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Dear East Bay Getting to Zero community,
    
Please see the weekly update on the
EBGTZ website and highlights below. Click here to download the PDF version. 

In national HIV news, the FDA approved the first extended-release, injectable HIV antiretroviral therapy regimen (cabotegravir and rilpivirine injectable formulation, brand name Cabenuva).

President Biden unveiled “The Biden-Harris plan to beat COVID-19,” including access to free testing, clear and consistent evidence-based prevention guidance, equitable distribution of treatment and vaccines, protecting older people and those at high risk, rebuilding pandemic defense infrastructure, and implementing mask mandates. The 200-page plan can be downloaded here.

Join us on Thursday, February 25, 2021 11-12:30 PM for State of the Pandemic in Alameda County: COVID-19 Conversations on Vaccines, Variants, and More. There will be a presentation, conversation and ample time for live Q&A. Learn more about the current state of COVID-19 in Alameda County, the vaccine and roll-out, and strategies that will protect your patients, consumers, and community from the virus and misinformation.

East Bay COVID-19 updates

COVID-19 daily case and hospitalization rates have decreased over the past three weeks but are still at high levels in the Bay Area. Death rates have begun to decline after record highs. Estimated transmission rates in the Bay Area have been decreasing and are now hovering around 0.8. Bay Area ICU capacity is 18.1% as of February 2.

The highly infectious U.K. variant has been identified in Alameda County, with seven cases reported on February 3. The U.K variant (B.1.1.7) is estimated to be 30-70% more transmissible due to mutations on the spike protein. 133 cases have been found across California thus far. Only a tiny fraction of viral samples is sequenced, so it’s unknown how far and wide this variant has spread. California is also seeing increasing numbers of two home-grown variants (B.1.427 and B.1.429) but whether they are more infectious or impact vaccine efficacy is unclear.    

The Bay Area regional shelter-in-place order was lifted on January 25 because the 4-week ICU capacity projection is above 15%. ICU capacity is projected to be 33% in 4 weeks. Bay Area counties have returned to their purple tier restrictions. Outdoor dining, outdoor gyms, zoos, libraries, hair/nail salons and stores are allowed to reopen with restrictions.

Don’t let down your guard! We will need to continue to wear masks, keep distance and get vaccinated as soon as we can, especially with more infectious variants in circulation. Please see below for more prevention tips. It’s a race against mutants!

Oakland Coliseum will become a mass-vaccination site starting February 16, Governor Newsom and the Biden-Harris administration announced on February 3. Oakland Coliseum and Cal State LA will be pilot mass vaccination sites co-run by the Federal Emergency Management Agency (FEMA) and the State of California through the Governor’s Office of Emergency Services (Cal OES). The two sites were chosen to increase access for communities disproportionately impacted by COVID-19. Registration for vaccine appointments will be available through the state’s MyTurn scheduling system in the coming days.

In addition to the Coliseum site, mass vaccination sites are planned in Berkeley, expected to open February 4 for people living in northern Alameda County, and at the Alameda and Solano Fair Grounds.

Vaccinations are available now for health care workers, nursing home residents and elders. Many vaccination sites have opened appointments for people ages 75+ and 65+ though it’s been difficult to get appointments due to low supply and high demand. Starting February 8 in Alameda County, essential workers in education/child care, emergency services and food/agriculture will be eligible for vaccines under Phase 1b Tier 1.

California state announced on January 25 that after these groups, the state will shift to prioritization based on age. This means CA will no longer prioritize vaccines by occupation after Phase 1b Tier 1.  On February 1, CA Health Officer Dr. Erica Pan announced that the state is still considering a Phase 1b Tier 2 that includes people with high-risk medical conditions. It’s still unclear if and how people living with HIV will be prioritized. There is emerging data that people living with HIV and CD4 counts less than 200 are at greater risk for hospitalizations and death.

Providers are encouraged to talk with patients and clients about vaccinations to combat misinformation and address concerns. Local clinics report that people are declining vaccines due to misinformation that vaccines cause sterility and/or COVID and fear of feeling sick, like after the flu shot. Communities of color continue to turn to their trusted health providers for counsel, and providers are changing minds about vaccinations. The ICD-10 code Z71.89 (other specified counseling) may be used for vaccine counseling done in medical provider visits. We are currently researching whether this code alone is sufficient for billing purposes.

People needing medical care for any condition are still encouraged to seek care as our clinics and hospitals remain open with strict safety protocols to take care of all people.

Community Spotlight on the COVID-19 Vaccine

Amber Taylor, Case Manager at WORLD, says:

“I got the vaccine due to working in the public, with a large number of people who are susceptible to catching the virus. Myself having asthma I am at a greater risk of catching COVID, so getting the vaccine I am protecting myself and the ones I love. I am always around my child, my father who is 65, my grandmother who is 70+, they are all at a greater risk of not recovering fully from this virus, so being around them I need to make sure they are protected at all times.”

