COVID-19 Response Plan
page last updated on 9/27/2023
Los Angeles County CDC COVID-19 Hospital Admission Level is:Low |
Los Angeles County (LAC) will continue to use the Centers for Disease Control and Prevention’s (CDC) COVID-19 hospital admission levels (table below) to guide assessment of risk across the county and inform the adoption of prevention strategies as described in the Community Safety Protection Measures and Prevention Strategies table. LAC will implement strategies for a higher hospital admission level when the hospital admission rate is at or above the threshold for a higher level for at least fourteen (14) consecutive days. Strategies will revert to a lower hospital admission level when the hospital admission rate has fallen below the threshold for the higher level for at least 7 consecutive days or the hospital admission rate has been declining consistently for the prior fourteen (14) days.
| Metric | Low | Medium | High | LA County’s Current Value* |
| New COVID-19 hospital admissions per 100,000 population (7-day total) | <10.0 | 10.0-19.9 | ≥20.0 | 6.7 |
*Data was posted by CDC on 9/25/23 using data for the 7-day period ending on 9/16/23.
(Aligned with CDC COVID-19 hospital admission levels)
The Community Safety Protection Measures and Prevention Strategies table below reflects mitigation efforts in four areas: indoor masking, testing, vaccination, and ventilation.
*NOTE: When there is circulation of an emerging COVID-19 variant of concern that shows potential evidence of vaccine avoidance, these recommendations and requirements will be modified.
The strategies in the table cover low, medium and high CDC hospital admission levels. Please scroll vertically to view all hospital admission level strategies.
| CDC hospital admission level: LOW |
CDC hospital admission level: MEDIUM |
CDC hospital admission level: HIGH |
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Indoor Masking
No one can be prevented from wearing a mask to participate in an activity or enter a business.
Regardless of the CDC hospital admission level, indoor masking may be required
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| For those confirmed positive |
Regardless of the level:
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| People with respiratory symptoms (such as cough, runny nose, sore throat) | Strongly recommended if need to be around others. | |||||
| For those exposed | Strongly recommended to mask indoors for 10 days after last day of exposure | Strongly recommended to mask indoors for 10 days after last day of exposure | Strongly recommended to mask indoors for 10 days after last day of exposure, unless general masking required | |||
| All healthcare settings and congregate care facilities | Strongly recommended for healthcare workers, patients, and visitors. | Strongly recommended or required depending on an assessment of local conditions at the time | Required for healthcare workers providing patient care and in patient care areas. Required for all patients and visitors. |
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| Correctional and detention facilities, homeless and emergency shelters | Individual preference1 outside of clinical areas, unless required by agency if no outbreak has occurred within 14 days. | Strongly recommended outside of clinical areas, unless required by agency if no outbreak has occurred within 14 days | Strongly recommended or required depending on an assessment of local conditions at the time. | |||
| Public transit, transportation hub, and transportation service (including shuttle bus, ride share, taxis, and medical transport) | Strongly recommended, unless required by transportation agency | Strongly recommended, unless required by transportation agency | Strongly recommended or required depending on an assessment of local conditions at the time. | |||
| Individuals, regardless of vaccination status, in all other settings. | Individual preference1 |
Strongly recommended for individuals at risk for severe illness2 especially when in crowded or poorly ventilated places. Strongly recommended for those who share a home or spend time with someone who is at risk for severe illness, when they are indoors with them. |
Strongly recommended or required for everyone when indoors in public, depending on an assessment of local conditions at the time. Individuals at risk for severe illness should consider avoiding spending time indoors in public, unless it is essential. If they do spend time indoors in public, they should wear their most protective mask, such as a N95, KN95, or KF94 respirator. This is especially important when in crowded or poorly ventilated places. |
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| Testing | ||||||
| Routine screening testing in workplaces | As required by the site or sector | |||||
| For those exposed | Strongly recommended as soon as possible after exposure to determine infection status and again between Day 3-5 from exposure. | |||||
| For those confirmed positive | Strongly recommended to exit isolation after day 5 | |||||
| Before gathering socially with those at elevated risk | Individual preference, unless required by site/host | Recommended, unless required by site/host | Strongly recommended, unless required by site/host | |||
| Visitors before going indoors at health care facilities, including congregate care sites | Individual preference, unless required by site/host | Recommended, unless required by site/host | Require all visitors, regardless of COVID-19 vaccination status, to be tested prior to indoor visitation | |||
| Vaccination | ||||||
| All residents | Strongly recommend having vaccines be up to date. | |||||
| Healthcare personnel (HCP) working in all licensed healthcare facilities | Strongly recommended to receive the new COVID-19 vaccine. HCP who decline the new COVID-19 vaccine will be required to wear a respiratory mask when in contact with patients or working in patient-care areas during the respiratory virus season. | |||||
| Environmental Mitigation | ||||||
| Ventilation throughout indoor spaces | Strongly recommended to ensure and maintain improved ventilation throughout indoor spaces. | |||||
(2) Individuals at elevated risk include: elderly, unvaccinated, those with underlying medical conditions, immunocompromised individuals, and those living in high poverty communities. This means that a person with one or more of these conditions who gets very sick from COVID-19 (has severe illness from COVID-19) is more likely to: be hospitalized, need intensive care, require a ventilator to help them breathe, or die. See CDC website for more details on the underlying medical conditions associated with elevated risk of severe COVID-19 illness.
