Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise F. Rogers, Chief, San Mateo County Health
Cassius Lockett, Director, Public Health, Policy and Planning
Subject: Approval for Public Health COVID Contract Tracing Staffing
RECOMMENDATION:
title
Adopt a resolution authorizing an amendment to Master Salary Resolution 076798 to add nine positions to the Public Health Communicable Disease and Epidemiology Programs.
body
BACKGROUND:
On May 26, 2020, County Health addressed the Board with its proposed plan to increase the contact investigation and tracing workforce of the Public Health Division’s Communicable Disease Control Program as needed for the COVID-19 mitigation strategy. The purpose of this memo is to present an amendment to the Master Salary Resolution that enables Public Health to increase staffing capacity required for contact investigation and tracing.
Contact investigation and tracing are core capabilities of the Public Health infrastructure needed to respond to and control the spread of COVID-19. In San Mateo County, contact investigation and tracing has been one of the Public Health Communicable Disease Control Program’s tools for responding to any one of the 87 communicable diseases they address each year. The COVID-19 pandemic requires scaling up that capability. Public Health has already expanded from a baseline workforce of 8.0 FTEs originally doing contact tracing and investigation work to 30 FTEs.
DISCUSSION:
Given current State recommendations for contact tracing, we believe we should expand the existing 30 communicable disease FTE by up to 85 FTE as needed to reach 230 new cases per day expanding the COVID19 contact tracing and investigation workforce up to 115 FTE in San Mateo County. To accomplish this goal, Health aims to recruit 150 staff in two phases with 115 being a desired outcome given turnover and other constraints. Health has been working with Human Resources to develop the process for identification of County employees to serve in these Disaster Service Worker roles. Phase one commences immediately in June and includes the addition of 45 FTE (total of 75 FTE in communicable disease); phase two is slated to happen in July and August as needed. Health requests the Board approve positions and funding for both phases to support budget development timing, management and limited term staffing. Positions, however, will only be filled as needed to support the increased tracing needs.
The existing management structure will have to be expanded as there is currently one Clinical Services Manager who oversees Communicable Disease (CD), Tuberculosis Control (TB) and HIV/STD programs and an existing workforce of 31FTEs all of whom have been redirected into the COVID-19 response including case investigation and contact tracing. Health recommends adding one Clinical Services Manager II - Nursing, one Program Services Manager I, one Community Program Supervisor and three Senior Communicable Disease Investigators, along with one Epidemiologist for the first phase of expansion (supporting a workforce of 75). Subsequently, to support the next 40-110 staff who will be added to the workforce, Health recommends adding one Health Services Manager (Epidemiology) and one Epidemiologist along with an additional limited term Community Program Supervisor and three additional limited term Senior Communicable Disease Investigators; these positions would be hired and funded through September budget changes if necessary.
Based on estimates to develop a vaccine we believe that we must plan to maintain the contact tracing workforce for at least a year. The other positions are intended to increase surveillance and clinical leadership to manage the ongoing COVID needs as well as mitigate future disease control risks. We expect to learn about our assumptions and expansion approach in the next 4-8 weeks as local cases are identified with expanded testing, full implementation of the two new software platforms/tools, as well as adjustments to the Shelter in Place order. This will allow us to track case growth and workforce onboarding and support needs as we ramp up.
Under the Guidance for the Epidemiology and Lab Capacity (ELC) CARES funding for Local Health Jurisdictions recently released, San Mateo County’s estimated allocation is $444,932. This will fund part of the additional contact tracing and surveillance effort.
Attached to this memorandum is the salary resolution adding nine permanent positions to execute Case Investigation and Contact Tracing work as follows:
Job Class Description Count
Clinical Services Manager II - Nursing 1.00
Program Services Manager I 1.00
Community Program Supervisor 1.00
Senior Communicable Disease Investigators 3.00
Health Services Manager I 1.00
Epidemiologists II 2.00
Total Permanent Positions 9.00
In addition to costs associated with staffing, this plan will also necessitate an additional $127,638 of funds for FY 2020-21 to temporarily enhance and staff the Case Investigation and Contact Tracing effort within the Public Health Communicable Disease Program as a result of COVID-19.
This resolution has been reviewed and approved by County Counsel as to form.
This action contributes to the Shared Vision 2025 outcome of a Healthy Community by providing enhanced disease control and effective contact tracing for San Mateo County residents.
PERFORMANCE MEASURE:
|
Measure |
FY 2019-20 Estimated |
FY 2020-21 Projected |
|
At least 15 contact tracers per 100,000 residents=115 FTE for SMC |
45 FTE |
75-115 FTE |
FISCAL IMPACT:
Creating enhanced contact tracing and case investigation staffing in Communicable Disease and Epidemiology will cost between $1,191,208 and $1,470,971 that will be addressed in September budget changes. At that time the extent of demand for contact tracers will be clear. The $444,932 allocation of ELC CARES funding will be used to offset the cost for this effort. This includes up to nine new employees that, with phased hiring, will initially cost between $925,163 and $1,156,492 and ultimately may cost up to $1,074,575 and $1,343,322. This also includes $127,638 for IT supplies and term support that will have to be added to the Public Health FY 20-21 budget.
Detail:
Apart from ELC CARES funding, there are no existing funding streams available to fund this effort and we expect to coordinate FEMA claims with the County Emergency Operations Center process. Employees who are assigned to participate in the response will continue to code their timecards to support tracking of the costs associated with the COVID-19. We will continue to monitor additional funding that flows to local health departments from the California Department of Public Health (CDPH) and work with the County Manager’s Office on the applicability of CARES, FEMA or other federal or state funding allocated to County Health to support our increased costs for COVID-19 mitigation. In the event the costs are not covered by FEMA or other emergency claims, they will be covered by County General Fund.