Loading...
COVID-19 Pandemic Update Work Session Copyrig hted April 5, 2021 City of Dubuque Work Session - Top # 1. City Council Meeting ITEM TITLE: 5:30 PM - COVID-19 Pandemic Update SUM MARY: City staff and network partners will provide updates on the internal and community-facing response to COVI D-19. SUGGESTED DISPOSITION: ATTACHMENTS: Description Type COVI D-19 Work Session Agenda-MVM Memo City Manager Memo staff inemo Staff Memo Vaccine Outreach Memo_UPDATED 4/5/2021 Supporting Documentation Dubuque THE CITY OF � ui-Aseria cih DuB E , . � . , � II � Maste iece on tj2e Mississi i zoo�•zoiz•zois YP pp zoi�*zoi9 TO: The Honorable Mayor and City Council Members FROM: Michael C. Van Milligen, City Manager SUBJECT: Agenda for April 5, 2021 City Council Work Session on COVID-19 Response DATE: March 31, 2021 Assistant City Manager Cori Burbach is transmitting the agenda for the Work Session on COVID-19 Response. The presentation will provide updates from City staff and our partners on the internal and community-facing response to COVID-19. v Mic ael C. Van Milligen MCVM:jh Attachment cc: Crenna Brumwell, City Attorney Cori Burbach, Assistant City Manager Dubuque THE CITY OF � All•p�eedoa Ci� Du B � ;�� �; � � � �� MRste iece on the MisSiSsi i zoo��zoiz=zois � pp zoi�*Zoi� TO: Michael C Van Milligen, City Manager FROM: Cori Burbach, Assistant City Manager DATE: March 31, 2021 RE: Agenda for 4.5.21 City Council Work Session: re: COVID-19 Response The purpose of this memo is to provide an agenda for the City Council Work Session scheduled for April 5, 2021. The presentation will provide updates from City staff and our partners on the internal and community-facing response to COVID-19. Tentative presentation order: 5:30 pm Community COVID-19 Update & Communication Response Mary Rose Corrigan, Public Health Specialist Alexis Steger, Housing & Community Development Director 5:45 pm Update on vaccine distribution, including GRC POD, call center and outreach to marginalized communities Rick Steines, Fire Chief Cori Burbach, Assistant City Manager Kelly Larson, Human Rights Director 6:00 pm American Rescue Plan + Financial Update Jenny Larson, Finance & Budget Director Teri Goodmann, Director of Strategic Partnerships 6:15 pm Community Partner Presentations Rick Dickinson, Greater Dubuque Development Corporation Jenna Manders, Community Foundation of Greater Dubuque 6:25 Q&A 6:30 Adjourn for regular Council meeting The most up-to-date information will be shared verbally during the work session. Thank you. https://cityofdubuque-my.sharepoint.com/personal/mcorriga_cityofdubuque_org/Documents/Coronavirus/COVID presentations/Covid PP city council/2021 4.5 City Council update.docx TO: Mike Van Milligen, City Manager FROM: Mary Rose Corrigan, Public Health Specialist SUBJECT: COVID-19 City Council Work Session update DATE: April 5, 2021 BACKGROUND INFORMATION The Dubuque County Public Health Incident Management (IMT) team consisting of City of Dubuque Health Services Department (Mary Rose Corrigan) Dubuque County Health Department, (Patrice Lambert) VNA (Stacey Killian) and the Dubuque County Emergency Management Agency (Tom Berger), along with both hospitals continue in full activation. The IMT also consists of county Health Department Assistant Director, Samantha Kloft and City of Dubuque Health Services Department Environmental Sanitarians Tim Link and Sydney Moquin. We are coordinating our response efforts in conjunction with the Iowa Department of Public Health (IDPH), and with guidance from CDC via weekly webinars and direct contact with our regional epidemiologist. Randy Gehl serves as the Public Information (PIO) officer for the IMT. Another section of the IMT is vulnerable populations, lead by Kelly Larson, Human Rights Director. The vulnerable populations section is assisted by Housing and Community Development Director Alexis Steger along with other city staff and many community partners. CURRENT INFORMATION Current case counts and other related COVID -19 data can be found at www.coronavirus.iowa.gov. COVID -19 Vaccine administration data can be found at https://coronavirus.iowa.gov/pages/vaccineinformation#VaccineInformation Vaccination scheduling and access information can be found at Vaccinate.Iowa.gov, and at https://vaccinefinder.org/ Long Term Care facility status: Dubuque County currently has no long term care facility (LTC) outbreaks and the state of Iowa reports only two current outbreaks. Health Services Department City Hall Annex 1300 Main Street Dubuque, IA 52001 Office (563) 589-4181 Fax (563) 589-4299 TTY (563) 589-4193 health@cityofdubuque.org www.cityofdubuque.org https://cityofdubuque-my.sharepoint.com/personal/mcorriga_cityofdubuque_org/Documents/Coronavirus/COVID presentations/Covid PP city council/2021 4.5 City Council update.docx Schools The Public Health Incident Management team continues to provide guidance and planning assistance with the county colleges and universities and the K-12 districts. Dubuque County K-12 schools have had 44 positive cases during the month of March, 2021. The Dubuque County higher education institution representatives also meet bi-weekly with the IMT. The IDPH has included colleges and universities as priorities for receiving the Johnson and Johnson vaccine. The IMT has initiated planning with county colleges and universities for immunizing their populations when Johnson and Johnson vaccine allocations are adequate and utilizing the other vaccines for those students and staff that will be present for both doses to be administered