Public Health will monitor the following signals to provide early indication of concerning trends that can result in future high rates of transmission and/or increased illness severity. The signals in the table below include four (4) community-wide measures (variants of concern, Emergency Department COVID-19 visits, cumulative case rate in high poverty communities, SARS-CoV-2 wastewater concentration) and four (4) sector specific measures (outbreaks at Skilled Nursing Facilities [SNFs], outbreaks at Transitional Kindergarten (TK) through 12th grade schools, outbreaks at settings assisting persons experiencing homelessness [PEH], clusters at worksites). An alert in any measure that reaches the threshold for medium or high concern will trigger an in-depth review of contributing factors and the possibility of modifications to community prevention strategies.
| LAC Early Alert Signals: Indicator Thresholds |
LAC Early Alert Signals: Low Concern |
LAC Early Alert Signals: Medium Concern |
LAC Early Alert Signals: High Concern |
LAC Early Alert Signals: LA County's Current Values |
| Percent of specimens sequenced that are identified as a new variant or subvariant of interest* (based on WHO, CDC, or local designation)1 Currently tracking: EG.5 |
< 10% | 10%-20% | > 20% | 31% |
| 7-day average of the percent of Emergency Department (ED) encounters classified as coronavirus-related2 | < 5% | 5%-10% | > 10% | 4% |
| 7-day cumulative age-adjusted case rate for the lowest income areas (30-100% area poverty)3 | < 100 per 100,000 | 100-200 per 100,000 | >200 per 100,000 | 26 per 100,000 |
| Current SARS-CoV-2 wastewater concentration as a percentage of the Winter 2022-2023 peak concentration value4 | < 30% | 30%-60% | > 60% | 30% |
| Number of new outbreaks in skilled nursing facilities over the past 7 days5 | ≤20 | 21-30 | >30 | 19 |
| Number of new outbreaks in TK-12 school classrooms over the past 7 days5 | ≤ 10 | 11-20 | > 20 | 4 |
| Number of new outbreaks in PEH settings over the past 7 days5 | ≤ 10 | 11-20 | > 20 | 2 |
| Number of worksite cluster reports in the past 7 days6 | < 150 | 150-350 | > 350 | 23 |
(1) Current 14-day period is 8/20/23 – 9/2/23.
Variant proportions are based on a sample of all rt-PCR positive specimens collected from Los Angeles County residents. On average, sequencing data is available two-week after specimen collection. Variant proportions are calculated in weekly intervals using date of specimen collection. Estimates may be revised as additional data is reported.
(2) Current 7-day period is 9/17/23 – 9/23/23.
Coronavirus classification is determined by a free text search for mention of coronavirus, COVID-19, and synonyms within extracts of patient chief complaint and diagnoses from Syndromic Surveillance participating hospitals. Some encounters may be missed due to incomplete and/or delayed reason-for-visit information or misclassified due to COVID-19 screening during a visit regardless of the actual primary reason for visit. This percentage from Syndromic Surveillance participating hospitals is not intended to reflect the exact percentage for the population, but is a useful tool for monitoring trends over time.
(3) Current 7-day period is 9/17/23 – 9/23/23.
Cases are counted by episode date which is the earliest existing value of: date of onset, date of diagnosis, date of death, date received, or specimen collection date. Area Poverty reflects the percentage of households living at or below the federal poverty line. The “lowest income areas” used in this metric are census tracts with 30-100% of households living at or below the federal poverty line. Area poverty estimates are derived from the US Census 5-year (2013-2017) American Community Survey at the census tract level. The case rate is age-adjusted and is per 100,000. Population estimates are derived from LAC PEPS 2018 demography files.
(4) Current period for weekly average is 9/10/23 – 9/16/23.
A weighted average is calculated by using the SARS-CoV-2 viral concentrations across 3 sewer systems that track the virus in LA County (Hyperion Water Reclamation Plant, Joint Water Pollution Control Plant, Lancaster Water Reclamation Plant), with the weights representing the population size served by each sewer system. Weekly weighted averages are then compared against the maximum weekly weighted average SARS-CoV-2 viral concentration observed during the Winter 2022-2023 surge.
