COVID-19 Testing Plan - montgomerycountymd.gov

Introduction

Although trending downward, COVID-19 cases, hospitalizations, and deaths remain significant in Montgomery County. As the County continues to fight to contain the spread of COVID-19, testing remains an essential tool. The Department of Health and Human Services (DHHS) is working to increase the number of sites, as well as the number of tests available to residents in the County. To date, over 112,000 Montgomery County residents have been tested. Combined with contact tracing and promoting safe practices, DHHS has reduced the number of positive cases in the County. Sadly, the impact of COVID-19 continues to hit some of our most vulnerable communities. The Department will continue to ramp up its testing efforts, as well as its human services supports, until it is successful in ending this pandemic for all of Montgomery County residents.

The COVID-19 testing plan, which leverages the increased availability of testing, is occurring along three concurrent tracks:

The Testing Plan includes:

COVID-19 CASE INVESTIGATION AND CONTACT TRACING – To identify and contain the spread of COVID-19.
HUMAN SERVICES SUPPORTS – Support to communities at elevated risk and households exposed to COVID-19.

The racial and ethnic disparities of COVID-19 across the County require that testing and services be prioritized for individuals in those communities that have been hardest hit, and continue to be at greatest risk (see map and top 10 ranking of positive COVID-19 cases by zip code on next page).

Testing Targets and Timeline

The long-term goal is expanding testing capacity until testing capacity is increased to 20,000 people/week by September 2020 and 30,000 people/week by October across all three testing tracks. The threshold of 20,000 people/week is based upon meeting the stated goal of testing 10% of the County's population monthly as a part of the County's re-opening dashboard; increasing to 30,000 people/week would meet the benchmark of testing approximately 10% of the population on a monthly basis. As of July 12, 2020, at least 10% of the population in each of the top 10 zip codes by cases have been tested.

Positive Cases by Zip Code

Data up to 07-09-2020 ( source )

Top 10 Montgomery County ZIP codes for positive cases
Zip Code	Postive Cases	Case per 1,000
20906	1,738	25
20902	1,348	26
20904	1,120	20
20877	994	26
20903	959	37
20874	712	12
20901	668	18
20886	650	19
20850	632	12
20910	513	12

Strategies to ensure outreach and connection with hardest impacted communities:

DHHS will continue to connect with community agencies and key stakeholders within those communities identified above as hardest hit by COVID 19. These partnerships are invaluable as they may offset community concerns of mistrust in utilizing government resources within the current political climate, and more quickly and effectively identify and communicate with families in need. In addition to sustained engagement, DHHS will utilize surveillance data to identify any areas with emerging cases, elevated test positivity rates, and high volumes of secondary contacts to lab confirmed cases. This will be accomplished through a combination of digital, social, print and visual media, leveraging community resources, and networks, including local TV outlets, etc. to convey appropriate prevention and educational outreach. This effort will be led by the PIO and Communications team, working closely with Ken Hartman, who meets regularly with representatives from a broad range of community groups, including the DHHS Minority Health Program and Health Initiatives. Additionally, the Public Health Services Disease Control team is partnering with community agencies, such as Casa de Maryland, to provide contact tracing in those high impacted zip codes.

In addition to providing contact investigations, the trained staff will also link individuals/families to social support services to address any non-clinical needs residents may face. The connection to human services is a critical component that will enable individuals/families to prioritize recovery as well as the implementation of recommended public health practices by removing barriers to accessing non-medical supports (e.g. housing, food, personal care items, financial assistance, counseling etc.). Programs/services across DHHS are working in collaboration with trusted community providers to address the human services needs of individuals/families impacted by COVID-19. Such efforts include the following examples:

Connecting Montgomery County residents to local food pantries (pick-up and home delivery available);
Enabling safe and secure COVID-19 isolation when needed,
Supporting the tremendous efforts of the County's Hubs (additional information regarding the Hubs is provided on page 4) that address a variety of needs;
Connecting residents to staff within various DHHS programs/services for assistance in eligibility determination/application for a spectrum of local and state resources; and
Connecting impacted communities to the services/resources available via the DHHS Street Outreach Network

Progress Metrics

COVID-19 testing progress will be monitored through an internal dashboard that monitors the number of participants tested in highly impacted zip codes, track the number of kits distributed & analyzed, identifies partners engaged throughout the County, records the progress of partnership testing events, and displays the schedule of COVID-19 testing events. Weekly reports will be provided to County Executive Elrich and the Montgomery County Council, and regular updates will be provided during scheduled briefings.

