives saved and improved through our work.

Essential Worker sign in Marin.

A mobile unit staffed by Marin County Fire and Dominican Nursing Students.

This isn’t forever. It’s just right now.

Volunteers assisting at the Northgate POD location.

Nurses waiting to administer the vaccine to Marin residents.

STORIES OF SERVICE

These are the heartwarming stories of Marin County employees who acting as disaster service workers, battled the coronavirus, collaborated with our community partners, supported each other, and put their lives on the line daily. They are the dedicated employees of Marin HHS who worked to overcome extraordinary challenges and save lives.

From Cheers to Tears

By Amanda Hyslop

Edited by Kat Richter

I will not lie and say it has been an easy 15 months. Although I was one of the fortunate ones who never caught COVID-19, I did feel its weight on me mentally. When the news began reporting how the virus was gripping the nation, there was a level of uneasiness I had not felt before. A melancholy I had not been accustomed to rose in my body, and I began not to sleep.

Looking back, this is when the cocktail of pandemic fatigue settled in. I was sick of hearing the news about people angry for having to wear masks, people shaming other people for not wearing masks, and people blaming people for having COVID. The reaction to COVID became highly politicized. It was difficult to hear anyone with a human, pragmatic, and compassionate response until I started working with the Marin Medical Reserve Corps.

Instantly I was struck by the leaders of the Marin Civic Center POD, who created an ecosystem where listening, learning, and leaping were the norm. A fireman sitting next to me put it wisely; the COVID-19 vaccine POD was like building a plane while taking off. Whereas in January, I was sitting down drawing up vaccines, handwriting my name and lot numbers, as well as vaccine number two return date, by April, I was handed basins of pre-loaded syringes, administering vaccines while the information on the CDC vaccine card was being inputted digitally.

From cheers to tears, everyone working was in such a good mood, proud to participate, and inspired to be a part of the solution. The people coming in to get their shots were appreciative. The firefighters put on tunes; we had Aloha Fridays. I was told that vaccinating against COVID-19 was the happiest place to be in medicine.

As corny as this may sound, volunteering at MMRC and seeing the fantastic public heroes in action has reignited my confidence in America and the American people. It has also rekindled optimism for this world again. Biden took office and asked us Americans to summon our better angels, and we did that here in Marin. I tell my friends and family that there are angels among us, and they take the shape of public health workers, firefighters, nurses, doctors, county employees, parks, and law enforcement. Their wings are so enormous that you must clip them down, or they will fly away. I appreciate the MMRC opportunity to participate in such a well-organized operation in this historic time.

Our Plane is Sturdy and Stable

By Lisa Dickey

Edited by Kat Richter

In the beginning, we didn’t know how long the COVID-19 pandemic would last. “Shelter in place,” they said. Most places were closed, there was no toilet paper for sale, and people got creative about their homemade face coverings. But this you already know.

Two months into it, someone remembered me and thought I could participate in the extraordinary public health effort. I already had experience with public health and case investigations and was familiar with the most vulnerable communities in Marin. I can see problems and create solutions.

I started working in May 2020 with the COVID-19 Case Investigation and Contact Tracing Team. The team was in its start-up phase, trying to figure out how to do the work and get it done. The phrase “building the plane while trying to fly it” was used ad nauseum by all involved to describe what we were doing. It quickly became cliché, but it didn’t matter because there was no better way to explain what we were doing. We had no choice in the matter because time was not on our side.

Many of our clients feared for their health, housing, livelihoods, etc. Our case investigators would often vicariously feel the stress of those we interviewed. When our clients didn’t express any pressure or responsibility for helping curb the spread, we would feel anxious because we knew that people were putting others at risk.

It has been a little over a year since it all began, and because of the success of the vaccines, it seems like the worst is behind us. We did well with what we had, and I realized that our plane was sturdy and stable somewhere along the way. Throughout this process, I have worked with countless incredible people. They are strong, intelligent, caring, and funny people. Bonds have been formed, and emotions have been felt that I wouldn’t have ever imagined would be possible in government work. Together we have made a difference in the fight against the pandemic and the lives of many. We have made history.

