DIVISIONS IN ACTION

20022

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.”

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 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.

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:

• 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.