This morning as County Manager Mike Callagy presented revisions to our budget for this fiscal year, I was reminded of the many ways our county, led by our board, continues to advance many long-term investments and actions that support recovery for our residents, in addition to supporting our immediate work responding to the pandemic.

Through June 30: multiple supported housing/hotels purchased or in development; investments to reduce the digital divide across the county; 5,294 households have received rental assistance; more than 2.7 million meals have been provided (including through the Aging and Adult Services Great Plates Delivered program); 309 childcare providers representing 8,183 childcare spots have been sustained; and more than 16,000 individuals and families, 900 small businesses and 190 community-based organizations have received support due to impacts of the pandemic.

Mike also highlighted how $73 million in relief funds continue to support elimination of homelessness, support small businesses and offer relief from fees, promote economic opportunity and alleviate food insecurity – all in addition to our effort to extend the reach of the vaccine. It is encouraging to be reminded of this broad array of community investments, while we remain unrelentingly focused on protecting our residents from the direct impacts of the pandemic by lifting vaccination rates. 

The Latest

As you will note below, each week brings progress and new opportunities. I am glad to bring news of the federal and state decisions about eligibility for one-shot boosters for some residents who received their second dose of the Pfizer vaccine six or more months ago. We remain grateful to many partners including County and nonprofit colleagues for enabling us to address this need. The 61 local pharmacies, the major healthcare systems, and many healthcare provider offices already had plans to meet residents’ needs as the federal and state recommendations were being finalized. In addition to those efforts, we will be remobilizing a high-volume vaccination operation at the San Mateo County Event Center and offering boosters at the County-run community-based vaccination clinics by late next week.

Scientists and federal and state officials shared the following direction late last week with the Centers for Disease Control (CDC) and the Western States Scientific Review Workgroup that advises California agreeing with the following recommendations:

• People 65 years and older and residents in long-term care settings should receive a booster dose of Pfizer-BioNTech’s COVID-19 vaccine at least six months after their Pfizer-BioNTech primary series.
• People aged 50-64 years with underlying medical conditions should receive a booster dose of Pfizer-BioNTech’s COVID-19 vaccine at least six months after their Pfizer-BioNTech primary series.
• People aged 18-49 with underlying medical conditions may receive a booster dose of Pfizer-BioNTech’s COVID-19 vaccine at least six months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.
• People aged 18-64 years who are at an increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster dose of Pfizer-BioNTech’s COVID-19 vaccine at least six months after their Pfizer-BioNTech primary series, after considering their individual benefits and risks.

The Western States Scientific Review Workgroup strongly endorsed the CDC’s recognition that longstanding health and social inequities have increased the risk of severe illness from COVID-19 and recommended that social determinants of vulnerability be included in the assessment of medical conditions that qualify individuals for booster doses. Because unvaccinated individuals remain at much higher risk of COVID-19 than vaccinated individuals, the Workgroup also reiterated that its members strongly support vaccination against COVID-19 for everyone 12 years of age and older.

The above guidance is for those residents who received Pfizer, and we are still waiting for guidance for those who received Moderna or Janssen (Johnson & Johnson) vaccines. 

As many parts of the country continue to grapple with hospital capacity constraints due to high virus transmission, California is seeing among the best improvement in our experience. The Bay Area’s trends show the positive impact of high vaccination rates, but we remain cautious and vigilant as the seriousness of mortality risk, especially for those not yet vaccinated, has been reinforced in our learning of 5 deaths due to COVID-19 last week.

Our most recent experience of the virus in San Mateo County

Similar to last week, our 7-day lagged average reported September 27th was 9 new cases per day per 100K in the population, which is down slightly from the 9.8 figure I shared a week ago. This is an average of 70 new COVID-19 cases per day, compared to 76 per day in my last report. 

Hospitalizations due to COVID-19 in San Mateo County have continued to trend downward, with a census of between 26 and 35 each of the last seven days. We have supported between 16 and 22 residents to isolate safely in our Alternative Housing Site hotels each day of the last seven days. We continue to monitor test positivity both countywide (1.6%) and in the Healthy Places Index lowest quartile census tracts (2.5%). Our testing was reported by the State at 830 tests per day per 100K population.

