The County of San Diego (COSD) is a county in the southwestern corner of the U.S. state of California. As of the 2021 census, the population was 3,286,069 making it California's second-most populous county and the fifth-most populous in the United States. The County has five supervisorial districts. The Department of Public Health Services is one department in the COSD Health and Human Services Agency, and it serves all of San Diego County. According to the 2021 census, the County's demographics are 43.8% White (not Hispanic/Latino), 34.8% Hispanic/Latino, 12.9% Asian, 5.6% Black/African American, 4.9% two or more races, 1.4% American Indian/Alaska Native, and 0.6% Native Hawaiian/Pacific Islander (United States Census Bureau, 2021). Eighty-eight point three percent of residents have at least a high school degree or higher, and 40.3% have a bachelor's degree or higher (United States Census Bureau, 2021). Median household income is $83,454; and 10.7% of residents live under the poverty threshold (United States Census Bureau, 2021). Six point three percent of residents under 65 years have a disability, and 8.2% of residents under 65 years are uninsured (United States Census Bureau, 2021).
The first COVID-19 case recorded in a San Diego County resident was on March 9, 2020 (Alverez, 2020). When COVID-19 was declared a national emergency on March 13, 2020 (Biden Jr., J. R., 2022), cases increased to 55 cases (SanDiegoCounty.Gov, 2022). By March 30, 2020, there were 72 total cases (SanDiegoCounty.Gov, 2022). Testing was limited during this time. The first testing data available reports 123 tests for March 11, 2020; by March 31, 2020, 11,343 tests were reported (County of San Diego, Health and Human Services Agency, Public Health Services, Epidemiology and Immunization Services Branch, 2020). By April 8, 2020, COSD reported a total of 36 cumulative deaths from COVID-19. Of the 36 individuals, 10 (28%) were Hispanic/Latino, 15 (42%) were White, and two (6%) were Asian (CBS 8 San Diego, 2020). Demographic information was not available for the remaining nine cases.
County residents were increasingly concerned about contracting COVID-19. The low access to testing supplies increased County residents' concerns. COSD worked tirelessly to communicate with the public throughout the pandemic and planned its COVID-19 response interventions with a health equity focus.
On March 23, 2020, the County created a dedicated phone line for residents to call and be connected to a Public Health Nurse to address COVID-19 questions. Initially called the Nurse Triage Line, the County eventually renamed the phone line to the Isolation and Support Nurse Help Line (ISNHL). The County temporarily reassigned more than 30 Public Health Nurses to staff the line and utilized an existing partnership with 211 San Diego to establish the phone line using 211 San Diego's call center infrastructure. The ISNHL answered incoming calls from residents and expanded to make outgoing calls to residents that tested positive for COVID-19 at County-operated test sites. The goal of ISNHL was to provide wraparound services to populations disproportionately impacted by COVID-19, with a special focus on those needing to quarantine or remain in isolation. The ISNHL nurses provided resources and referrals to residents to ensure they had adequate resources while in quarantine and/or isolation. Core responsibilities of the ISNHL staff nurses are to:
1. Respond to all live calls.
2. Respond to off-hour voicemails.
3. Provide education about COVID-19 and how to safely quarantine/isolate.
4. Help schedule testing appointments as necessary and when available.
5. Remind callers of testing options, including State and County-run testing sites.
6. Document all caller(s) information using appropriate forms.
7. Communicate positive and inconclusive test results to individuals via phone and email and assist individuals with receiving copies of their results via email if needed.
8. Refer callers to various resources depending on needs (e.g., housing or food).
In October 2021, the ISNHL was integrated into one of the core activities of the Centers for Disease Control and Prevention (CDC) grant OT21-2103, the National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities. The ISNHL continues to call and reach positive COVID-19 cases and direct people to needed services. The process objectives and milestones for the ISNHL as part of this grant include the following:
1. Maintain existing staff and/or hire additional staff to continue providing helpline services.
2. Coordinate with entities (e.g., health care providers, testing sites, and community organizations) to refer individuals to the ISNHL.
3. Contract/partner with agencies providing lodging, food, transportation, and medical care to ensure individuals have comprehensive services to meet their needs while in isolation.
From March 23, 2020 to September 30, 2022, the ISNHL received 116,493 incoming calls and answered over 115,000 calls from the public. In addition, between November 1, 2020 and September 30, 2022, the ISNHL made more than 170,000 outgoing calls to speak with residents who tested positive at a COVID-19 test site operated by the County of San Diego.
ADDITIONAL LINKS
· Main COSD COVID-19 site: https://www.sandiegocounty.gov/coronavirus.html
· COSD testing site: https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/testing.html
· 211 San Diego: https://2-1-1sandiego.org/
References
Álvarez, J. A. (2020, March 10). San Diego County's first positive COVID-19 case reported. San Diego County News Center. Retrieved December 26, 2022, from https://www.countynewscenter.com/san-diego-countys-first-positive-covid-19-case-reported/
Biden Jr., J. R. (2022, February 18). Notice on the continuation of the national emergency concerning the Coronavirus Disease 2019 (covid-19) pandemic. The White House. Retrieved December 13, 2022, from https://www.whitehouse.gov/briefing-room/presidential-actions/2022/02/18/notice-on-the-continuation-of-the-national-emergency-concerning-the-coronavirus-disease-2019-covid-19-pandemic-2/#:~:text=On%20March%2013%2C%202020%2C%20by,and%20safety%20of%20the%20Nation
CBS 8 San Diego. (2019, April 8). San Diego County officials provide daily coronavirus update - April 8, 2020. [Video]. YouTube. https://www.youtube.com/watch?v=2skkHiBFAEg
County of San Diego, Health and Human Services Agency, Public Health Services, Epidemiology and Immunization Services Branch. (2022, December 8). County of San Diego - Coronavirus Disease 2019 (COVID-19). ArcGIS dashboards. Retrieved December 13, 2022, from https://www.arcgis.com/apps/dashboards/96feda77f12f46638b984fcb1d17bd24
SanDiegoCounty.Gov. (2022, December 8). Cases, hospitalizations, and deaths by Demographics. Coronavirus Disease 2019. Retrieved December 13, 2022, from https://www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/community_epidemiology/dc/2019-nCoV/status/COVID19_Cases_Hospitalizations_Deaths_by_Demographics.html
United States Census Bureau. (2021, July 1). U.S. Census Bureau QuickFacts: San Diego County, California. QuickFacts. Retrieved December 13, 2022, from https://www.census.gov/quickfacts/fact/table/sandiegocountycalifornia/PST045221