How Do We Get There?

1. Community-Based Testing (Target: 20,000 Tests/Week)

A. Expansion of Capacity at Current Testing Locations

DHHS will expand to five testing locations in various locations throughout the Montgomery County; preference for placement will be in highly impacted zip codes, and where access to testing has been limited. The testing sites would include the current sites in the Wheaton and Germantown areas, the Dennis Avenue Health Center, and the Gaithersburg Lake Forest Mall parking lot.
County and large-scale testing sites will expand hours of operations to 5 - 7 days/week for a minimum of 4 hours. Individual testing locations may run longer.
Testing clinics will vary times of operation throughout the day to provide options for access to testing, this includes some locations with evening hours.
Target is to provide 400 or more appointments/day at 5 tests sites, or 2,000 kits daily.
The strategy for increasing volume of testing at existing sites include: increase hours of operations and number of tests per day; increased use of AdvaGenix collection process; and addressing staffing requirements.
The co-location of DHHS human services personnel at COVID-19 sites is a recent addition to the Department's efforts. Residents are offered materials (and in some instances screened onsite) regarding additional human services programs/supports administered by various entities (the County, local non-profits and the state).

B. Standing Up Additional County Test Sites

Two Centers for Disease Control and Prevention (CDC) trailers as fixed test sites
- Targeted capacity: 400 appointments daily/2,000 weekly
- Proposed locations: Lake Forest Mall, Dennis Avenue Health Center (Start date: week of July 13)
Pop-up testing sites throughout the County, including in municipalities (e.g. Takoma Park, Friendship Heights, Rockville, Silver Spring)
- Target capacity: 400-1,000 appointments/session/2,000-4,000 weekly (Start date: in progress)

C. East County Hub Test Site Using Contracted Site Coordination – Targeted Capacity

Working with representatives from AASTHA to provide daily testing at their east county clinic space, with a targeted capacity of 6000/week; the facility would be open 7 days/week.
- Contract completion in progress
- Staffing and support in progress
- Training and testing orientation in progress
- Logistics support in progress
Start date: Week of July 20

D. Support Montgomery County Hubs and Other Community Partners Coordinating Community-Based Testing Events

Community-based testing in collaboration with the Montgomery County Hubs (Upcounty Consolidation Hub for Community Needs, Gaithersburg CARES Hub, East County Hub, Silver Spring Hub, and the Mid-County Hub) and other community partners.
Testing events will be managed by community volunteers and local providers with County support to assist in providing focused community-based testing and DHHS human services outreach and support.

E. Montgomery Cares Clinics

Identification of Montgomery Cares clinic partners to provide testing onsite for clinic patients; four have been currently identified for initial engagement (Proyecto Salud, Holy Cross clinics, Mary Center, Chinese Culture and Community Services Center)
Targeted capacity: 1,000/weekly
Start date: last week of July

F. Employer based closed pod testing

Targeted capacity: dependent upon employer size 1,000-2,000/weekly
Provide large employers, including large retailers, local hospitals with closed pod distribution and collection.
Start date: August 2020

G. Resume Home-Based Testing through contract with Ready Responders National Capital Region PC

Targeted capacity: 56 appointments/weekly
Ready Responders will serve as the County's Rapid Response Team to conduct in-home testing seven days/week for County residents residing in geographic areas highly impacted by COVID-19; who are members of population groups disproportionally affected by COVID-19; who are homebound or face significant barriers to accessing community testing; and, households with complex or unique situations in which in-home testing would be more effective than community testing. Households impacted by COVID-19 will be connected to community-based human service supports to assist their recovery.
Priority scheduling will be given to households in zip codes with the highest positive case counts. (See above.)
While onsite, Ready Responders will also complete a brief human services assessment to gauge the household's need and interest in receiving follow-up by DHHS to ensure access to community and County resources that meet identified need(s).