(5) Current 7-day period is 9/20/23 – 9/26/23.
Counts include outbreak investigations initiated in the past 7 days at skilled nursing facilities, TK-12 school classrooms, and homeless settings. Counts exclude investigations initiated more than 28 days after the first case's test or onset date (to account for delayed reporting to DPH).
(6) Current 7-day period is 9/20/23 – 9/26/23.
Worksite clusters are 3 or more cases within 7 days as reported by an employer. Worksite clusters can represent outbreaks or non-outbreaks and, if there are additional cases, can be multiple reports of the same site. On 5/23/22, changes in cluster report data processing were implemented, including exclusion of duplicate reports with fewer than 3 cases.
For each of the sectors, the table below provides additional general mitigation measures and other measures that should be implemented based on an assessment of the situation including metrics in the CDC COVID-19 hospital admission levels and LA County Early Alert Signals tables above. Please see individual sector guidance for more information.
NOTE: All sectors should follow the minimum requirements related to indoor masking, testing, vaccination, and ventilation measures as described in the Community Safety Protection Measures and Prevention Strategies.
| General Mitigation Measures | Enhanced Mitigation Measures | ||||
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SECTOR: Skilled Nursing Facilities *The measures in this table are general information for the public. Healthcare facilities must follow specific LAC DPH guidance and CDPH and CMS requirements. |
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Resources for Skilled Nursing Facilities:
1)Guidelines for Preventing & Managing COVID-19 in Skilled Nursing Facilities 2)COVID-19 Guidelines for Community Care Facilities 3)Infection Prevention Guidance for Healthcare (including EMS) Personnel |
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| SECTOR: Transitional Kindergarten (TK)-12 Grade | |||||
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Resources for Transitional Kindergarten (TK)-12 Grade and Other Educational Settings:
1)COVID-19 Prevention and Response Guidelines for Education Settings |
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| SECTOR: Shelters and Interim Housing Serving Persons Experiencing Homelessness (PEH) | |||||
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| SECTOR: Worksites | |||||
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Resources for Worksites:
1)Responding to COVID-19 in the Workplace 2)Best Practices to Prevent COVID-19—Guidance for Businesses and Employers |
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| SECTOR: Highly Impacted Communities | |||||
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Much of the COVID-19 Response Plan depends on our ability to focus resources on response actions and preparedness activities. Response actions include addressing increasing levels of community risk and early alert signals that may be sector specific. Preparedness activities are focused on strategies that consistently allow the county to respond to changing conditions.
Note: Starting May 25, 2023, the dashboard will be updated once per month on the third Thursday of the month.
| Preparedness Actions | Needs Improvement | Adequate | Outstanding | LA County Current Values |
| Access to vaccines: Number of mobile vaccination sites per week | Less than 200 | 200-300 | More than 300 |
204 (9/15/23 - 9/22/23) |
| Access to vaccines: Number of fixed vaccination sites offering free vaccinations | Less than 550 | 550-649 | More than 650 | pending |
| Access to vaccines: Percentage of eligible homebound residents referred to DPH and vaccinated who received their vaccine within 2 weeks from date of referral | Less than 60% | 60%-75% | More than 75% | 100% (8/20/23-8/26/23) |
| Vaccine uptake: Percentage of residents 65+ who are up to date on COVID-19 vaccines1 | Less than 60% | 60%-90% | More than 90% | 41% (as of 9/17/23) |
| Testing access for LA County residents: Number of antigen tests distributed by DPH in the past week2 | Less than 100,000 | 100,000-150,000 | More than 150,000 | 229,814 (9/11/23-9/17/23) |
| Testing access at Schools: Percentage of TK-12 public schools that have capacity for response testing | Less than 80% | 80%-90% | More than 90% | 100% (9/11/23-9/17/23) |
| Testing access at SNFs: Percentage of Skilled Nursing Facilities (SNFs) that have capacity for routine response testing | Less than 90% | 90%-99% | 100% | 100% (9/11/23-9/17/23) |
| Access to therapeutics: Number of sites in the most vulnerable communities3 that dispense therapeutics4 | Less than 150 sites | 150-250 sites | More than 250 sites | 581 (as of 9/20/23) |
| Access to therapeutics: Percentage of eligible residents using the call center who received recommended therapeutics | Less than 80% | 80%-90% | More than 90% | 100% (9/5/23-9/11/23) |
| Surveillance – Sequencing: Number of positive case specimens that are sequenced in the most recent two-week period | Less than 150 | 150-300 | More than 300 | 1,462
(8/6/23 - 8/19/23) |
| Surveillance –Wastewater: Number of Service Planning Areas (SPAs) represented in wastewater collection and testing 3X/week | Less than 5 | 5-7 | 8 | 7 (as of 9/20/23) |
| Surveillance – EDs: Percentage of EDs reporting COVID-like illness data | Less than 80% | 80%-90% | More than 90% | 81% (as of 9/20/23) |
1 Percent of LA County residents who have received 1 bivalent vaccine, regardless of whether they have received any original COVID-19 vaccines.
