To: Board of Supervisors
From: DHHS: Administration
Agenda Section: Consent
SUBJECT:
title
The Department of Health and Human Services (DHHS), Public Health requests an allocation of a Laboratory Assistant I/II position and requests authorization of Supplemental Budget for Epidemiology and Laboratory Capacity (ELC) Enhancing Detection Expansion (4/5 Vote Required)
end
RECOMMENDATION(S):
Recommendation
That the Board of Supervisors:
1. Approve the allocation of 1.0 full time equivalent (FTE) 1.0, Laboratory Assistant I/II (salary range 308/349, class 1571A/B) in BU 1175-435; effective the pay period following Board of approval;
2. Approve the attached supplemental budget to supplement Fund 1175, Budget Unit 435 - Public Health Laboratory for Fiscal Year 2020-21 (4/5 vote required); and
3. Approve the attached supplemental budget to supplement Fund 1175, Budget Unit 455010 - ELC Enhancing Detection Expansion for Fiscal Year 2020-21 (4/5 vote required).
Body
SOURCE OF FUNDING:
Public Health Fund (1175)
DISCUSSION:
Local Health Jurisdictions are mandated by the state to conduct investigations of certain infectious diseases and report to the state regarding cases and outbreaks. While DHHS - Public Health and other Local Health Jurisdictions (LHJs) receive minimal funding for these activities, funding is often specific to certain diseases such as tuberculosis or HIV, limiting the ability to increase infrastructure to respond to a pandemic. Funding for Public Health services in general, including infectious disease investigation, prevention and control has decreased significantly over the last 10 years. Prior to the COVID-19 pandemic, DHHS - Public Health’s Communicable Disease (CD) Unit had one Communicable Disease Investigator and two Public Health Nurses to conduct contract tracing and case investigations for all infectious diseases, including but not limited to sexually transmitted diseases, tuberculosis, norovirus, influenza, pertussis, HIV, rabies and more. Staffing at that time was challenging to meet state reporting requirements for all infectious diseases. The staffing in the Communicable Disease program is also linked to the staffing in the Public Health Laboratory as testing in the lab often goes hand in hand with disease investigation by CD staff.
At the time of this report, DHHS - Public Health has been responding to the COVID-19 pandemic for over a year, since its first reported case in February, 2020. Within that year, staffing has significantly increased to appropriately respond to the pandemic through a combination of county staff reassigned as Disaster Service Workers (DSWs), community volunteers, extra help (temporary) staff, and state-assigned workers. The effort to respond to COVID-19 has strained county resources and over time, many DSWs needed to return to their original assignments to ensure appropriate levels of services are provided to the community beyond the scope of pandemic response.
COVID-19 response efforts have included but are not limited to: contact tracing, case investigation, testing, collection of specimens for testing, vaccination distribution oversight and vaccine clinics targeting high-risk populations, creating and providing messaging, outreach and education to various populations within the community and engaging in other infection prevention and control-related activities. While DHHS - Public Health anticipates many of these costs to be reimbursed by FEMA and state-funded Public Health Realignment, there was little funding dedicated to infectious disease prevention and control available at the start of the pandemic. Over time, the federal government and state have approved and allocated funding specific to COVID-19 response to LHJs.
Some of the funds driving response efforts include Epidemiology and Laboratory Capacity (ELC) Enhancing Detection funding through Nov. 17, 2022, allocated by California Department of Public Health (CDPH). On Nov. 3, 2020, the Board authorized several grant-funded positions and a supplemental budget, which included the ELC Enhancing Detection funding as part of the Paycheck Protection Program and Health Care Enhancement Act. ELC Enhancing Detection funding supports a number of activities crucial to COVID-19 response. This includes a significant increase of testing capacity from 25 samples a day to nearly 300 in the Humboldt County Public Health Laboratory (HCPHL), software upgrades to accept test request information and send results of tests electronically to providers, and the cost of laboratory testing supplies and support staff needed to manage the increased volume of work. This funding also supports the North Coast Regional Testing Partnership with United Indian Health Services and County of Del Norte, a second Epidemiologist to account for increased need for analysis of case data and various staff to increase contact tracing and case investigation capacity, provide infection prevention and control guidance to local long-term care facilities, healthcare providers and other entities and populations where staff or individuals are at high risk of exposure.