in Dubuque County. Dubuque VNA Continues to operate the public call center for Dubuque County 7 days/week for general COVID questions. To date VNA has fielded over 40,000 contacts calls/contact from the community. The VNA continues contact tracing for positive cases along with providing daily public health follow up to two facilities including local school districts. VNA staff have administered approximately 2500 vaccines at the POD in the last two weeks. VNA staffed the initial Dubuque County Sleeves Up phone line and now is working with the Equity Immersion Team for assisting vulnerable populations with vaccinations. In addition, VNA continues to provide thermometers, food assistance and other human needs referrals. VNA staff are contacting 2 facilities daily to assist with COVID-19 management and support. Emergency Management Agency (EMA) Director Tom Berger reports they travel to the regional node in Cedar Rapids to pick up requested PPE. Increased supplies were delivered last week to local healthcare and other institutions needing PPE. The EMA continues to provide logistical and operational support for the POD and ongoing vaccination planning in conjunction with City Health Services staff. Hospital Capacity Planning The IMT continues to monitor hospital capacity and capability and communicate with MercyOne and UnityPoint Finley Hospitals. This includes closely monitoring new cases, outbreaks and other data points to assure that hospitals continue to plan for surges while maintaining services for other non-COVID-19 patients. As we continue to meet with hospital management and human resources staff, and plan for an alternate care facility site, the hospitals’ census has remained manageable. The Incident Management Team will continue planning and meeting on the issue, but the hospitals are not experiencing the level of urgency they were in November. The https://cityofdubuque-my.sharepoint.com/personal/mcorriga_cityofdubuque_org/Documents/Coronavirus/COVID presentations/Covid PP city council/2021 4.5 City Council update.docx Dubuque County Board of Health (BOH) executed a no cost agreement/contract for an alternate care facility through March. Public Information The IMT, in conjunction with the City Public Information (PIO) Office, continues to provide daily COVID-19 updates along with social media posts and fielding and responding to a variety of news media requests. The daily updates continue to report new positive cases, active cases, deaths, and test positivity but now emphasize vaccinations, including the percentage of the total county population fully vaccinated. A new "SleevesUp!" Dubuque County campaign was initiated recently to promote vaccinations and expanded vaccination eligibility. Social media posts and videos featuring messages on vaccine safety and effectiveness as well as testimonials from county board of health members and city council members are scheduled over the coming weeks and a countywide billboard campaign will begin next week featuring multiple messages on 10 different locations. PIO staff will continue to provide messaging that explains the safety and effectiveness of the vaccines and addresses FAQs and misinformation and they will promote public vaccination clinics as they become available COVID- 19 Vaccination The IMT continues to manage the IDPH vaccine allocations along with the allocations local pharmacies are receiving through the Federal Retail Pharmacy Program. We receive allocation notifications on Wednesday mornings which requires expeditious planning for local distribution and administration by the IMT and the local providers. The local distribution request must be returned to IDPH by Thursday at noon and the vaccines arrive here anytime between Friday and Tuesday. Three local Federal Retail Pharmacy Providers are receiving allocations: MercyOne, HyVee and Hartig Drug. These allocations are expected to increase over the next several weeks. Crescent Community Health Center will be receiving doses through the Federal Health Center COVID-19 Vaccine Program in mid-April. A community point of distribution (POD) for vaccine providers to administer vaccines has been operational since Feb 10, 2021 at the Kennedy Mall former women’s Younkers store. Unity Point Finley, Grand River Medical Group, VNA, Medical Associates and Union Family Pharmacy have utilized the POD. With the removal of the Iowa Vaccine Shortage Order, COVID-19 vaccine are available to all Iowans. County residents age 65 and over continue to be contacted by their healthcare provider when vaccines are available and vaccination appointments can be scheduled. Health care providers have also started scheduling 16-64 year-olds who are at increased risk of severe illness from COVID-19 due to specific medical conditions. Healthcare providers are contacting their patients through a variety of channels including telephone, text, email, and letter. Detailed information on how to schedule appointments will be https://cityofdubuque-my.sharepoint.com/personal/mcorriga_cityofdubuque_org/Documents/Coronavirus/COVID presentations/Covid PP city council/2021 4.5 City Council update.docx provided by each healthcare provider. Priority groups tied to worksites and within other priority tiers will also receive vaccinations at the POD, or at a provider, depending on the criteria. Individuals without a primary health care provider can receive vaccination assistance and information on the Dubuque County Sleeves Up phone line at 563 587 4950. Phase 1b tiers 2 through 5 are now being substantially