November 20, 2020 Edition

State Pulls Emergency Brake on Blueprint for Safer Economy, Issues Limited Stay-at-Home Order for Purple Tier Jurisdictions

Amid a sharp rise in COVID-19 cases and hospitalizations across the country and California, the Newsom Administration this week took immediate actions to mitigate the further spread of COVID-19. On Monday, the state pulled an “emergency brake” in the Blueprint for a Safer Economy, moving 28 counties into the most restrictive Tier 1 (Purple/Widespread) category, nine counties into Tier 2 (Red/Substantial), and two counties into Tier 3 (Orange/Moderate). Counties now in Tier 1 account for 94.1 percent of the state’s population. The state additionally strengthened its guidance for the use of face coverings to require residents to wear a face covering whenever outside their home, with limited exceptions.

Following Monday’s actions, Acting State Public Health Officer Dr. Erica Pan on Thursday issued a limited stay-at-home order requiring non-essential work, movement, and gatherings to cease between 10:00 pm and 5:00 am in Tier 1 (Purple/Widespread) counties. The order will take effect at 10:00 pm on Saturday, November 21 and remain in effect until 5:00 am on Monday, December 21.

The additional action order comes as the state continues to realize an unprecedented, rapid rise in COVID-19 cases and hospitalizations. The current growth in COVID-19 cases is faster than the state experienced in July 2020, which led to a significant peak in cases. According to the Newsom Administration, the state’s latest order is designed to reduce opportunities for disease transmission as activities conducted between 10:00 pm and 5:00 am are often non-essential and more likely to be social activities.

A copy of the State Public Health Officer order is available here. FAQs on the order are available here.

Legislature Convenes Oversight and Informational Hearings on COVID-19, Healthcare Costs

This week, the California Legislature convened several oversight and informational hearings on the impacts of the ongoing COVID-19 pandemic, as well as healthcare costs in California. Below, we briefly summarize these hearings.

COVID-19 Impacts on Foster Care

The Senate Human Services Committee convened an informational hearing on Monday to explore the COVID-19 impacts on the state’s foster care system. The hearing featured an overview of the current foster care system and associated challenges, as well as youth and caregiver and family needs and challenges during the COVID-19 pandemic. Representatives from the California Department of Social Services (CDSS), Los Angeles and Kings counties, as well as other youth-related organizations provided testimonies during the hearing, highlighting the pandemic’s impact on California foster children and services.

The hearing agenda is available here, and a background paper is available here.

Food Assistance During the COVID-19 Pandemic

On Tuesday, the Senate Human Services Committee also convened an informational hearing on food assistance efforts for vulnerable populations during the COVID-19 pandemic. The hearing explored how COVID-19 has impacted the need for nutrition assistance, recent state and federal funding for nutrition programs, efforts to meet the increased need for nutrition assistance during the pandemic, and changes in school meal programs during the pandemic. A broad array of representatives testified at the hearing, including those from local food banks, the Legislative Analyst’s Office (LAO), CDSS, Office of Emergency Services (CalOES), and the County Welfare Directors Association (CWDA).

The hearing agenda is available here, and a background paper is available here.

Workplace Health Safety Protections During COVID-19

The Assembly Committee on Labor and Employment on Tuesday convened an informational hearing entitled, “Safeguarding our Frontline Workers During COVID-19: The Need for Robust Workplace Health and Safety Protections.” The hearing provided an overview of workplace health and safety policies amid the ongoing COVID-19 pandemic and featured representatives from the LAO, Cal/OSHA, and the State Labor Agency. Experiences from frontline employees from four industries – agriculture, food service, warehouses, and hospitality – were additionally highlighted during the hearing.

The hearing agenda is available here.

COVID-19 in California State Prisons

On Thursday, the Senate Public Safety Committee and the Senate Special Committee on Pandemic Emergency Response convened a joint oversight hearing on COVID-19 in California state prisons. Recall, the Legislature has convened previous hearings earlier this year on the unprecedented outbreaks within state prisons and correctional facilities. Legislators were provided an update on actions and efforts to mitigate the spread of COVID-19 from the California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) Division, including early releases to decrease state prison populations, COVID-19 precautions, utilization of personal protective equipment (PPE), and health services available to CDCR inmates. Notably, a significant portion of the hearing focused on CDCR transfers from state prisons to Immigration and Customs Enforcement (ICE) detention centers.

The hearing agenda is available here.

Health Care Industry Consolidation and Prices

The Assembly Health Committee on Tuesday convened an informational hearing on health care industry consolidation and impacts on California’s health care prices. Tuesday’s hearing featured an overview of health care industry consolidation from a faculty member of the University of Auckland, as well as an overview of California’s current regulatory landscape from representatives from the California Department of Justice (DOJ) and the Department of Managed Health Care (DMHC). The hearing highlighted recent consolidation activities among health care delivery entities, changes in health care pricing, and impacts of consolidation on consumers.