Vaccine eligibility and access updates

As of February 3, Alameda County, Contra Costa County, and Solano County are prioritizing vaccinations for health care workers, people in nursing homes and people over the age of 75. Starting February 8 in Alameda County, people ages 65+ and essential workers in education/child care, emergency services and food/agriculture will be eligible for vaccines under Phase 1b Tier 1. Please see the infographic below.

All COVID-19 vaccines should be available for free regardless of insurance status.

To access vaccines, we recommend the following steps:

  1. Check with your medical provider and/or county for when the vaccine is available for your age or occupation group. See links below.
  2. When vaccine is available for your group:
    • Check if you can get a vaccine through your health plan or clinic first.
    • If you cannot get a vaccine through your health plan or clinic, check if you can get a vaccine through a public (county) vaccination site.

Vaccines through medical providers:

Vaccines for the public through county vaccination sites:

Coming soon! Vaccines for the public at mass vaccination sites:

  • Oakland Coliseum FEMA site is expected to open starting February 16. Appointments are not available yet as of February 3, so please check back.
  • The Berkeley mass vaccination site is expected to open February 4 for people living in northern Alameda County.

Who is eligible for vaccines now?

Bay Area counties are following CA state guidelines on vaccine prioritization, which were updated on February 1:

People living with HIV and COVID-19 vaccines

Currently all people living with HIV (PLWH) are recommended to get the COVID-19 vaccine once eligible so long as they don’t have severe allergic reactions to components of the vaccines. As of February 3, it’s unclear if and how people living with HIV will be prioritized in California as having a medical comorbidity. There is emerging data that people living with HIV and CD4 counts less than 200 are at greater risk for hospitalizations and death.

The Moderna vaccine trial included 179 PLWH and the Pfizer trial included 196 PLWH but data on these sub-groups has not been reported separately yet. There is currently no recommendation to check antibody levels for people living with HIV after completing vaccination. We are not sure yet if commercially available SARS-CoV2 antibody tests such as at Quest and LabCorp check for the spike antibodies generated by the vaccines, but providers and patients may consider checking for spike IgG antibody levels two or more weeks after the second vaccine dose while we await more data.

Help the vaccine roll-out effort!

For more COVID-19 vaccine resources, please click here.

Trends in cases, transmission rates and disparities

Transmission rates (Re) have improved to 0.80 in Alameda County, 0.79 in Contra Costa and 0.81 in Solano County, and 0.70 statewide. Our goal is to support the vaccine roll-out and community measures around masking, distancing, staying outdoors and avoiding gatherings to keep transmission rates less than 1.

Alameda County data as of February 3:

Contra Costa County data as of February 3:

Solano County data as of February 3:

SF Chronicle, 2/3/21: COVID-19 daily cases and deaths in the Bay Area.

Latinx and Black/African American Californians continue to be disproportionately impacted by COVID-19 as shown here as of February 3, 2021 in the CDPH CA State COVID-19 dashboard. 

In Alameda County, while case rates are falling from their January peak, Latinx people are still more than 4 times more likely to be diagnosed with COVID-19 than white people. Black/African American residents are nearly 2 times more likely to die from COVID-19 compared to their white neighbors.

New Alameda County vaccination equity data shows that Latinx and Black health care workers are underrepresented among those who have received vaccinations. The County is investigating this disparity and working with local community-based organizations to find ways to address it.

Nationwide, Black Americans are also getting vaccinated at lower rates than white Americans: Black people have been vaccinated at 2-3 times lower rates compared to white people, including in the first health care workers group. “Access issues and mistrust rooted in structural racism appear to be the major factors leaving Black health care workers behind in the quest to vaccinate the nation.” (Kaiser Health News)

A new study projects that in 2020, COVID-19 will reduce US life expectancy disproportionately by race/ethnicity. Life expectancy in the US is estimated to be reduced by 1.13 years overall, with reductions for Black and Latinx people 3 to 4 times that for White people.

A new UCSF study ranks the riskiest jobs in California during the pandemic with food/agricultural workers at highest risk (39% increase in mortality), transportation workers (28% increase) and facilities (27%) and manufacturing workers (23%). Latinx food/agricultural workers experienced a 59% increase in mortality, Black retail workers experienced a 36% increase and Asian health care workers experienced a 40% increase in mortality during the COVID-19 pandemic.

Harm reduction tips and resources

  • Question of the month: Should I double-mask?

With evidence of the highly infectious U.K. variant circulating in the East Bay, we may be wondering if we should increase our prevention efforts. With masking, the most important thing is to wear a mask that you will keep over your nose and mouth and maintain 6+ feet distance whenever you are outside your home. A mask will not be useful if you can’t keep it on over both your nose and mouth, no matter how many layers it has.

If you are motivated to use two masks or multiple layers and can keep them fitted on your face, this can provide more protection for you and others.