complete. The IMT continues working with GDDC in conjunction with the Dubuque Area Chamber of Commerce and the Dyersville Area Chamber of Commerce to gather information from county employers in order to vaccinate essential workers. Looking ahead • Continue Planning and scheduling for community wide vaccinations including hosting the Sleeves Up call in center • Provide ongoing education and access for COVID -19 to vulnerable populations, with the assistance of the Equity Immersion Committee and many community partners. • Plan for additional community vaccine distribution and administration sites and methods in case they are needed • Update messaging and community education for vaccine education and administration as availability continues to change • Implementing and distributing ever changing guidance from CDC, IDPH and DOE. • Monitor and provide community education on SARS CoV2 variants. • Provide COVID-19 guidance for spring and summer special events and activities • Think ahead to vaccinating children DUBUQUE CITY COUNCIL COVID-19 UPDATE City Council update-April 5, 2021 Mary Rose Corrigan, Public Health Specialist INCIDENT MANAGEMENT TEAM (IMT) Mary Rose Corrigan City of Dubuque Stacey Killian VNA Patrice Lambert Dubuque County Health Department Tom Berger Dubuque County EMA Randy Gehl City of Dubuque Public Information Officer TRENDLINE OF NEW CASES 3 WEEKS AGO 7 19 12 16 10 5 2 5 18 8 5 13 4 3 14-DAY TRENDLINE TRENDLINE OF NEW CASES CURRENT 16 21 26 21 17 6 8 23 18 37 27 26 18 13 TRENDLINE OF NEW COVID-19 CASES IN DUBUQUE COUNTY PERCENT OF POSITIVE CASES 2.0% 4.5% 14-DAY AVERAGE OF PERCENT OF POSITIVE CASES TRENDLINE OF NEW CASES COMMUNITY PROFILE REPORT VACCINATION PROGRESS exported 05 Apr 2021 Vaccinations Completed by Age Group Dubuque County Residents Dec 14, 2020 -Apr 4, 2021 IDPH PHASE 1B TIER 2 BUSINESSES Vaccination Week Number of Essential Workers being Vaccinated Last Week’s Vaccinations (3/29)~ 2,022 This Week’s Vaccinations (4/5)~ 1,410 Remaining Vaccinations ~ substantially complete this week *All other tiers in Phase 1B are complete, while a small number of groups/individuals continue to come in from each tier. PHASE 1B TIER 2 ●Frontline essential workers in food, agriculture, and manufacturing sectors who live or work in non- social distanced settings ●Other essential workers VACCINE COMMUNITY EDUCATION •Targeted Outreach to Organizations & Populations •Social Media •City/County Newspapers & Publications •Billboards in City & County •Public Access Television (Dubuque, Dyersville, Epworth, Farley) VACCINE INFORMATION New Sleeves Up! Phone line 563-690-6253 (690-MAKE) For Residents needing •Vaccination •Booster •Appointment navigation NEW TRAVEL GUIDANCE HTTPS://WWW.CDC.GOV/CORONAVIRUS/2019-NCOV/TRAVELERS/TRAVEL-DURING-COVID19.HTML NEW GUIDANCE- FULLY VACCINATED KEEP DOING: •Mask wearing in public & with unvaccinated •Avoid medium/large gatherings •Travel precautions •Watch for symptoms •Stay home if ill •Gather indoors with other fully vaccinated •Travel domestically without testing or quarantine •Quarantine not required if exposed to COVID-19 (unless symptoms) QUESTIONS? City Council Meeting –April 5, 2021 Dubuque County Public Health Incident Management Team TO: Michael C. Van Milligen, City Manager FROM: Kelly Larson, Human Rights Director DATE: April 5, 2021 RE: Race and Equity in Vaccine Distribution The purpose of this memo is to provide a summary of work that the Equity Immersion Team has been doing to reach-in to groups likely to experience inequitable outcomes in vaccination rates under the State distribution structure. Desired Outcome The desired outcome of the COVID-19 vaccination effort is to vaccinate as many people as quickly as possible to gain herd immunity while ensuring that those at greatest risk for adverse outcomes from contracting the virus, including racial and ethnic minorities and English language learners, are able to receive the vaccine when they are eligible. Background Data The percentages of positive cases in Dubuque County from March 2020 through April 4, 2021, broken down by race and ethnicity, are as follows: • Racial identity unknown or pending investigation = 50% • White = 46% • Black or African American = 2% • Asian = 1% • Native Hawaiian or Pacific Islander = 1% • American Indian or Alaskan Native = 0% • Ethnic identity unknown or pending investigation = 54% • Not Hispanic or Latino = 45% 2 • Hispanic or Latino = 1% A total of 202 people in Dubuque County have died from COVID-19 between March 2020 and April 4, 2021. In order to be sensitive to privacy concerns, disaggregated numbers are not included in this memo. However, deaths have not been disproportionate to representation in the general population. Critical population estimates for Dubuque County from the Iowa Department of Public Health: • Residents without insurance = 4195 • Tribal residents = 0 • Homeless adults and children = 387 • Offenders = 69 • College students = 5063 • Chronic conditions = 626 • Hispanic and American Indian/Alaskan Native = 107 (0 over 65) • Hispanic and API = 53 (4 over 65) • Hispanic and Black = 159 (1 over 65) • Hispanic and White = 2241 (123 over 65) • Non-Hispanic and American Indian/Alaskan Native = 187 (20 over 65) • Non-Hispanic API = 1888 (92 over 65) • Non-Hispanic Black = 3969 (102 over 65) Unknowns: • The level of racial and ethnic diversity among patients served by the various healthcare providers and employers who have been receiving the bulk of the vaccines; • Whether vaccine providers are collecting and analyzing demographic