The hearing agenda is available here. A background paper is available here.

Standards Board Adopts Emergency Regulations to Protect Workers from COVID-19

The Department of Industrial Relations (DIR) Occupational Safety and Health Standards Board unanimously adopted emergency temporary standards to protect workers from hazards related to the COVID-19 pandemic. The emergency standards take effect immediately if approved by the Office of Administrative Law (OAL) within the next 10 calendar days.

The temporary standards apply to most workers in California not covered by Cal/OSHA’s Aerosol Transmissible Diseases standards. Under the new regulations, employers must have a written COVID-19 Prevention Plan that addresses critical areas including a system for communicating information to employees about COVID-19 procedures, identification and evaluation of COVID-19 hazards, investigating and responding to COVID-19 cases in the workplace, and other applicable COVID-19 precautions.

A full news release is available here. A copy of the adopted emergency, temporary regulations is available here.

DOF Publishes Second Quarter CARES Act Report

This week, the California Department of Finance (DOF) issued the Coronavirus Relief Funds (CRF) second quarter report, detailing state and local expenditures incurred responding to the ongoing COVID-19 pandemic. The second quarter report covers expenditures between March 1 and September 30. Recall, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was passed by Congress earlier this year and provided a total of $15.3 billion to California with $9.5 billion allocated directly to the state and $5.8 billion allocated to 15 large counties and five cities with populations over 500,000 residents.

As of September 30, 2020, state and local government recipients reported a total of over $6.4 billion in eligible expenditures ($4 billion) and obligations ($2.4 billion). Compared to the first quarter report, this amount represents an increase of nearly $4 billion. Counties reported approximately 78 percent of their total funding, or more than $1 billion, was spent or obligated. A total of 27 counties reported funds as fully spent or obligated. Cities reported more than 75 percent of their total funding, or more than $377 million, was spent or obligated. All cities provided reports and 343 reported funds as fully spent or obligated.

Of the $4 billion expended through September 2020, the five largest expenditure categories, representing nearly 75 percent of total expenditures, are:

  • Facilitating Distance Learning ($862 million)
  • Payroll for Public Health and Public Safety ($699 million)
  • Personal Protective Equipment ($663 million)
  • Public Health Expenses ($429 million)
  • Budgeted Personnel – Substantially Different Use ($347 million)

DOF also reports that through September 30, costs totaling more than $1.9 billion will be paid or reimbursed with CRF monies. Of this amount, approximately $1.4 billion will be used to pay the state’s cost share for the FEMA Public Assistance Program funding for purchases related to personal protective equipment, medical surge capacity, testing, and emergency operations. The balance will be used to support various COVID-19-related activities, including contact tracing, support for healthcare workers, residential care facilities, senior programs, food banks, and people experiencing homelessness.

DOF will update expenditures and obligations through December 30, 2020, in January 2021 after filing the federal report which is due in early January.

The full second quarter report is available here.

LAO Publishes 2021-22 Budget Fiscal Outlook

This week, the California Legislative Analyst’s Office (LAO) published its annual report providing an independent assessment of the California state budget condition for the upcoming fiscal year and over the longer term. The LAO’s latest report finds the state’s budget situation has improved considerably relative to the 2020-21 Budget Act, with an estimated $26 billion windfall in 2021-22. However, the state also faces an operating deficit beginning in 2021-22 and throughout the outlook period, growing to $17 billion by 2024-25.

The LAO notes the state’s economy has experienced a quicker rebound than expected amid the ongoing COVID-19 pandemic, but the recovery has been uneven with many low-income residents out of work and most high-income residents spared. Tax collections and expenditures are consistent with the state’s economic picture, and data on new applications for safety net programs, including Medi-Cal and CalFresh, in the first few months of 2020-21 indicate applications have been below 2019-20 levels.

The projected $26 billion windfall results from revisions in prior- and current-year budget estimates and is entirely a one-time surplus. The LAO’s analysis suggests revenues could easily end up $10 billion or more above or below the main 2021-22 forecast due to the unprecedented amount of uncertainty associated with the state’s fiscal picture. Despite this one-time windfall, the LAO projects the state will face an operating deficit which is relatively small in 2021-22 and gradually grows moving forward.

The LAO outlines a series of recommendations to the Legislature as they begin budget considerations in the new year. Notably, the LAO recommends using approximately half of the projected windfall ($13 billion) to restore the budget’s fiscal resilience by making an optional deposit into a state reserve, such as the Safety Net Reserve, to help maintain services when demands on safety net programs increase. The other half of the windfall, according to the LAO, is recommended to be dedicated to one-time purposes, focusing on activities that mitigate the adverse economic and health consequences of the ongoing COVID-19 pandemic. The LAO notes the budget cannot afford any new ongoing augmentations and recommends the Legislature use the upcoming budget process to begin to address the state’s ongoing deficit through spending reductions or revenue increases.