2. Clinical and Congregate Settings (Target: 8,000 Tests/Week)

A. Continuation and Expansion of Testing in Clinical and Congregate Settings

CLINICAL AND CONGREGATE SETTING TYPE	PROJECTED TEST KITS WEEKLY	PROJECTED TEST START DATE
Shelters	100	June 2020
Independent Living and Older Adult communities	To be determined (TBD)	July 2020
Group Homes (DDA Homes and Smaller Assisted Living)	TBD	July 2020
Large Assisted Living Facilities (>50 residents)*	3,500	August 2020
Nursing Homes*	3,500	July 2020
Hospitals** MedStar Montgomery/Holy Cross Health/Ascension Health	TBD

B. Strategy for Expanding Capacity

DHHS is working with local healthcare practices and congregate care locations to also test staff, patients and residents. Testing occurs on-site at facilities approved to test. Testing facilities must have Site Collector access from AdvaGenix prior to testing.

Testing will occur weekly with facilities dropping off specimens at the Dennis Avenue Health Center (DAHC) or requesting pick up of test kits from DAHC logistics.
*Test kits are currently provided by the state. All staff are required to be tested weekly. Upon identification of a positive case linked to a staff member or resident, all residents must be tested in addition to staff. When facilities have completed outbreak protocols, they can stop weekly testing of all residents and testing requirements are reduced by approximately half. On July 9, 2020, the Maryland Department of Health (MDH) notified all Nursing Homes that it will be providing testing, at least through August 1, 2020. Large Assisted Living Facilities have not received a start date as of yet. However, MDH has indicated that these facilities will also receive testing from the state for required weekly testing of staff and contractors, at least through August 1, 2020. DHHS is in discussion with MDH on the post August 1, 2020 plans.
** County Hospitals have indicated that routine testing for staff will be optional. These facilities are exploring testing options with both the County and their existing lab and corporate partnerships.
Facilities will conduct their own testing using dedicated medical staff on-site. Exceptions may occur with DHHS providing testing staff on a case by case basis.
DHHS will provide test kits and potential pick-up service.
Test kits will be primarily oral swab or nasal swab.

3. Montgomery County Employees (2,500 kits/week)

Public Health Services' Disease Control team facilitates employee testing for each County Department. Testing occurs at the employee's worksite.

Department	Status	Tests	Test Start Date
MCFRS	Active	1000	Started
Sheriffs	Active	200	Started
DOCR	Active	538	Started
HHS	Active	551	Started
ABS	Active	100	Started
MCPD	Planning	1000	July 31, 2020
REC	Planning	350 Projected	July 31, 2020
DGS	Planning	350 projected	July 27, 2020
Procurement	Planning	10 projected	July 27, 2020
OHR	Planning	5 projected	July 27, 2020
OMS	Planning	5 projected	July 27, 2020
OMB	Planning	5 projected	July 27, 2020
Public Libraries	Planning	307 projected	July 27, 2020
DOT	Planning	722 projected	July 27, 2020
DPS	Planning	119 projected	July 27, 2020
DHCA	Planning	40 projected	July 27, 2020
DEP	Planning	80	July 27, 2020
Ethics	Planning	5 projected	July 27, 2020
CAO	Planning	10 projected	July 15, 2020
CE	Planning	9 projected	July 15, 2020

*At this time, it is not mandatory for departments to test, therefore, numbers will vary weekly. Testing of County employees requires Union agreement.
Locations will conduct their own testing using trained staff on-site. Exceptions may occur with DHHS providing testing staff on a case by case basis.
DHHS will provide test kits and potential pick-up service.
Test kits will be primarily saliva or oral swab.

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