2 The “Testing access for LA County residents” metric includes antigen tests distributed by DPH to all sites, including schools and SNFs
3 The “most vulnerable” communities are classified based upon at least 11 community characteristics, including economic, housing, environment, social, education, transportation and health care compiled in the California Department of Public Health Vaccine Equity Metric or by having a fully vaccinated population coverage less than the overall Los Angeles County estimate.
4 Therapeutics include oral and injectable medications used to prevent infection or disease progression among those with infection.
The lessons we have learned from navigating more than three years of the pandemic will inform preparedness activities for LA County. The five focus areas identified below include: preparedness for outbreak management, vaccine distribution/information dissemination, testing, therapeutic distribution, and surveillance.
Outbreak Management Preparedness
Outbreak notification letters which include recommended and required mitigation measures will be sent to all sites experiencing an outbreak. Sites may be required by DPH to implement mitigation measures, such as indoor masking, routine testing, and other infection control measures, to limit the spread of COVID-19 among residents, employees, and students. See, County Health Officer Order for applicable COVID-19 case reporting requirements.
Vaccination Preparedness
Vaccinations provide the most powerful personal and community protection from COVID-19. Increasing coverage by ensuring access and addressing concerns regarding vaccine efficacy and safety remain priority activities. The following actions are essential components of the preparedness plan:
- Increase up-to-date vaccination coverage among those at elevated risk for severe illness and those working/living with those at elevated risk.
- Provide focused support for Skilled Nursing Facilities with technical assistance, education, and incentives to increase the proportion of patients and staff who are up to date on vaccinations.
- Maintain a network of at least 200 mobile sites per week that can provide access to vaccines in low-coverage communities and at schools.
- Maintain an extensive community-located clinic and pharmacy vaccination network to ensure access across the entire county.
- Increase numbers of medical providers offering vaccines to their patients through their routine services. Emphasize pediatricians incorporating COVID-19 vaccination into routine vaccination practice.
- Increase participation of health plans in ensuring homebound residents have access to vaccinations and boosters.
- Maintain homebound services to provide vaccinations to those at elevated risk for severe illness.
- Increase the number of residents trained as community ambassadors, parent ambassadors, and student ambassadors.
- Increase funding for CBOs and FBOs to support dissemination of vaccination information and promote access to vaccine clinics.
- Provide expanded services in at least 2 Public Health vaccination sites to provide multiple COVID-19 resources including vaccination, testing, therapeutics, and mental health services.
Testing Preparedness
- Testing may continue to be required by businesses, local or state HOOs, Cal/OSHA or state AFLs in high-risk settings (e.g., SNFs, shelters, correctional facilities, health care facilities, schools), and for outbreak management.
- Access to free and accessible testing for those with symptoms, exposures, exiting isolation or quarantine, or complying with travel and return to work/school requirements, is important. While there are requirements that health plans provide reimbursement to their members for testing, not everyone is insured and there is neither sufficient supply of tests nor ability for all members to purchase tests. Community testing sites that provide free and accessible testing to residents will remain essential over the upcoming months.
- Distribution of antigen test kits continues to be needed in high-risk settings and communities with high case rates, where testing remains an essential strategy for protecting workers and community members/residents.
Therapeutic Distribution Preparedness
The supply of effective therapeutics is currently widely available but there remains a need to ensure that those with less access to health care can receive appropriate therapeutics. This includes the following:
- Ensure a vast network of providers with information, supply of therapeutics, and prescribing ability across the county, with emphasis on deep penetration in hard hit and low-resourced communities.
- Ensure a vast network of distribution sites (including pharmacies and community clinics) that can distribute oral medications with no barriers with deep penetration in hard-hit and less-resourced communities.
- Provide a call center where residents can get more information about therapeutics and how to access therapeutics; provide culturally and linguistically appropriate information and information on accessing free medications.
- Provide a telehealth platform that provides services free of charge for those who are uninsured, underinsured or have difficulty accessing therapeutics through their own providers. This resource would augment sites that can prescribe and distribute oral therapeutics in low-resourced communities.
Surveillance Preparedness
To maintain an early alert system that can track the presence of emerging variants of concern, the following is required:
- Capacity to sequence at least 300 positive specimens over a 2-week period.
- Ability to expand wastewater surveillance to all areas of the county.
- Expanded sentinel surveillance capacity to detect changing patterns in community rates of respiratory illness that might indicate the emergence of a new variant.
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