The full LAO Fiscal Outlook report is available here.

Newsom Announces $62m Emergency Allocation to Support Project Roomkey

On Monday, Governor Gavin Newsom announced the state’s intent to immediately allocate $62 million in one-time funds from the state’s Disaster Response-Emergency Operations Account (DREOA) to counties providing housing to current Project Roomkey participants. According to the Administration, funds are being made available to Roomkey sites to ensure clients living in motel or hotel rooms will not be forced to return to street homelessness while the COVID-19 pandemic continues.

Project Roomkey has been made possible through the federal Coronavirus Relief Funds (CRF) and FEMA cost-sharing and has provided interim housing to approximately 23,000 individuals. As part of the federal legislation passed providing CRF to California, funds may only be used for costs incurred through December 30, 2020. Once this federal funding lapses, it is anticipated that approximately 4,000 individuals living in Roomkey sites may lose their shelter.

The $62 million in additional funds will be provided by the Department of Social Services (CDSS) to Roomkey jurisdictions. $24 million will be available to support Project Roomkey operations, $35 million will be available to develop and implement plans to transition individuals from Project Roomkey into permanent housing, and $3 million will be available to contract with experienced housing provides to provide technical assistance.

The announcement from the Governor’s Office is available here. A Department of Finance (DOF) memo describing the additional investment is available here.

Governor’s Business and Jobs Recovery Task Force Releases Report

Today, the Governor’s Task Force on Business and Jobs Recovery released its final report, “Recovery for All.” Recall, the nearly 90-member task force was assembled in April to chart a path forward on economic recovery in the wake of the COVID-19 pandemic. The report outlines key priorities and challenges in the state’s fight against COVID-19 and ongoing work to rebuild a more equitable, sustainable, and resilient economy. According to the Newsom Administration, the report reaffirms the importance of the state’s health-first approach in reopening the economy amid the COVID-19 pandemic.

The report identifies several key priorities to guide the state’s continued progress in economic recovery, including:

  • Preserving California’s competitive edge by supporting the needs of businesses
  • Expanding efforts to create quality jobs and equitable pathways for all Californians
  • Focusing on sectors that correlate to California’s strengths, including the care economy (childcare and elder care)
  • Pursuing inclusive regional strategies that leverage each region’s assets and mix of industries
  • Supporting essential workers by protecting those who bear an increased risk of exposure to the COVID-19 pandemic
  • Expanding support and providing flexibility to small businesses
  • Continuing efforts to close the digital divide
  • Promoting telemedicine as a way to provide essential care to more Californians
  • Incorporating equity and sustainability at every stage of the economic recovery effort.

The full task force report is available here. A press statement from the Governor’s Office is available here.

CDC Advises Against Thanksgiving Holiday Travel

This week, the U.S. Centers for Disease Control and Prevention (CDC) issued an advisory, urging Americans to celebrate the upcoming Thanksgiving holiday at home with household members only. The CDC indicates travel may increase the risk of getting or spreading COVID-19 and postponing travel and staying home is the best way for Americans to protect themselves and others this year.

As part of the guidance, CDC identifies alternative Thanksgiving holiday celebrations, including a virtual Thanksgiving meal and other activities. The CDC’s holiday travel advisory comes after California issued a similar travel advisory amid significantly increased COVID-19 cases and hospitalizations in California and throughout the country.

The CDC’s Thanksgiving guidance is available here.

Pfizer Applies for COVID-19 Vaccine EUA

Today, Pfizer and BioNTech submitted an emergency use authorization (EUA) request to the U.S. Food and Drug Administration (FDA) for its mRNA vaccine candidate for use against the COVID-19 virus. According to Pfizer, today’s FDA filing would potentially enable use of the vaccine in high-risk populations in the U.S. by the middle to end of December 2020.

The EUA submission is based on a nearly 95 percent vaccine efficacy rate with no serious safety concerns that was recently demonstrated in the companies’ Phase Three clinical study. The company expects to produce up to 50 million doses worldwide in 2020 and up to 1.3 billion doses by the end of 2021. According to Pfizer, vaccines will be ready to distribute within hours of receiving approval from the FDA.

A full joint announcement between Pfizer and BioNTech is available here.

FDA Approves First At-Home COVID-19 Test

This week, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the first prescription at-home COVID-19 test, developed by Lucira Health, for use by people who are at least 14 years old and have COVID-19 symptoms. The test is available for younger people, but a healthcare provider must collect the sample. The EUA approval is available here.