information as people register for the vaccine to make adjustments to insure equitable distribution. Anticipated Barriers We anticipated the following barriers would arise under the vaccine distribution plan: • Limited English ability • Information overload, misinformation, unaddressed concerns about the vaccine • Distrust in government • Lack of transportation to distribution locations • Lack of a healthcare provider 3 • Inability to get time off work to get a vaccine Strategies and Actions to Address Barriers The general strategy employed by the team has been to supplement the marketing conducted through the Incident Management Team with additional messaging that : • Is translated into Spanish and Marshallese to address limited English ability; • Uses social media and short bursts of information to address misinformation , concerns, and information overload; • Is distributed through trusted messengers to address distrust; • Includes information on transportation options to points of distribution; • Includes information on Sleeves Up Dubuque for people who do not have a healthcare provider; • Encourages people to speak with their employer regarding time off for vaccination. The Equity Immersion Team has been meeting on a bi-weekly basis since January 11 to implement this strategy. Team members include: • City Staff Members: Temwa Phiri, Kelly Larson, Collins Eboh, Gina Bell, Jesse Coulson, Hollie Ohnesorge, Kecia Dougherty, Kristin Dietz, Cheryl Sheldon, Rick Fullmer, Jeremy Jensen • Community Partners: James Sizer, Director Multicultural Student Affairs University of Dubuque; Katie Bahl, East Central Iowa Intergovernmental Association; Jason Neises, Community Foundation of Greater Dubuque ; Clara Lopez-Ortiz, Community Foundation of Greater Dubuque; Alex Baum, Community Foundation of Greater Dubuque; Gisella Aitken-Shadle, Northeast Iowa Community College; Gabby Sullivan, Dubuque Dream Center; Josh Jasper, Resources Unite • Loras College Civic Leaders: Logan Jones, Jenna Jager, Stefanie Hill, Joshua Delgado, Max Ellenbecker, Sarah Backus The team has identified the following trusted messengers who are networked with various people on the Equity Immersion Team: • Minority Owned Businesses • Crescent Community Health Center & Pacific Islander Health project • Fountain of Youth • Presentation Lantern Center • Dubuque Dream Center • Immigration Needs Assessment Group 4 • United Way monthly call – social service agencies • Homeless Advisory Council/Shelters • Switching Places Foundation • Dub City Radio • Afro Dubuque Facebook Group – Over 200 members • Latino Empowerment And Development (L.E.A.D.) Facebook group – over 200 members • Tri-State Marshallese Community Facebook Group – over 350 Members • Café Latino Dubuque Facebook Group – Over 135 Members • I Need Help Dubuque Facebook Group – Over 4.4K Members To date, the following actions have been taken: • Information has been distributed through Tri-Phoenix Group social media and e- mail to their network that includes Black business owners, organizations, and professionals. They are also in the process of creating a page on their website for updates as well as adding weekly updates via their radio platform. • Information is distributed through bi-weekly meetings that are held with members of the Pacific Islander Health Project, including Marshallese community leaders. Reports are that people are ready and willing to get vaccinated, though there is some concern about distrust arising from a vaccination campaign in the Marshall Islands several decades ago that impacted fertility rates. Upcoming focus groups with each of the Marshallese churches will also include information. • Several Marshallese community leaders employed by Crescent Community Health Center and the Dubuque Community School District videotaped themselves receiving the vaccine and those videos have been distributed through social media. • Loras College LULAC (League of United Latin American Citizens) members have developed and distributed a video in Spanish that has been shared across social media: https://www.facebook.com/LorasCollegeLULAC/ • We have engaged translators/interpreters who speak Spanish and Marshallese to assist us with translation of information. We have received and distributed the following in English, Marshallese and Spanish: Dubuque County Vaccine Mailer, Sleeves Up information, Phase IB information. To date, we have not had success in getting information translated into any of the Guatemalan dialects. • General vaccine information and Sleeves Up information has been distributed through the Food Provider network on bi-weekly calls and through an e-mail. This includes 32 agencies, along with additional partners and funders, serving low-income populations in Dubuque and rural areas around Cascade and 5 Dyersville. Information has also been posted on the Feed Dubuque County facebook page. • General information and free transportation information has been shared through the Housing Department Facebook page in English, Spanish, and Marshallese, reaching over 600 followers. • ECIA has shared available information with their staff to share with clients and networks, and posted on Facebook. • We have shared information on free RTA rides to vaccination clinics. • We participate in monthly meetings through United Way with human services providers to provide updates, collect information on barriers, and request distribution of information. The county-wide vaccine mailer in English, Spanish, and Marshallese was shared and distributed through this