The First Law of Public Health

By Dr. Stephen McCurdy

Early in 2020, it dawned on me what we were facing from the coronavirus. I contacted Drs. Willis and Santora and offered assistance, suggesting that my background as a recently retired professor of public health sciences was well suited to case investigation and contact tracing efforts. In my naïveté, I imagined volunteering between 10 and 15 hours per week. Two days later, I had a (more than!) full-time position as a Deputy Health Officer. Little did I know that, despite having devoted much of my career to training public health professionals, my education in public health was about to begin in the third year of my retirement.

I suspect that the decision to bring me on board was clinched when I mentioned to Dr. Willis and his team what I call the First Law of Public Health — Public Health is a Team Sport — and its corollary: “All of us is smarter than one of us.” The team approach is our “secret sauce,” and I have emphasized it every chance I get. (My apologies to those who roll their eyes for having heard it perhaps once too often . . .)

And now, nearly a year has passed. Amid our pain, the year’s greatest gift has been a sense of gratitude for me. I have worked with the most dedicated, influential, collegial people I have ever met. I found these qualities everywhere — in the Marin Medical Reserve Corps volunteers who saved us from collapse in the early days of the pandemic, in the public health professionals and redeployed county and state workers unmoored from their everyday work to a world of “All COVID All the Time,” and in our new hires now introduced to the world of public health. Many have discovered the magic of public health in this experience — it will be a unique inflection point in their personal and professional lives.

I am fortunate also to be among those little more than inconvenienced by the pandemic. We are among the lucky, housed, and with an unthreatened livelihood. Yet even in California’s wealthiest county, there are much less fortunate. Unsurprisingly, we encounter a rainbow of responses from those we attempt to help: darkest anger, impenetrable denial, and tears of gratitude — sometimes all in the same individual. Our privilege and challenge are to treat all with charity and grace, sometimes through gritted teeth.

I am deeply grateful to my community and you, my friends, and my public health colleagues for the opportunity to contribute and partner. Together we are saving lives, protecting livelihoods, and making history.

I’m Going to be a Doctor

By Eduardo Portella-Parra

Edited by Amanda Hyslop

As a future medical student, I highly value the ability to build rapport with my community and help people during difficult times. That is why I decided to work as a case investigator for the county of Marin. Case investigators not only attempt to dive into people’s minds and figure out the origin and potential directions of viral transmission to minimize spread but also act as a bridge to facilitate accommodations to those who are both affected and in need.

With a tired, half-broken voice, “Miguel” told me that he had been sleeping in his car two nights before because he tested positive for COVID-19 and did not want to infect his roommate. His roommate had been leaving John fruits and sandwiches on the car’s roof. Right after the interview, I connected him to the resource department so that they could lodge and isolate him in a motel room. I called him a couple of hours later that afternoon to find out if he was already isolated in the motel room. He thanked me and said: “It’s starting to rain right now. It would have been rough for me in the car tonight.”

I also had the opportunity to help “Ana,” an 18-year-old single mother who was taking high school classes online. The baby’s intense and spontaneous babbling gave us a laugh and made communication slightly challenging. The four-month-old baby had tested positive for COVID-19, causing Ana, her brother, and her mom to remain in quarantine. Ana told me she had never been under so much stress, worried about her baby and the isolation/quarantine orders. They were worried about their inability to work and what it meant financially. Fortunately, I could connect them with the county’s resource department so that they could assist the family with money for rent and supplies for the baby.

Sometimes, cases and close contacts avoid our calls. Occasionally, we cannot convince them to disclose relevant information for optimal risk management. However, interactions like those with Miguel and Ana make this job worth the time and effort. Being able to influence the community’s quality of life during a devastating health crisis has been mentally taxing but significantly fulfilling.

The Toughest and Most Rewarding Job

By Denise Hill

I came on board with Marin County, as a CI/CT supervisor, in mid-December. It did not take long to recognize genuine concern for the community. I was (and still am) very impressed by the way the program is run and the support that has been received from everyone involved.