NACCHO Releases Recommendations for Biden Administration, 117th Congress

This week, the National Association of County and City Health Officials (NACCHO) released a series of recommendations for the incoming Biden Administration and the 117th Congress. In its recommendations, NACCHO highlights the role of local health departments (LHDs) in responding to the unprecedented COVID-19 pandemic, as well as the critical services delivered by LHDs nationwide.

NACCHO calls on the Biden Administration and Congress to:

  • Support LHDs on the frontlines of the COVID-19 response, including providing at least $3 billion in funding designated specifically for LHDs
  • Strengthen the governmental public health partnerships to harness expertise from the local level in national planning efforts
  • Invest in COVID-19 Vaccine Development and Infrastructure, including providing at least $8.4 billion in funding for COVID-19 vaccine distribution
  • Restore support and trust in public health

NACCHO additionally urges the federal government to make long-term investments in the public health infrastructure to protect the public and strengthen health equity. Among NACCHO’s requests are to provide an additional $4.5 billion in annual funding to federal, state, and local governments for core public health infrastructure, create a public health loan repayment program, and leverage COVID-19 investments to bolster the country’s public health system.

NACCHO’s full recommendations are available here.

CDPH Reports Rise in Rare, Severe Complications from Untreated Gonorrhea

Today, the California Department of Public Health reported a recent increase of a severe form of gonorrhea called disseminated gonococcal infections (DGI), which is an uncommon, but significant complication of untreated gonorrhea. According to CDPH, untreated DGI can lead to joint pain and swelling from infected joints, small, painless red based skin lesions, infection in the blood, or, on rare occasions, infections of the heart values or fluid around the brain. Most of the cases in California have presented with joint pain and infected joints. CDPH instructs anyone with symptoms to contact their healthcare provider.

CDPH continues to work with local health departments and healthcare providers to better understand these infections and to ensure people with STDs receive timely testing and treatment.

The full press announcement from CDPH is available here.

Governor’s Task Force on Alzheimer’s Disease Prevention Releases Report

Today, the Governor’s Task Force on Alzheimer’s Disease Prevention, Preparedness, and the Path Forward issued its final report detailing recommendations to Governor Gavin Newsom. Recall, the task force was formed in Fall 2019 and tasked with developing a statewide plan to address and manage Alzheimer’s disease and other aging-related conditions. The task force was chaired by former state first lady Maria Shriver.

The report details 10 recommendations for statewide action, including:

  • Appointing a Senior Advisor on Alzheimer’s
  • Establishing California Voluntary Savings Accounts for Long-Term Care
  • Launching a California “Blue Zone” City Challenge
  • Launching a Californians For All Care Corps Program

The full task force report is available here.

Proposition 64 Cannabis Research Grant Funding Recipients Announced

Last week, the Bureau of Cannabis Control (BCC) announced an investment of over $29 million in research funding to several California universities on a variety of cannabis related topics. Recall as part of Prop 64, a portion of revenues derived from cannabis industry is directed to the impacts of cannabis on California; cannabis research must focus on several topical areas including public health, criminal justice and public safety, economic, environmental impacts of the cannabis industry. A chart of the research projects funded is available here.

ACEs Aware to Hold MCAH Webinar on December 2

ACEs Aware will be holding a webinar on December 2, 2020, from 12:00 pm to 1:00 pm on “Supporting Patients in Pregnancy: ACEs and Maternal Health.” The webinar will provide information for women’s health providers about the importance of ACE screening in improving maternal health. Speakers will share resources for providers looking to introduce ACE screening in their practice, examples of how to create a healing environment for patients, and case studies on how to respond to ACEs with trauma-informed care.

Upon completion of the webinar, participants should be better able to recognize the science and impact of ACEs and toxic stress and understand the value of ACE screening in maternal health care practice, identify opportunities in prenatal care to build trust and safety between patients and providers, and describe ways to create healing environments and respond to ACE screening in maternal health clinical practice. 1.0 continuing medical education (CME)/maintenance of certification credit is available.

Registration and more information are available here.

CDPH CHC to Convene LHD Webinar on December 10

The California Department of Public Health (CDPH) Center for Healthy Communities (CHC) will convene a peer-to-peer learning collaborative session on Thursday, December 10 from 2:00 pm to 3:30 pm. The webinar will focus on “Positive Promotion: How to Harness the Power of Young Social Media Influencers to do Good” and will feature Contra Costa County Public Health in collaboration with their Youth Ambassadors Program.

Attendees will learn from Contra Costa County on how a social media program can engage youth and young adults to promote COVID-19 prevention messages, how to recruit and motivate youth and young adults to own and co-design a COVID-19 Youth Ambassadors program, and how social media reach and impressions can contribute the impacting COVID-19 positivity rates among disproportionately impacted communities.

Registration for the webinar is available here.