group. • The county-wide vaccine mailer was also distributed through the Presentation Lantern Center in multiple languages. Reports are that community members served through Presentation Lantern Center are ready and willing to receive the vaccine. • Information has been distributed through immigrant support groups including: o The Immigration Forum o The Immigration Needs Assessment Steering Committee o The immigration group of the Sisters Collaborative • Some general conversations have been had with members of the Marshallese, Guatemalan, and African-American communities to try to address vaccine skepticism. • Information has been shared with members of the immigration work group through the Community Foundation of Greater Dubuque with the request it be shared further through networks and information on barriers be shared back through the group. • We have continually reinforced the importance of interrupting the spread of rumors and relying on trusted sources of information. • We continue to share general information clarifying the phases and distribution options in Dubuque County on a regular basis, through social media and the networks above. Ongoing Concerns and Adjustments Ongoing concerns include the following: • Crescent Community Health Center, whom we know serves many of our critical populations, was recently notified that they will be receiving vaccines through the Federal Health Center allocation beginning in mid-April. They have received some County allocations for their patients to test out their administration process. 6 Although the allocation amount is unknown, we are in conversations with Crescent about their ability to reach beyond their patient population under federal rules and with additional staffing support. • We have no information on the demographics of patients served by the providers who have been receiving the bulk of vaccines up to this point. Similarly, we lack any information on how pharmacies receiving vaccines are registering people and whether they are taking demographics into account. • We have received anecdotal information that some people outside of priority categories may be able to receive vaccines when volunteering at a vaccination clinic. Upon discovering this, we have done our best to broaden who is receiving information on volunteer opportunities. • We also are concerned about the tendency to judge people who decline a vaccine, as there are valid reasons someone may not be vaccinated. We think it is important to recognize that each individual must balance their own and their family’s needs with the needs of the larger community. • Finally, it’s important to note that distrust in government and/or in the healthcare community did not begin with the COVID-19 vaccine and will not end there. This is simply the current issue facing us. There are cultural competency concerns shared within our communities of color and with our Human Rights staff that often are not discussed outside of those groups because of an overarching feeling of being unwelcome in Dubuque in the first place and/or a fear of backlash. Work within each institution throughout our community to increase cultural competency and to examine operations through an equity lens continues to be needed long term. Adjustments being made or under consideration include the following: • We recently released a supplemental flyer highlighting crucial information and listing the Human Rights Department as a point of contact for members to relay any barriers being encountered. • We are investigating options to support distribution through Crescent Community Health Center or another provider for populations who do not have a healthcare home. • We are developing contingency plans for a mass vaccination site in the event that the number of vaccines received increases dramatically. • L.E.A.D., with the support of the Presentation Lantern Center, the Community Foundation of Greater Dubuque, and Medical Associates, will be hosting an on- line panel discussion consisting of Latino physicians and residents who have received vaccines and are willing to answer questions and share their experiences. This event will be conducted in Spanish and live -streamed on Facebook. We are working to put together a similar panel designed to address 7 questions and concerns that have been shared with us by a variety of Black and brown community members. • The Visiting Nurse Association has worked with us to implement adjustments to their process - based on feedback from community leaders within Spanish- speaking immigrant communities – that are improving this group’s access to vaccines. Over the past two weeks, these changes have permitted us to schedule approximately 40 members of our Latinx population for vaccines. Performance Measures and Accountability As of April 4, 2021, the number of completed vaccinations in Dubuque County breaks down as follows: • Total of all races = 24,051 • Black = 107 (0.4% of vaccines given) • Pacific Islander = 108 (0.4% of vaccines given) • Other race = 37 (0.2% of vaccines given) • Asian = 81 (0.3% of vaccines given) • American Indian = 11 (0.05% of vaccines given) • Unknown = 2,864 (12% of vaccines given) • White = 20,843 (87% of vaccines given) • Hispanic or Latino = 135 (0.6% of vaccines given) • Unknown = 3,033 (12.5% of vaccines given) • Not Hispanic or Latino = 20,883 (87% of vaccines given) As of April 4, 2021, number of initiated vaccinations in Dubuque County breaks down as follows: • Total of all races = 12,172 • Black = 100 (0.8% of vaccines given) • Pacific Islander = 107 (0.9% of vaccines given) • Other race = 61 (0.5% of vaccines given) • Asian = 96 (0.8% of vaccines given) • American Indian = 18 (0.1% of vaccines given) • Unknown = 1,920 (16% of vaccines given) • White = 9,870 (81% of vaccines given) • Hispanic or Latino = 143 (1.2% of vaccines given) • Unknown = 2,219 (18% of vaccines given) 8 • Not Hispanic or Latino = 9,810 (81% of vaccines given) Later this year, we will forward our suggestions and observations regarding what did and did not work to the incident management team as part of an after-action debrief. cc: Mary Rose Corrigan, Public Health Specialist Temwa Phiri, Community Engagement Coordinator Collins Eboh, Organizational Equity Coordinator THE CITY OF DUbi1[�UE � D�L J� AnAmencaEitY � � I�� MasteYpiece on the Mississippi 2aa,.za�2.zo,3 TO: Michael C. Van Milligen, City Manager FROM: Kelly Larson, Human Rights Director DATE: April 5, 2021 RE: Race and Equity in Vaccine Distribution The purpose of this memo is to provide a summary of work that the Equity Immersion Team has been doing to reach-in to groups likely to experience inequitable outcomes in vaccination rates under the State distribution structure. Desired Outcome The desired outcome of the COVID-19 vaccination effort is to vaccinate as many people as quickly as possible to gain herd immunity while ensuring that those at greatest risk for adverse outcomes from contracting the virus, including racial and ethnic minorities and English language learners, are able to receive the vaccine when they are eligible. Background Data The percentages of positive cases in Dubuque County from March 2020 through April 4, 2021, broken down by race and ethnicity, are as follows: • Racial identity unknown or pending investigation = 50% • White = 46% • Black or African American = 2% • Asian = 1% • Native Hawaiian or Pacific Islander = 1% • American Indian or Alaskan Native = 0% • Ethnic identity unknown or pending investigation = 54% • Not Hispanic or Latino = 45% • Hispanic or Latino = 1% A total of 202 people in Dubuque County have died from COVID-19 between March 2020 and April 4, 2021. In order to be sensitive to privacy concerns, disaggregated numbers are not included in this memo. However, deaths have been disproportionate to representation in the general population. Critical population estimates for Dubuque County from the lowa Department of Public Health: • Residents without insurance = 4195 • Tribal residents = 0 • Homeless adults and children = 387 • Offenders = 69 • College students = 5063 • Chronic conditions = 626 • Hispanic and American Indian/Alaskan Native = 107 (0 over 65) • Hispanic and API = 53 (4 over 65) • Hispanic and Black = 159 (1 over 65) • Hispanic and White = 2241 (123 over 65) • Non-Hispanic and American Indian/Alaskan Native = 187 (20 over 65) • Non-Hispanic API = 1888 (92 over 65) • Non-Hispanic Black = 3969 (102 over 65) Unknowns: • The level of racial and ethnic diversity among patients served by the various healthcare providers and employers who have been receiving the bulk of the vaccines; • Whether vaccine providers are collecting and analyzing demographic information as people register for the vaccine to make adjustments to insure equitable distribution. Anticipated Barriers We anticipated the following barriers would arise under the vaccine distribution plan: • Limited English ability • Information overload, misinformation, unaddressed concerns about the vaccine • Distrust in government • Lack of transportation to distribution locations • Lack of a healthcare provider 2 • Inability to get time off work to get a vaccine Strategies and Actions to Address Barriers The general strategy employed by the team has been to supplement the marketing conducted through the Incident Management Team with additional messaging that: • Is translated into Spanish and Marshallese to address limited English ability; • Uses social media and short bursts of information to address misinformation, concerns, and information overload; • Is distributed through trusted messengers to address distrust; • Includes information on transportation options to points of distribution; • Includes information on Sleeves Up Dubuque for people who do not have a healthcare provider; • Encourages people to speak with their employer regarding time off for vaccination. The Equity Immersion Team has been meeting on a bi-weekly basis since January 11 to implement this strategy. Team members include: • City Staff Members: Temwa Phiri, Kelly Larson, Collins Eboh, Gina Bell, Jesse Coulson, Hollie Ohnesorge, Kecia Dougherty, Kristin Dietz, Cheryl Sheldon, Rick Fullmer, Jeremy Jensen • Community Partners: James Sizer, Director Multicultural Student Affairs University of Dubuque; Katie Bahl, East Central lowa Intergovernmental Association; Jason Neises, Community Foundation of Greater Dubuque; Clara Lopez-Ortiz, Community Foundation of Greater Dubuque; Alex Baum, Community Foundation of Greater Dubuque; Gisella Aitken-Shadle, Northeast lowa Community College; Gabby Sullivan, Dubuque Dream Center; Josh Jasper, Resources Unite • Loras College Civic Leaders: Logan Jones, Jenna Jager, Stefanie Hill, Joshua Delgado, Max Ellenbecker, Sarah Backus The team has identified the following trusted messengers who are networked with various people on the Equity Immersion Team: • Minority Owned Businesses • Crescent Community Health Center & Pacific Islander Health project • Fountain of Youth • Presentation Lantern Center • Dubuque Dream Center • Immigration Needs Assessment Group 3 • United Way monthly call — social service agencies • Homeless Advisory Council/Shelters • Switching Places Foundation • Dub City Radio • Afro Dubuque Facebook Group — Over 200 members • Latino Empowerment And Development (L.E.A.D.) Facebook group — over 200 members • Tri-State Marshallese Community Facebook Group — over 350 Members • Cafe Latino Dubuque Facebook Group — Over 135 Members • I Need Help Dubuque Facebook Group — Over 4.4K Members To date, the following actions have been taken: • Information has been distributed through Tri-Phoenix Group social media and e- mail to their network that includes Black business owners, organizations, and professionals. They are also in the process of creating a page on their website for updates as well as adding weekly updates via their radio platform. • Information is distributed through bi-weekly meetings that are held with members of the Pacific Islander Health Project, including Marshallese community leaders. Reports are that people are ready and willing to get vaccinated, though there is some concern about distrust arising from a vaccination campaign in the Marshall Islands several decades ago that impacted fertility rates. Upcoming focus groups with each of the Marshallese churches will also include information. • Several Marshallese community leaders employed by Crescent Community Health Center and the Dubuque Community School District videotaped themselves receiving the vaccine and those videos have been distributed through social media. • Loras College LULAC (League of United Latin American Citizens) members have developed and distributed a video in Spanish that has been shared across social media: https://www.facebook.com/LorasCollegeLULAC/ • We have engaged translators/interpreters who speak Spanish and Marshallese to assist us with translation of information. We have received and distributed the following in English, Marshallese and Spanish: Dubuque County Vaccine Mailer, Sleeves Up information, Phase IB information. To date, we have not had success in getting information translated into any of the Guatemalan dialects. • General vaccine information and Sleeves Up information has been distributed through the Food Provider network on bi-weekly calls and through an e-mail. This includes 32 agencies, along with additional partners and funders, serving low-income populations in Dubuque and rural areas around Cascade and 4 Dyersville. Information has also been posted on the Feed Dubuque County facebook page. • General information and free transportation information has been shared through the Housing Department Facebook page in English, Spanish, and Marshallese, reaching over 600 followers. • ECIA has shared available information with their staff to share with clients and networks, and posted on Facebook. • We have shared information on free RTA rides to vaccination clinics. • We participate in monthly meetings through United Way with human services providers to provide updates, collect information on barriers, and request distribution of information. The county-wide vaccine mailer in English, Spanish, and Marshallese was shared and distributed through this group. • The county-wide vaccine mailer was also distributed through the Presentation Lantern Center in multiple languages. Reports are that community members served through Presentation Lantern Center are ready and willing to receive the vaccine. • Information has been distributed through immigrant support groups including: o The Immigration Forum o The Immigration Needs Assessment Steering Committee o The immigration group of the Sisters Collaborative • Some general conversations have been had with members of the Marshallese, Guatemalan, and African-American communities to try to address vaccine skepticism. • Information has been shared with members of the immigration work group through the Community Foundation of Greater Dubuque with the request it be shared further through networks and information on barriers be shared back through the group. • We have continually reinforced the importance of interrupting the spread of rumors and relying on trusted sources of information. • We continue to share general information clarifying the phases and distribution options in Dubuque County on a regular basis, through social media and the networks above. Ongoing Concerns and Adjustments Ongoing concerns include the following: • Crescent Community Health Center, whom we know serves many of our critical populations, was recently notified that they will be receiving vaccines through the Federal Health Center allocation beginning in mid-April. They have received some County allocations for their patients to test out their administration process. 5 Although the allocation amount is unknown, we are in conversations with Crescent about their ability to reach beyond their patient population under federal rules and with additional staffing support. • We have no information on the demographics of patients served by the providers who have been receiving the bulk of vaccines up to this point. Similarly, we lack any information on how pharmacies receiving vaccines are registering people and whether they are taking demographics into account. • We have received anecdotal information that some people outside of priority categories may be able to receive vaccines when volunteering at a vaccination clinic. Upon discovering this, we have done our best to broaden who is receiving information on volunteer opportunities. • We also are concerned about the tendency to judge people who decline a vaccine, as there are valid reasons