I am grateful to have the opportunity to participate in such a worthwhile effort, and while the future is uncertain, I feel that the end of this pandemic is in sight. While I do not have personal contact with cases or contacts, I do hear about the resources that are made available to those in need and the care and compassion that they are given, during what is sure to be, some of their darkest days. My heart and appreciation go out to all of you for taking on what is most likely the most challenging and rewarding job you have had. Thank You! Your efforts have inspired me.

I’m a Contact Tracer

By Lee Ann Bartolini

I spoke with an older woman who lived alone and had tested positive for COVID-19. Her symptoms worsened, and I noticed, even over the phone, that her breathing was labored. I advised her to call her doctor or go to the emergency room. She called me back from the emergency room, where she was admitted to the hospital, and thanked me for the help. These stories were familiar during the last nine months I have been a contact tracer. There was so much anxiety associated with COVID-19 symptoms that being a person who could listen and direct others to receive the help they needed was genuinely worthwhile.

COVID-19 Forced Us to Care for Others

By Evelyn Colindres

COVID-19 has changed everyone’s life in so many aspects. Life certainly hasn’t been easy, and for many, it’s been the worst thing to happen, as many have also struggled with other health issues. Health issues like depression have worsened due to the lack of social interactions and support because of the shelter-in-place order. So many have had to struggle financially due to the impact that COVID-19 has had on the workforce.

COVID-19 has also forced us to stop for a moment and think about others — it has almost caused us to be more conscious and to care for others (not just ourselves), including our loved ones. It has forced us to care for humanity in general and to see how vulnerable we are yet so strong. We keep moving forward during this pandemic.

One aspect of my life that has changed because of COVID-19 is my work. I was moved from my “regular” job in Health and Human Services to a completely different place and role in public health: working as a Case Investigator. I was still able to help our community. Besides investigating positive cases of COVID-19, I was able to enter people’s homes via phone conversations and listen to their needs and fears. Many people in our community were and still are experiencing anxiety. A friend of mine always says, “If you have a friend, you don’t need a psychologist,” in other words, an understanding ear makes a world of difference. That’s what we did in so many cases. We did our best to provide quality interactions in each call.

I remember the following case: It was a lady in her 70s. When she answered the phone, I introduced myself as I would in every case I worked, “Hello, my name is Evelyn. I work for Marin County Health & Human Services, and I was calling to see how you are feeling today.” She was pleased to hear the first question and told me that she was experiencing depression and felt lonely because she had moved to her garage to prevent the rest of her family from getting sick. I listened to her explain her situation, and in the process, she provided me with the information that I needed, and I was also able to provide her with helpful resources. In the end, she expressed gratitude for the time I took to listen to her, and she asked me to call her back the next day to talk a little bit more. I laughed conscientiously, and I told her that I would. Little did she know, I was supposed to call her back anyway for a follow-up call. I felt good about my job that day — it felt gratifying. In many cases, I could show people that we cared and were there for them to support them.

There is Amazing Collaboration in This County

By Linda Metz

I am a retired senior public health nurse still working with juveniles, so I offered to help the COVID-19 team. The public health officer asked me to join the Schools/Childcare/Camp Team in June 2020, and I’ve been working there ever since.

Since joining the Schools team, “collaboration” has been a fantastic process that I have witnessed this year. It started with the Marin County Office of Education and the Marin County Public Health Office. When I joined the team, the two organizations had already been working together to close schools, open special education programs, and finally develop a 30-point plan for schools to reopen in September 2020. There was a common goal — get as many students back in the classroom as safely and quickly as possible.

Then the Schools became involved and worked on the 30-point plan for reopening with their task forces for each campus in Marin. Private and public schools were all working on developing guidance for their campus to ensure a safe return to school. Staggered arrivals, departures, recess, moving furniture around to allow for a six-foot distance, procuring supplies for cleaning and protection, removing extra items from classrooms, and adding air filters for proper circulation. Each campus also named two public health liaisons to work with MCOE and Schools team for guidance and policy when a positive case appeared at school. The Marin HHS Schools team worked with the task force from each school to ensure their safety plan incorporated the most recent guidance from CDC, CDPH, and Marin County PHO. All safety plans were reviewed by the Schools team and approved by Dr. Matt Willis.