Vaccination update

We continue to urge that COVID-19 vaccination for all who are eligible is the most important action to take to protect oneself and the community. While we are seeing demand at our “radically convenient” clinics declining, we continue to see slow but steady progress each week. The State immunization registry report of September 26th showed that 94.0% (631,699) of our total eligible County population aged 12 and older have received a COVID vaccine. Our updated estimate of the number of unvaccinated eligible San Mateo County residents is now 40,000 (a decrease of 5K since last week’s report). As we prepare for a new group of residents to become eligible for the vaccine (5-11 year olds) sometime in October/November, it is important to also track the vaccination rate in our overall county population (all ages regardless of current eligibility for vaccine), which is currently at 81.5%. 

We see that we have reached 82.5% of those ages 10 and over in our lowest quartile Healthy Places Index census tracts overall, and we continue to focus on raising the lowest of these. While the following communities still show vaccination rates below 80%, we are continuing to learn from partners involved in the outreach effort in these communities and hope to adjust our vaccination rates based on more realistic assumptions of the remaining unvaccinated population. While we get a better understanding of the remaining unvaccinated, we continue to provide targeted pop-up and weekly vaccine clinics to reach residents in these specific communities and leverage trusted community partners to promote vaccine confidence messages. 

Communities under our goal of at least 80% vaccinated

Geographic Community as of 9/26/2021	# of 1st and single dose vax given by any entity in past 7 days	% vax with 1st or single dose	Estimate # eligible unvax
Broadmoor	4	70.9%	1,375
El Granada	4	66.7%	1,857
Loma Mar*	0	69.8%	52
Moss Beach	1	53.2%	1,453

*Vaccinations by city are calculated by geocoding and aggregating self-reported addresses by city or town. Population estimates are less precise for areas with small population.

Of the total county residents who have been vaccinated, 58.7% are people of color, 36.2% are white, and 5.1% are of unknown race/ethnicity. We continue to focus our efforts on increasing vaccination rates among Black, Hispanic and Pacific Islander communities in which rates are still below 80%. Over this last week, we saw a greater increase in vaccination rates among Black and Hispanic residents. However due to data collection and reporting limitations these estimates are still likely under-reporting our true reach in each of the racial/ethnic groups as approximately 88,500 residents are still categorized as “unknown” or “other.” 

Race/Ethnicity Groups under our goal of 80% vaccinated

Note: Due to data collection and reporting limitations these estimates are imprecise and likely reflect under-reporting of reach in each racial/ethnic group given the number of residents who self-identify as “other,” “multi-race” or for whom race/ethnicity data was not collected by the vaccinating entity. 

Race / Ethnicity	% age 12+ vax as of 9/19/21	% age 12+ vax as of 9/26/21	% increase since 9/19/21	Estimate # eligible unvax
Black / African American	62.0%	62.9%	+0.9 percentage points	6,668
Hispanic	60.4%	61.4%	+1.0 percentage points	67,019*
Multiracial	55.3%	57.8%	+1.5 percentage points	8,930
Native Hawaiian / Pacific Islander	63.9%	64.4%	+0.5 percentage points	3,476

*This is an over-estimate of the number of Hispanic residents to be reached as it exceeds the total number of residents to be reached; however, we see this is as our largest community under-reached by COVID-19 vaccination among the groups that are still below 80% vaccination rates.

We expect COVID-19 vaccines will be approved for the 5–11 year-old population sometime this fall and are already preparing for our role in reaching this newly eligible group. Pediatric providers within large and small health care systems are already planning how to provide vaccines to this younger group, and we expect our local pharmacies to also have a role in vaccinating youth. San Mateo County Health is also collaborating with the County Office of Education on additional pathways to reach the 5-11 year-old population using strategies that will best meet the unique needs of this age group.

All Together Better,
Louise F. Rogers