someone may not be vaccinated. We think it is important to recognize that each individual must balance their own and their family's needs with the needs of the larger community. • Finally, it's important to note that distrust in government and/or in the healthcare community did not begin with the COVID-19 vaccine and will not end there. This is simply the current issue facing us. There are cultural competency concerns shared within our communities of color and with our Human Rights staff that often are not discussed outside of those groups because of an overarching feeling of being unwelcome in Dubuque in the first place and/or a fear of backlash. Work within each institution throughout our community to increase cultural competency and to examine operations through an equity lens continues to be needed long term. Adjustments being made or under consideration include the following: • We recently released a supplemental flyer highlighting crucial information and listing the Human Rights Department as a point of contact for members to relay any barriers being encountered. • We are investigating options to support distribution through Crescent Community Health Center or another provider for populations who do not have a healthcare home. • We are developing contingency plans for a mass vaccination site in the event that the number of vaccines received increases dramatically. • L.E.A.D., with the support of the Presentation Lantern Center, the Community Foundation of Greater Dubuque, and Medical Associates, will be hosting an on- line panel discussion consisting of Latino physicians and residents who have received vaccines and are willing to answer questions and share their experiences. This event will be conducted in Spanish and live-streamed on Facebook. We are working to put together a similar panel designed to address 6 questions and concerns that have been shared with us by a variety of Black and brown community members. • The Visiting Nurse Association has worked with us to implement adjustments to their process - based on feedback from community leaders within Spanish- speaking immigrant communities — that are improving this group's access to vaccines. Over the past two weeks, these changes have permitted us to schedule approximately 40 members of our Latinx population for vaccines. Performance Measures and Accountability As of April 4, 2021, the number of completed vaccinations in Dubuque County breaks down as follows: • Total of all races = 24,051 • Black = 107 (0.4% of vaccines given) • Pacific Islander = 108 (0.4% of vaccines given) • Other race = 37 (0.2% of vaccines given) • Asian = 81 (0.3% of vaccines given) • American Indian = 11 (0.05% of vaccines given) • Unknown = 2,864 (12% of vaccines given) • White = 20,843 (87% of vaccines given) • Hispanic or Latino = 135 (0.6% of vaccines given) • Unknown = 3,033 (12.5% of vaccines given) • Not Hispanic or Latino = 20,883 (87% of vaccines given) As of April 4, 2021, number of initiated vaccinations in Dubuque County breaks down as follows: • Total of all races = 12,172 • Black = 100 (0.8% of vaccines given) • Pacific Islander = 107 (0.9% of vaccines given) • Other race = 61 (0.5% of vaccines given) • Asian = 96 (0.8% of vaccines given) • American Indian = 18 (0.1% of vaccines given) • Unknown = 1,920 (16% of vaccines given) • White = 9,870 (81% of vaccines given) • Hispanic or Latino = 143 (1.2% of vaccines given) • Unknown = 2,219 (18% of vaccines given) 7 • Not Hispanic or Latino = 9,810 (81% of vaccines given) Later this year, we will forward our suggestions and observations regarding what did and did not work to the incident management team as part of an after-action debrief. cc: Mary Rose Corrigan, Public Health Specialist Temwa Phiri, Community Engagement Coordinator Collins Eboh, Organizational Equity Coordinator 8 April 5, 2021 Community COVID-19 Update Mary Rose Corrigan, Public Health Specialist Alexis Steger, Housing & Community Development Director Vaccine Distribution Updates Rick Steines, Fire Chief Cori Burbach, Assistant City Manager Kelly Larson, Human Rights Director Grand River Center POD Potential use of Parking Garage & Exhibit Hall A: 4/1/21 –7/31/21 Ability to serve public transit-dependent and other traditionally hard to reach populations, when supported by a robust and targeted outreach strategy and in coordination with other “meet people where they are” strategies May be staffed by Dubuque Fire Department and/or other providers as needed and available Dubuque County financial assistance: Not to exceed $47,300 Grand River Center POD First clinic: April 8, 2021 12 –7 pm Vulnerable populations focus SleevesUp! Call Center Inbound & outbound calls Day 1: 70% of timeslots filled Majority = vulnerable populations Waitlist is operational Will be updated to utilize scheduling software soon Equity Immersion Team Update Anticipated Barriers Strategies to Address Barriers Performance Measures & Accountability DESIRED OUTCOME: to vaccinate as many people as quickly as possible to gain herd immunity while ensuring that those at greatest risk for adverse outcomes from contracting the virus, including racial and ethnic minorities and English language learners, are able to receive the vaccine when they are eligible. American Rescue Plan Update Teri Goodmann, Assistant City Manager Community Partner Updates Community Foundation of Greater Dubuque (Jenna Manders, Director of Strategic Relations) Greater Dubuque Development Corporation (Rick Dickinson, President/CEO) available for questions Additional Questions?