Then in September, classrooms opened to in-person learning; scenarios of positive cases and close contacts of positive instances started. The public health liaisons worked with the Marin HHS Schools team to determine times of isolation and quarantine and who needed to be tested. Every day, new lessons were learned, and guidance changed weekly as tier levels changed and restrictions were added or released. Sports became involved, and the athletic trainers began collaborating with Marin HHS and the Schools team.

In March, most schools in Marin are open for in-person learning. Since September, only 11 in-school transmissions and less than 200 cases have occurred. Through all of this, the collaboration continues and the non-stop work at changing guidelines and policies to ensure safe schools and safe sports in the schools continues. We aren’t done — BUT— we will prevail due to the fantastic collaboration in this county on all levels.

Personal Reflections

By Nora Hirschler, MD

I returned to my office today and saw the piles and piles of notes I took while working as a bilingual contact tracer. I started reading some of my notes and remembered Margarita, Leonidas, and many more. Many had children, and some worked in the local restaurants where I had previously been. Some work in the supermarket where we do our shopping. Some of them were here, ensuring that our gardens look lovely. Perhaps I had never noticed them. And now, I am talking to them, and they are telling me their worries.

They are talking about a father or a mother who is far away and has died of COVID-19. They are telling me they need to work because they cannot pay their rent and will be evicted if they do not get paid. I provided as much help as I could. I offered them the food and supplies that Marin County offered. I told them about rent support and any other service we could provide. I was grateful that Marin County understood many of the problems and offered some support to contain the epidemic.

I found the people I talked to very thankful for our phone calls. They always tended to be a bit reserved at the beginning, but generally, they were easy to talk with. I used simple conversational techniques to gain their trust, like complimenting them on the lovely names of their kids, offering help with food, and explaining that I understood their issues. By the end of our conversation, we were chatting like friends, and I felt that I had gained their trust.

Many cases warmed my heart with their problems and made me feel guilty for having a comfortable life. I developed a tremendous appreciation for their fight to gain a better livelihood and escape the terrible situation in the countries where they used to live.

They came to this country looking for a better life while escaping gangs and depressing lives in their countries. After all, my great-grandparents left Russia/Ukraine for Argentina to escape persecution and look for better opportunities in their lives. President Biden said recently, “Unaccompanied children come to this country, not because I am a good person, but because their mothers send them, even if the journey is dangerous, hoping that they can get a better life in this country.” Those are the people I interacted with.

I Cried for the First Time

By Rachel Lanoza

When I was doing case investigation (CI) calls, I was three weeks new to CI. I saw an 86-year-old case in the queue. I initially hesitated as I knew people at that age typically weren’t responding well to COVID-19. I paused for a few minutes and decided to take the case. It was my new job. I called the number, and her daughter answered, she was mean and rude, and I sensed she was angry. She said, “My mother can’t talk right now, she’s at the hospital in ICU, and I get hourly updates if she’s going to make it or not.”

My heart dropped, and I immediately felt her pain as I also have an elderly mother. I told her I was sorry and that I felt her pain as I also have an elderly mother and can’t even understand how she must be feeling, but I know it’s complicated. After that, she opened up and changed her whole demeanor. She was friendly and polite. We talked about her situation, and she said she also tested positive. At that moment, I realized how real COVID-19 was and how it’s tearing families apart. After our call ended, I cried for the first time and realized how VERY REAL COVID is!

COMMUNITY PARTNERS

Community and Faith-based organizations were essential in helping Marin Public Health deliver critical services and support as communities across the county cope with the pandemic.

COVID-19 will continue to disrupt our lives for the foreseeable future. For those that rely on social services, these organizations will play an essential role in providing critical services and support, allowing them to adjust to the COVID-19 era.

