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FAQs: Local Public Health Orders

What should hospitals do if a local public health order contains a requirement that differs from state guidance?

First, read the local public health “order” very carefully. Many documents issued by public health officers (PHOs) are actually “advisories” or “guidance,” rather than orders that carry the force of law. CHA has reviewed PHO documents that have the word “order” at the top of the first page, but the wording of the document instead includes “recommendations” rather than mandates, or discuses activities or actions the hospital “should” take, rather than “must” or “shall” take. Read more  (9/22)

How does the state factor in equity in determining each county’s tier status?

On Sept. 30, the California Department of Public Health (CDPH) released a new equity metric that it will use as part of its calculation of each county’s tier in the Blueprint for a Safer Economy framework. In this framework, counties fall into one of four tiers based on risk of community transmission: Purple (widespread), Red (substantial), Orange (moderate), and Yellow (minimal). A county’s status determines the level of reopening for its indoor businesses.

To advance to the next less restrictive tier, depending on its size, a county will need to meet the equity metric and demonstrate targeted investments to eliminate disparities in COVID-19 transmission.

The metric requires counties with a population of greater than 106,000 to ensure that the test positivity rate in its most disadvantaged neighborhoods, defined as being in the lowest quartile of the Healthy Places Index (HPI) census tracts, does not significantly lag behind its overall county test positivity rate. The California Healthy Places Index is a composite measure of socioeconomic opportunity applied to census tracts that includes 25 individual indicators across economic, social, education, transportation, housing, environmental, and neighborhood sectors. While the state’s lowest quartile HPI census tracts are home to 24% of Californians, they account for 40% of COVID-19 cases. Due to data limitations in small populations, the equity metric cannot be reliably applied to smaller counties.

Every county must submit a plan for targeted investments to eliminate disparities in COVID-19 transmission that (1) defines its disproportionately impacted populations, (2) specifies the percent of its COVID-19 cases in these populations, and (3) shows that it plans to invest Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (Strategy 5: Use Laboratory Data to Enhance Investigation, Response, and Prevention) grant funds at least at that percentage to interrupt disease transmission in these populations. The targeted investments can include spending on augmenting testing, disease investigation, contact tracing, isolation/quarantine support, and education and outreach efforts for workers. 

Beginning with the Oct. 13 tier assignment, this plan must be submitted before a county may progress to a less restrictive tier. (10/6)

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