COVID-19 Update John M. Douglas, Jr, MD Executive Director Tri-County Health Department
Tri-County Health Department Board of Health Meeting July 8, 2021 Overview
•Data review •Vaccine progress •TCHD vaccine strategy •Looking ahead Trends in COVID-19 Case Rates in Tri-County Area (7/7/21) Trends in COVID-19 Hospitalization Rates in Tri-County Area (7/7/21) Variants of Concern: Recent Trends (6/7 to 6/29) and Rapid Growth of Delta New Challenge of Delta Variant
● Originally from India, now worldwide (99% of UK strains ● Others by new nomenclature: A (UK), B (S Africa), G (Brazil) ● 2X as contagious as strain in Colorado last winter ● 2X as severe (chance of hospitalization) ● Now 75% of all cases in Colorado, 2nd highest in US ● Severe outbreak in Mesa County CO, 99+% due to Delta ● Concerns about development of further mutations (eg, “Delta plus”) ● Vaccines work ■ especially Pfizer vaccine ■ need to get both doses Global Trends in COVID-19 Vaccination (6/30)
7 U.S. Vaccine Distribution by State (6/30) Vaccination Rates by County in Colorado (7/5) Vaccine Coverage Progress: Trying to Finish the Marathon (7/7)
June 9 1.44 m doses 798 k Vx’d 61.7% Vx’d Vaccine Coverage by Race/Ethnicity and Age (7/7)
Percent of all Vx’d Unknown R/E Adams 18% Arapahoe 14% Douglas 11% Cumulative COVID-19 Vaccine Initiation by Race/Ethnicity by Week (6/27) Adams, Arapahoe, Douglas Counties (wk of 5/3/21)
Impact of Unknown Race/Ethnicity on Population Estimates ‐‐“Unknown” is 2nd‐3rd most common R/E listed ‐‐If 50% of Unknown are actually Hispanic, % vaccinated increase ‐‐Adams: 30% to 44% ‐‐Arapahoe: 29% to 53% Correlation of Percent Vaccinated of Unknown Race/Ethnicity with Percent Hispanic by Census Tract in TCHD Area (6/27) Correlation of Rates of Vaccination with Case and Hospitalization Rates by County (7/7) Vaccination Uptake Progress Across Metro Counties (6/27) Vaccine Uptake Across Census Tracts in Metro Denver Counties (7/1) Progress in High-Priority Neighborhoods: Federal Heights—Events Underway or Planned
• 6 partners conducting promotion and navigation efforts Adelante Community Development Alianza Business Assistance Center City of Westminster Early Childhood Partnership of Adams County Growing Home and Maiker Housing Servicios de la Raza • Collborating with Servicios de la Raza, Adams12, City of Federal Heights, Representative Mullica, Adelante, COLOR & ECPAC for mobile home parks and including HUD on affordable housing efforts • Outreach (canvassing) Collaborated with COVIDCheck Colorado to arrange canvassing of area homes and businesses in the area prior to events Working with partners for canvassing at events (Mile Hi Flea Market) • Vaccine access Identify and shared details about state and other vaccine locations near partner service areas to facilitate navigation Weekly: Maiker Housing/Alto building, TCHD clinics Single events: Tuscan Heights Apartments and Federal Heights Elementary Intermittent . 2 Anythink library sites Huron Street and Perl Mack in partnership with Clinica Family Health Federal Heights area . TCHD Mobile clinic in partnership with Adams 12 schools summer programming events and large back to school event in August. . Mile Hi Flea Market with CDPHE support . Cross‐roads Church, Northglenn Progress in High-Priority Neighborhoods: Federal Heights—Events Under Discussion • Outreach to other faith‐based communities • Possible vaccine sites Large scale site seeking alternate locations to continue (Dicks/Water World) Smaller sites at strip malls, carniceria, additional manufactured home parks and affordable housing locations (HUD) • Incentives for upcoming events –grocery cards, food trucks, bonus bucks for farmers markets, ride/food tickets at Fairs etc • Conduct targeted social media and radio outreach about prevention, vaccine education, and sites to get vaccinated • Coordination with state outreach (CDPHE and HCPF) and access initiatives for example, working with community partners for vaccine bus stops, collaborating on canvassing and other approaches in areas with low vaccine rates. Progress in High-Priority Neighborhoods: Commerce City
