CURRENT/EMERGING ISSUES & STRATEGIES FOR SUCCESS

1. Increasing positivity rates among children, increasing the risk of spread -- especially in congregate settings.
2. Needing more I&Q facilities to accommodate Delta surge while areas are shutting them down despite available funding to continue them.
3. Increasing confusion and consternation as plans are made to close alternate care sites only to have them extended at the last moment.
4. Preparing for COVID-19 boosters as flu season ramps up presents significant logistical challenges on an overburdened workforce.
5. Meeting surveillance testing needs as positive cases occur because most facilities have stopped regular testing.
6. Addressing mistrust in vaccines as breakthrough cases occur despite vast majority of hospitalizations being among those unvaccinated – especially in areas where the overall vaccination rate is highest.
7. Maintaining confidentiality and privacy of staff while implementing routine testing mandates for those who are unvaccinated.
8. Anticipating the impending surge of COVID cases in places that have not yet seen the impact.
9. Unceasing hardship of working through a pandemic (and now a resurgence) is overwhelming and causing staff to burn out and leave.
10. Disruptions in the motor vehicle supply chain have brought mobile services to a stand-still when vehicles break down and cannot get the parts necessary for repairs.
    

1. Reestablish surveillance testing at all shelters and alternate care facilities to identify positive cases early and to avoid testing scrambles.
2. Implement testing as part of entrance into medical respite, shelters, and any other residential programs. (Note that testing cannot be a requirement for services in publicly funded programs.)
3. Hire a director of telehealth medicine using COVID-19 funding.
4. Continue offering telehealth services in shelters, even when clinics are co-located, to provide additional options for people to access care safely.
5. When a large outbreak occurs with high numbers of potentially exposed people: reverse the alternate care site model – provide isolation and quarantine in the shelter and move non-exposed people to the alternate site.
6. Utilize telehealth for hard-to-access specialty care, second opinions, and psychiatry visits to increase rates of completed appointments.
7. Double-up clients in I&Q rooms to maximize limited resources.
8. Continue to leverage the impact of trusted community leaders by partnering with them to offer vaccines in their communities.
9. Standardize mask requirements for unvaccinated individuals entering buildings so that they remain in effect if requirements change for vaccinated people.
10. Develop plans for implementing post-exposure prophylaxis of REGEN-COV for individuals who are at high risk of developing severe COVID-19.
    

POLICY DEVELOPMENTS

• The FDA gave full approval to the Pfizer/BioNTech COVID-19 vaccine for individuals 16 years old and older. This means it has met the FDA’s rigorous, scientific standards in safety, efficacy, and manufacturing quality. The emergency use authorization (EUA) remains in effect for individuals ages 12-15, and for the administration of a third dose in certain immunocompromised individuals.
• The CDC recommends that all people who are pregnant or thinking about becoming pregnant get vaccinated against COVID-19. The guidance states that it is safe to get vaccinated at any point during pregnancy.
• A federal judge ruled that the Biden Administration’s eviction moratorium can remain in effect.
• The Biden Administration announced $19 million in funding to expand telehealth nationwide, specifically targeting rural and underserved communities.
• The White House announced FEMA will continue to cover 100% cost sharing for non-congregate shelter and other COVID-19 related expenses through December 31, 2021.
  

NEW RESOURCES

• CDC MMWR: Alternative Methods for Grouping Race and Ethnicity to Monitor COVID-19 Outcomes and Vaccination Coverage
• CDC MMWR: Reduced Risk of Reinfection with SARS-CoV-2 After COVID-19 Vaccination – Kentucky, May-June 2021
• CDC MMWR: Rapid Increase in Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant – Mesa County, Colorado, April-June 2021
• CDC MMWR: Effectiveness of COVID-19 Vaccines in Preventing Hospitalization Among Adults ≥65 Years – COVID-NET, 13 States, February-April 2021
• CDC MMWR: Effectiveness of Pfizer-BioNTech and Moderna Vaccines in Preventing SARS-CoV-2 Infection Among Nursing Home Residents Before and During Widespread Circulation of the SARS-CoV-2 B.1.617.2 (Delta) Variant – National Healthcare Safety Network, March 1-August 1, 2021
• CDC MMWR: New COVID-19 Cases and Hospitalizations Among Adults, by Vaccination Status – New York, May 3-July 25, 2021
• CDC MMWR: Sustained Effectiveness of Pfizer-BioNTech and Moderna Vaccines Against COVID-19 Associated Hospitalizations Among Adults – United States, March-July 2021
• CDC MMWR: Disparities in Excess Mortality Associated with COVID-19 – United States, 2020
• CDC MMWR: Use of COVID-19 Vaccines After Reports of Adverse Events Among Adult Recipient of Janssen (Johnson & Johnson) and mRNA COVID-19 Vaccines (Pfizer-BioNTech and Moderna): Update from the Advisory Committee on Immunization Practices – United States, July 2021
• CDC: The Health and Homelessness: Lessons Learned Partner Convening Webinar Held on July 13, 2021
• UPDATED: CDC: Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States
• FDA: FDA Authorizes REGEN-COV Monoclonal Antibody Therapy for Post-Exposure Prophylaxis (Prevention) for COVID-19
• USICH: Delta Guidance for Protecting People Experiencing Homelessness
• HUD: Vaccine Equity Series
• CFPB: Toolkit and Program Locator for Rental Assistance
• San Francisco Department of Public Health: Interim Guidance for Safe Sleeping for Unsheltered Persons Experiencing Homelessness to Reduce the Risk of COVID-19
• NAEH: Hotels to Housing Case Studies
• Urban Institute: Lessons from Communities’ Responses to Homelessness During the COVID-19 Pandemic
• Manatt: Strategies for States to Drive Equitable Vaccine Distribution and Administration
  

RESEARCH

• Oxford Academy: Household Transmission of SARS-CoV-2 in the United States: Living Density, Viral Load, and Disproportionate Impact on Communities of Color
  

WHAT WE'RE READING

• Health Center Advocacy Network: Community Health Centers: Chemistry for Stronger Communities
• The Oaklandside: Delta Variant Poses New Threat to Homeless Community in Oakland
• HealthTech: Ensuring Secure, Audio-Only Telehealth During the Pandemic and Beyond
• AMA: Why a Patient’s Housing Qualifies as a Health Care Treatment
• The Commonwealth Fund: How a Medical Respite Care Program Offers a Pathway to Health and Housing for People Experiencing Homelessness
  

• KHN: ‘I Don’t Want to Risk My Life for a Paycheck’: Immunosuppressed People Grapple With Returning to Work
• KHN: If the Unvaccinated Want to Work, They Face a Series of Hurdles
• KHN: ‘We Sent a Terrible Message’: Scientists Say Biden Jumped the Gun With Vaccine Booster Plan
• AP News: High Trust in Doctors, Nurses in US, AP-NORC Poll Finds
• AP News: Washington Mandates Vaccine for State, Health Care Workers
• AP News: California to Offer Vaccine Incentive to Medicaid Population
• Urban Institute: Out of the Pandemic, A Better Approach to Homelessness
• Fierce Healthcare: Survey: Nurses Largely On Board with COVID-19 Vaccines But Want More Info On Boosters, Long-Term Study