Here are the qualities that make masks more protective, which we recommend using in indoor public settings (see higher/highest risk settings in our infographic):

  • Use tightly-woven fabric or non-woven material, like in surgical masks.
  • Use multiple layers:
    • 2 layers provide decent protection.
    • 3 or more layers provide maximal protection, including double-masking.
    • Consider adding a face shield and/or goggles in the highest risk settings.
  • Make it fit:
    • Use tight/snug cloth masks.
    • Reduce top gaps by using masks with adjustable nose wires/clips.
    • Reduce gaps in ear loop masks by tying knots near the sides. (video here)
    • In high risk settings, get fit-tested for an N95 mask.
    • Keep in mind that KN95 masks are not fit-tested and are less protective than N95 masks. Treat them like surgical masks.
  • Double-mask or use a non-woven filter:
    • A non-woven layer, such as a disposable surgical-type mask or filter layer can help repel droplets.
    • You can double-mask by using a fitted cloth mask with a disposable surgical-type mask, like in the diagram below.

Diagram from “Uniting Infectious Disease and Physical Science Principles on the Importance of Face Masks for COVID-19,” by Dr. Monica Gandhi and Linsey C. Marr. Scientific references for these masking tips are located here.


Harm reduction resources
 
Our summary of
COVID-19 harm reduction strategies is continuously updated with new studies. 
 
Free COVID-19 testing sites:
Click here for Alameda County, Contra Costa County and Solano County testing sites.

Other Updates & Opportunities

Job opportunities:

  • Urban Leaders Fellowship is a full-time fellowship where fellows spend half of their time working on impactful policy proposals for an elected or appointed official, and the other half of their time working at a community-based company or organization equally committed to social justice and positive impact. For the ULF Oakland site specifically, fellows will be working out of the City of Oakland's Director of Education and focusing on policy initiatives related to advancing education equity in the Oakland community. Deadlines for the application: February 6th and March 20th. Early applications are encouraged as slots fill up quickly. The dates of the program will be around June 7-July 23.
  • The Praxis Project is accepting applications for a paid summer Health Justice Internship. The Health Justice Internship is a great opportunity to engage in health justice policy, public health training, organizational capacity building, and field organizing. This is a remote position, and the pay is $19-21/hour depending on experience.
  • California Department of Public Health jobs:
    • The Office of Health Equity within the California Department of Public Health  provides a key leadership role to reduce health and mental health disparities experienced by vulnerable communities in California. They have an Associate Governmental Program Analyst position open in their Richmond office.
    • The STD Control Branch is recruiting to fill a Project Policy Analyst III, Clinical Services Coordinator, position. The Clinical Services Coordinator will provide technical assistance (TA), capacity-building assistance, and consultation to local health jurisdictions (LHJs), STD and sexual health clinics (and other clinics that provide a substantial number of STD and sexual health services), and other relevant stakeholders.

Funding opportunities:

  • Youth-serving organizations: There is a new funding opportunity through ETR’s Youth Engagement Network. The Youth Engagement Network (YEN) is a 3-year project funded by the Office of Population Affairs that aims to strengthen youth engagement in sexual and reproductive health programs, services and systems change efforts. They are currently seeking to fund organizations to refine and evaluate existing youth engagement interventions. Proposals are due Monday, February 22, 2021. Learn more about the opportunity here.
  • The Centers for Disease Control and Prevention (CDC) published the Notice of Funding Opportunity (NOFO) PS21-2104: Partnering and Communicating Together. The NOFO seeks to engage strategic partners from across a variety of sectors to support the dissemination of messages and resources from the Let’s Stop HIV Together campaign to the populations and communities most impacted by HIV. The Partnering and Communicating Together funding opportunity is part of CDC’s efforts to increase HIV awareness, testing, prevention, and treatment under the Ending the HIV Epidemic (EHE) initiative.

Resources for the community:

  • Covered California announced that effective Feb. 1, anyone uninsured and eligible to enroll in health care coverage through Covered California can sign up through May 15. Sign up for Covered California here.
    • As a reminder, people with HIV with income between 138% and 500% of MAGI FPL can purchase insurance via Covered CA and enroll in ADAP and OA-HIPP to have medication co-pays and insurance premiums paid for by the State of CA Office of AIDS.

Other resources:

  • Webinar: HIV Grand Rounds with Dr. Stephanie Cohen, Medical Director of the San Francisco City Clinic and Assistant Professor of Medicine at UCSF, for the ‘Sex (and STIs) in the time of COVID’ seminar. This online webinar will be held on Wednesday, February 10th, at 12 PM PST via Zoom.
The EBGTZ website continues to have weekly updates on Wednesday evenings, and this newsletter will be sent out twice a month on 1st and 3rd Wednesdays. Please follow and share our Instagram, Facebook and Twitter accounts. 
 
Thank you for all that you do for our communities!
Sophy, Yamini and Sami
 
***
Sophy S. Wong, MD, Director
Yamini Oseguera-Bhatnagar, Program Manager
Sami Lubega, MD, Prevention Director

East Bay Getting to Zero

 
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