• Underway/Planned 2 partners conducting promotion and navigation efforts . City of Commerce City . Adelante Community Development Outreach (canvassing) within Mile Hi Flea Market and working with partners to sustain it. Vaccine access . Anythink Libraries location – Commerce City Branch . City of Commerce City Govt Concert Series at various locations and dates through August . TCHD Mobile clinic in partnership with Adams 12 schools summer programming events and large back to school event in August. . Mile Hi Flea Market with CDPHE support . Identify and shared details about state and other vaccine locations near partner service areas to facilitate navigation (including the CDPHE bus routes https://www.mobilevax.us/denver‐metro) • Under Discussion Partnerships ‐ meeting 1:1 with CBO, business, and faith‐based partners to hear more about how we can support and leverage existing efforts and help with the gaps; could result in neighborhood groups forming similar to Federal Heights. Conduct targeted social media and radio outreach about prevention, vaccine education, vaccine sites Incentives: grocery cards, food trucks, bonus bucks for farmers markets, ride/food tickets at Fairs etc. Coordination with state outreach (CDPHE and HCPF) and access initiatives . working with community partners for vaccine bus stops . collaborating on canvassing and other approaches in areas with low vaccine rates. Progress in High-Priority Neighborhoods: North Aurora (Colfax Corridor): Events Underway or Planned
• 4 partners conducting promotion and navigation efforts (Aurora Economic Opportunity Coalition (AEOC), Mosaic Church of Aurora, RISE Colorado, Arapahoe Libraries) • Working with many other partners informally • Partners (AEOC/Mosaic) walking individuals to vaccine sites, assisting in filling out paperwork • Outreach (phone banking and flyer drops) within the AEOC/Mosaic service area • TCHD recall phone calls and postcards • Identified HUD multi‐family housing units for targeted outreach and canvassing • Identify and shared details about state and other vaccine locations near partner service areas to facilitate navigation (including the CDPHE bus routes https://www.mobilevax.us/denver‐metro) • Vaccine access Aurora Economic Opportunity Coalition in July Aurora Soccer Parks in July Village Exchange Center ongoing on Thursday –working to support and sustain Dayton and Dallas Street Opportunity Centers ongoing –working to sustain and support Aurora Public Schools Back to School Event Aurora Mall Regional Transportation District Employee event at East Metro Maintenance Facility MLK Library site provided by STRIDE Progress in High-Priority Neighborhoods: North Aurora (Colfax Corridor): Events Under Discussion
• Incentives for upcoming events –grocery cards, food trucks, bonus bucks for farmers markets, ride/food tickets at Fairs etc. • Coordination with state outreach (CDPHE and HCPF) and access initiatives (eg, working with community partners for vaccine bus stops, collaborating on canvassing and other approaches in areas with low vaccine rates) • Replicate RTD bus stop vaccine events if pilots in Denver successful • Outreach to additional faith‐based leaders TCHD District Wide Efforts to Enhance Vaccine Uptake: Implemented/Planned
• TCHD supports formal (from CBO vaccine and navigation funding opportunity) and informal (any other) partners in several ways Weekly office hours to ask questions, get support or guidance on promotion and navigation issues, for example a partner navigating to a community clinic requested vaccine consent forms in Spanish –we worked with Colorado Access provider relations to get the forms to the practice Weekly update emails and talking points • Vaccine Champions program –TCHD training/deploying bilingual staff as vaccine champions for events, presentations • Working with State Vaccine Equity Group and Immunize Colorado to provide speakers and vaccine champions • Vaccine call‐back efforts – Phone/postcard outreach in multiple languages to people in CIIS and associated with TCHD vaccine clinics, but who have not yet initiated a COVID vaccine series. Individual phone calling resulted in 1500 vaccines administered at TCHD clinics • Identified HUD multi‐family housing units for targeted outreach and canvassing Innovative Housing Concepts in Englewood will be hosting an “Ask a Nurse” ice cream social so residents can get individual COVID vaccine questions answered Those interested referred to the Malley Recreation Center vaccine clinic next day. • Working with CDPHE on bus routes, canvassing, call‐banking and other outreach efforts in areas that are not within our priority neighborhoods to ensure situational awareness and coordination • TCHD fixed and mobile sites continue including jails, GEO and at events for People Experiencing Homelessness TCHD District Wide Efforts to Enhance Vaccine Uptake: Under Discussion