On March 2, 2021, CDPH announced an expansion of the ELC Enhancing Detection funding, which included the ability to spend funding on a broader range of activities including vaccination, non-congregate sheltering, genomic sequencing, and, as appropriate, to extend Enhancing Detection-funded activities through July 31, 2023. DHHS - Public Health was allocated $6,114,292 through this ELC Enhancing Detection Expansion (ELC ED-E) funding. DHHS - Public Health plans to use this funding to continue ELC Enhancing Detection activities, support organizations that can assist with providing services to and messaging to high-risk communities and community members and fund several ongoing activities that currently do not have an identified, dedicated funding source other than Realignment funds or FEMA reimbursement when applicable.
This funding will be used to onboard in-house genomic sequencing at the Humboldt County Public Health Laboratory (HCPHL), which, combined with other increased activities surrounding the COVID-19 pandemic requires additional staff. Currently, HCPHL contracts with the Chan Zuckerberg Biohub for genomic sequencing, but that project will sunset at the end of June. Genomic sequencing in-house will allow the laboratory to more quickly identify variant strains of COVID-19, which will lead to the ability to better prioritize contact tracing and case investigation, as well as better understanding of COVID-19 transmission within the community. Genomic sequencing will continue beyond the COVID-19 pandemic to better understand disease transmission of other infectious diseases as well. ELC ED-E funding will also fund continued efforts by DHHS staff to provide non-congregate sheltering isolation/quarantine resources to those experiencing homelessness, or are at otherwise high risk in their home environment, and also supports the funding of extra help (temporary) positions to support vaccine clinics as vaccination allocations are anticipated to increase in coming weeks.
This item before your Board today approves the allocation of 1.0 full time equivalent (FTE) Laboratory Assistant I/II to ensure the laboratory is adequately staffed on an ongoing basis, in order to support increased testing volumes and the additional ability to conduct genomic sequencing. It also approves a supplemental budget that addresses the allocation received from CDPH the ELC ED-E funding expected to be spent in the 2020-21 Fiscal Year.
FINANCIAL IMPACT:
The annual salary and benefits associated with a Laboratory Assistant I/II is $59,325. The overall estimated increase for the remainder of fiscal year (FY) 2020-21 is $14,385 in Fund 1175, Budget Unit 435 - Public Health Laboratory, supplemented in the attached Supplemental Budget - 435. This position will be funded by Epidemiology and Laboratory Capacity - Enhancing Detection Expansion (ELC ED-E) funding. The supplemental budget includes fixed assets in the amount of $225,000 in Fund 1175 - 455 Public Health Emergency Preparedness for genomic sequencing equipment for COVID testing, and $475,000 for four vans for mobile vaccination and testing. It also includes $290,165 in 1175 - 455 for non-congregate sheltering for April through June, 2021.
The total ELC ED-E funding allocated to Humboldt County is $6,114,292 for the funding term of Jan. 15, 2021 to July 31, 2023. A supplemental budget for ELC ED-E funding anticipated to be expended in FY 2020-21 is attached to supplement Fund 1175, Budget Unit 455010 - ELC Enhancing Detection Expansion for a total of $1,528,573 in FY 2020-21. The remaining $4,585,719 of this grant funding, and additional costs related to this position will be included during the annual county budgets in future fiscal years. There is no impact to the General Fund.
STRATEGIC FRAMEWORK:
This action supports your Board’s Strategic Framework by protecting vulnerable populations.
OTHER AGENCY INVOLVEMENT:
None
ALTERNATIVES TO STAFF RECOMMENDATIONS:
Your Board may choose to not approve the allocation of a 1.0 FTE Laboratory Assistant I/II, and choose not to approve the attached Supplemental Budget; however, that is not recommended as it would not permit DHHS - Public Health to spend grant funding slated for the current fiscal year, or meet grant deliverables of the ELC Enhancing Detection Expansion funding.
ATTACHMENTS:
1. ELC ED-E Allocation Letter
2. Supplemental Budget - 435
3. Supplemental Budget - 455010
PREVIOUS ACTION/REFERRAL:
Board Order No.: C-7
Meeting of: 11/03/20
File No.: 20-1320; 21-465