Marin’s Department of Health and Human Services would like to thank the Marin County COVID-19 Community Advisory Board and the following organizations for their ongoing assistance in helping to keep our community safe.

The following organizations are a representative sample of some of our outstanding partnerships.

COMMUNITY ORGANIZATIONS

Agricultural Institute of Marin

Bay Area Community Resources

Bolinas Food Pantry

Bridge the Gap

Buck Institute

Canal Alliance

Catholic Charities

Center for Domestic Peace

Community Action Marin

Community Emergency Response Teams (CERT)

Dance Palace

Dominican University

Downtown Streets Team

EAH Housing

First Responder Therapy Dogs

Golden Gate Bridge Transportation District

Homeward Bound

Human Good-San Rafael Rotary Manor

Iglesia de Dios Neopentecostes

Integrated Community Services

Inverness Disaster Council

Marin Asian Advocacy Project

Marin Center for Independent Living

Marin Childcare Council

Marin County Fire

Marin Community Foundation

Marin County Office of Education

Marin County Cooperation Team

Marin Interfaith Council

Marin Medical Reserve Corps

Marin Volunteers Organized Against Disaster (VOAD)

Maskateers

Multicultural Center of Marin

North Marin Community Services

Novato Food Pantry

Parent Services Project

Performing Stars

Play Marin

Point Reyes Station Food Pantry

San Francisco-Marin Food Bank

San Geronimo Food Pantry

San Geronimo Valley Community Center

Solidaridad Guatemalteca

Spahr Center

Tomales Food Pantry

U.C. Cooperative Extension Marin

University of California San Francisco

Vivalon

West Marin Community Services

West Marin Senior Services

Westminster Presbyterian Church YMCA

FAITH-BASED ORGANIZATIONS

Cornerstone Community Church of God in Christ

First Missionary Baptist Church

Presbyterian Church Novato

Sacred Heart Church

San Geronimo Community Presbyterian Church

MarinHealth Medical Center

Sleepy Hollow Presbyterian Church

St. Raphael Church

St. Vincent de Paul Society

The Salvation Army

The Street Chaplaincy at First Presbyterian Church

HOSPITALS

Sutter Novato Community Hospital

Kaiser San Rafael

FEDERALLY QUALIFIED HEALTH CENTERS

Marin Community Clinic

Marin City Health and Wellness Center

Ritter Center

Petaluma Health Center in West Marin

Marin County Southern CRT.

Teamwork by DSW colleagues made the difference.

POD and CRT volunteers were the heroes of the day.

Wear a mask, stay safe, and stay healthy!

SCHOOLS

The pandemic has had a devastating effect on learning in TK-12 schools. Nearly every school nationwide, including those in Marin, closed its doors in March 2020 for the remainder of the 2019-20 academic year, replacing in-person instruction with online classes.

Through the end of the 2021 school year and continuing into 2021-22, closures, reopening, and guidance advisories to staff and students changed frequently based on the nature of the virus. One constant reminder was to wear a mask.

Marin Public Health and the Marin County Office of Education (MCOE), and all public, private, parochial, and independent school leaders worked closely to establish guidelines for the return to full-time site-based TK-12 in-person instruction. This collaboration created the Marin County SMARTER Schools Plan. The Plan targets seven areas to maintain a safe learning environment where students can succeed. They are shots, masks, awareness, readiness, testing, education, and resilience.

Additionally, the collaboration created the MCOE Rethinking Schools Task Force, which developed documents, presentations, training seminars, and other resources. These materials are regularly updated with the guidance of public health. They are available to schools and districts to utilize as assistance to meet the needs of students, staff, families, and the community.

Marin County Superintendent of Schools Mary Jane Burke said, “Dr. Willis and Dr. Santora were incredible partners for many years before COVID-19 arrived in Marin County. From the day that the shelter-in-place was announced, they have been relentless in their support of helping our schools navigate the risks of COVID-19 by maintaining a laser focus on doing what is best for students. Within a day or two, protocols and mitigation strategies were developed to open pop-up childcare for first responders, which became the framework for bringing back students with special needs, which led to the 30 Point and ultimately resulted in Marin County students being among the first to return to site based instruction in the state. We cannot express in words — on behalf of all the schools in Marin County — how grateful we are to Matt and Lisa and the entire team at public health for their ongoing support and partnership!”