• Assigning faith‐based leaders distribution list to county teams for outreach • Assigning businesses distribution list to county teams for outreach • Discussing larger strategy support e.g., door to door canvassing, tailored personal responsibility approach such as “Me, You, Us” • Incentives for upcoming events –grocery cards, food trucks, bonus bucks for farmers markets, ride/food tickets at Fairs etc. • Replicate RTD bus stop vaccine events if pilots in Denver were successful • Coordination with state outreach (CDPHE and HCPF) and access initiatives for example, working with community partners for vaccine bus stops, collaborating on canvassing and other approaches in areas with low vaccine rates Reflections on Working with our Communities to Increase Vaccine Uptake • What lessons have we learned about the types of efforts that appear to be increasing uptake? Broad, unfocused mass marketing approaches less effective. Individualized/tailored information and Q&A to address individual barriers Pairing or layering strategies (tailored outreach/messaging with easily accessible vaccine access points ‐ as defined by community members themselves, incentives) • What types of approaches do we think are making the most difference ? Vaccine access: both large and small events, familiar location, regularly occurring and no appointments necessary Tailored and personalized outreach/messaging ‐ culturally appropriate and in the individuals’ native language, and that addresses specific concerns not general statements Cultural broker/trusted community partners ‐ Community perception of endorsement by a trusted cultural broker/community organization Layered approaches ‐ outreach (canvassing, phone calls etc,) coupled with a vaccine event in the neighborhood within a day or two, incentives (though challenging to provide) Vaccination Administration Trends in High Priority Neighborhoods (6/28) Vaccination Administration Trends in High Priority Neighborhoods (7/4) COVID-19 Vaccine Marketing June 2021
• June marketing: included paid advertising on Univision, KBNO and KQKS radio stations, digital online and digital streaming, out of home advertising.
• Paid Television Advertising: TCHD ran a television ad on Univision to reach soccer fans during World Cup games.
• Unpaid Media coverage (eg, interviews on radio, television, and online newspapers and blogs): 2,594,718 Impressions.
• Radio: • KBNO reaches Spanish speakers. This campaign is estimated to generate 192,000 impressions through 124 spots running on average 5 times a day for 25 days. • KQKS reaches 18 + audience with the highest Hispanic reach in the Denver market. (We received 20 free spots from this station) 237,600 impressions through 60 spots running on average 4 times a day for a two‐week period. Total • Radio is focused on letting people know there are resources available to them if they have to miss work after Impressions 4.9 Million getting the COVID‐19 vaccine. • Continued weekly interviews (since 3/20) by Dr. Douglas on KOSI on Area Agency on Aging Sunday morning show
• Digital online ads and video ads that run on a variety of digital websites such as Hulu, NBC, Yahoo, Reddit, Bing, etc.: • 781,000 Impressions
• Social media including Facebook, Twitter, Instagram and Snapchat: • 796,384 Impressions through paid social ads • TCHD received 300,135 impressions through its own unpaid social channels TCHD Use of Influencers to Reach Targeted Groups
• Starting in July, diverse influencers will reach more than 384,000 followers in Adams, Arapahoe and Douglas through August. • 12 Influencers from the Tri‐County area have been contracted and trained, representing the following demographics: 4 LatinX influencers .3 Spanish Dominant 2 Refugee/Immigrant influencers from Ghana and Senegal 4 African American influencers 1 Vietnamese Influencer 1 Caucasian • Out of home advertising in 21 locations. CDPHE “Get Out the Vaccine” Statewide Campaign
• Results as of 6/30 1.4 m calls last 8 d 471k texts sent, 430 k more by 7/2 1.8 mailers, 1.3 m more by 7/3 • Results Most respondents report all in household vaccinated (will be doublechecked w CIIS) Interest in vaccine among others low Of those interested, schedule rate 50+% Looking Ahead
• Vaccinations Maintaining momentum (?increasing after licensure) Attention to any modifications required by variant evolution/spread Preparing for younger kids when approved and boosters if needed Preparing for a “maskless” flu season Catching up on childhood vaccinations • Protecting LTCFs • Exploring RX options (eg, new generation Monoclonal antibodies) • Preparing for school State has ended PHO; providing input on new guidance In discussion with schools about value of “local guidance” Role of masks in <12 unvaccinated a likely source of discussion • TCHD PHO Low probability of hospitalization rates triggering return of Dial PHO unlikely to be extended after Aug 15 Questions