Students with Staff Member Jonathan Lucha from Marin’s Community School.

Raemona Little Taylor, Deputy Director of Marin County Free Library, moves boxes full of Summer Learning Backpacks.

School Status Dashboard.

The MCOE Rethinking Schools Task Force: Mike Grant, Janelle Campbell, Patrick McLaughlin, Ken Lippi, Michelle Drake, Mary Jane Burke, Melina Boyd.

Mary Jane Burke, Matt Willis thank volunteers.

EMT worker manning the vaccination line.

IN MEMORIAM

Dedicated to the 266 residents of Marin County who have passed away as a result of the COVID-19 pandemic

When Great Trees Fall

Maya Angelou

When great trees fall, rocks on distant hills shudder, lions hunker down in tall grasses, and even elephants lumber after safety.

When great trees fall in forests, small things recoil into silence, their senses eroded beyond fear.

When great souls die, the air around us becomes light, rare, sterile. We breathe, briefly. Our eyes, briefly, see with hurtful clarity. Our memory, suddenly sharpened, examines, gnaws on kind words unsaid, promised walks never taken.

Great souls die and our reality, bound to them, takes leave of us. Our souls, dependent upon their nurture, now shrink, wizened. Our minds, formed and informed by their radiance, fall away. We are not so much maddened as reduced to the unutterable ignorance of dark, cold caves.

And when great souls die, after a period, peace blooms, slowly and always irregularly. Spaces fill with a kind of soothing electric vibration. Our senses, restored, never to be the same, whisper to us… They existed. They existed. We can be. Be and be better.

*In 1987 Maya Angelou wrote this poem upon hearing of James Baldwin’s passing and read it at his funeral.

Photo Credit: Bruce Guthrie

Artist: Suzanne Brennan Firstenberg Exhibition Name: In America

IN GRATITUDE

COVID-19 caught the world off guard. Public health experts had theorized for years that a pandemic like this was likely to occur. Their warnings fell on deaf ears, and the world found itself unprepared. A worsening hyper-partisan divide complicated matters even more. So where are we now, and what did we learn?

If we learned nothing more in the past two years, let it be that the health and well-being of the residents of Marin County rest safely in the hands of its public health institutions. Without their oversight and guidance, the risk of significant illness and death from the virus would have increased exponentially.

Notwithstanding the Omicron surge in January of 2022, polling from multiple organizations indicates that the perceived risk of catching and suffering from COVID-19 has steadily declined. Like Americans across the country, residents in Marin have increasingly continued to engage in away-from-home behaviors. They are getting on with their lives despite intermittent spikes of the virus.

The virus exposed the vulnerability of Marin’s elderly, the poor, the incarcerated, people of color, and other marginalized groups. The fragility of our healthcare system and the social determinants of health once again highlighted inequities in access to housing, education, and employment.

Despite this, there are reasons to be hopeful about the future, even as the pandemic continues. With operational procedures, treatments, and vaccines at our disposal, we’re in a much better state of preparedness to deal with new occurrences and the unexpected. The experience also brought out the best of us.

The response to the virus showcased the humanity, bravery, and commitment to service by Marin’s public health officials, healthcare professionals, and everyday citizens who stepped up to meet the challenge of this awful moment.

So how do you recognize and celebrate these individuals? A simple thank you seems so inadequate. How can you pack all of the gratitude, awe, wonder, joy, laughter, and love we have experienced for the past two years into those two words?

You simply can’t. To all of the devoted Marin Health and Human Services employees, please accept our deep gratitude for the dedicated work you did day after day in service of the residents of Marin. Your commitment and professionalism mean more than you know. It’s easy to see how much you care about the people you serve. Thank You