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COVID-19 Response Plan

page last updated on 3/21/2023

LA County Department of Public Health is working on updating the information on this page based on recent changes to state and local guidance. The data in the Los Angeles County Metrics, Early Alert Signals, and Preparedness Plan will continue to be updated regularly during this transition.

LA County’s Current CDC Community Level is:

Low

View Los Angeles County COVID-19 Response Plan (PDF)

Los Angeles County Metrics
New Cases
(per 100,000 people in last 7 days)		 New COVID-19 admissions per 100,000 population (7-day total) Proportion of staffed inpatient beds occupied by COVID-19 patients (7-day average)
49.5/100,000 5.4 3.1%
The case rate is calculated by the LA County Department of Public Health to allow for more timely updates. The two hospitalization metrics are calculated by the CDC and posted on the CDC Community Levels website. Data was updated on March 16, 2023.

Los Angeles County (LAC) will continue to use the Centers for Disease Control and Prevention’s (CDC) COVID-19 COVID-19 Community Level Matrix to guide assessment of risk across the county and inform the adoption of prevention strategies (see Community Safety Protection Measures and Prevention Strategies below). LA County will implement strategies for a higher community level when results for both hospital metrics in the framework are at or above the thresholds for the higher community level for at least fourteen (14) consecutive days. Strategies will revert back to a lower community level when the result for at least one hospital metric has fallen below the threshold for the higher community level for at least fourteen (14) consecutive days.

Indicators Low Medium High
Fewer than 200 New COVID-19 admissions per 100,000 population (7-day total) <10.0 10.0-19.9 ≥20.0
Proportion of staffed inpatient beds occupied by COVID-19 patients (7-day average) <10.0% 10.0-14.9% ≥15.0%
200 or more New COVID-19 admissions per 100,000 population (7-day total) NA <10.0 ≥10.0
Proportion of staffed inpatient beds occupied by COVID-19 patients (7-day average) NA <10.0% ≥10.0%

(Aligned with CDC Community Levels and Community Transmission)

The Community Safety Protection Measures and Prevention Strategies below reflect CDC, state, and county mitigation efforts in four areas: indoor masking, testing, vaccination verification, and ventilation. Federal and state requirements are embedded in the table below and will be changed if and when these requirements change.

*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 community levels. Please scroll horizontally to view all community level strategies.

CDC Community Level1:
LOW		 CDC Community Level1:
MEDIUM		 CDC Community Level1:
HIGH
Community Transmission:
Weekly Case Rate		 <100/100K >100/100K <100/100K >100/100K All Transmission Levels
Indoor Masking

Note: Employers must offer well-fitting medical masks and respirators to employees working indoors in close contact with other workers and/or customers at all sites		 All individuals, regardless of vaccination status Individual preference3, unless required by site Strongly recommended unless required by site Individual preference3, unless required by site Strongly recommended unless required by site Required indoors in all public spaces and businesses
Individuals at elevated risk2 Strongly recommended in higher risk settings unless required by site Strongly recommended unless required by site Strongly recommended in higher risk settings unless required by site Strongly recommended unless required by site Required
For those exposed Required to mask indoor for 10 days after last day of exposure Required to mask indoor for 10 days after last day of exposure Required to mask indoor for 10 days after last day of exposure Required to mask indoor for 10 days after last day of exposure Required to mask indoor for 10 days after last day of exposure
For those confirmed positive Required to isolate for up to 10 days unless test negative on day 6; mask strongly recommended for those who test negative on day 6-10; in workplace settings masks are required for the full 10 days Required to isolate for up to 10 days unless test negative on day 6; mask strongly recommended for those who test negative on day 6-10; in workplace settings masks are required for the full 10 days Required to isolate for up to 10 days; mask strongly recommended for those who test negative on day 6-10, in workplace settings masks are required for the full 10 days Required to isolate for up to 10 days unless test negative on day 6; mask strongly recommended for those who test negative on day 6-10; in workplace settings masks are required for the full 10 days
All healthcare settings and congregate care facilities Required Required Required Required Required
Correctional and detention facilities, homeless and emergency shelters Individual preference3 outside of clinical areas unless required by agency, if no outbreak has occurred within 14 days Strongly recommended, unless required by agency, if no outbreak has occurred within 14 days Required Required Required
Public transit, transportation hub, and transportation service (including shuttle bus, ride share, taxis, and medical transport) Strongly recommended, unless required by agency Strongly recommended, unless required by agency Strongly recommended, unless required by agency Strongly recommended, unless required by agency Required
Testing Routine screening testing in workplaces As required by the site or sector As required by the site or sector As required by the site or sector As required by the site or sector As required by the site or sector
For those exposed Required if not quarantining Required if not quarantining Required if not quarantining Required if not quarantining Required if not quarantining
For those symptomatic / confirmed positive Required to exit isolation at day 5; otherwise Isolate for 10 days Required to exit isolation at day 5; otherwise Isolate for 10 days Required to exit isolation at day 5; otherwise Isolate for 10 days Required to exit isolation at day 5; otherwise Isolate for 10 days Required to exit isolation at day 5; otherwise Isolate for 10 days
Before gathering socially with those at elevated risk Individual preference3, unless required by site Strongly recommended, unless required by site/host Individual preference3, unless required by site Strongly recommended, unless required by site/host Strongly recommended, unless required by site/host
Vaccination / Negative Test Verification For healthcare workers, employees at healthcare facilities, and employees at high-risk congregate care settings and homeless shelters Vaccination Required Vaccination Required Vaccination Required Vaccination Required Vaccination Required
For visitors indoors at healthcare facilities, including congregate care sites Strongly recommended unless required by site Strongly Recommended unless required by site Strongly recommended unless required by site Strongly recommended unless required by site Require all visitors, regardless of COVID vaccination status, to be tested (PCR or Antigen) prior to indoor visitation
Outdoor mega events Individual site preference Individual site preference Individual site preference Individual site preference Individual site preference
Indoor mega events Individual site preference Individual site preference Individual site preference Individual site preference Strongly recommended unless required by site
For staff in homeless shelters Vaccination Required Vaccination Required Vaccination Required Vaccination Required Vaccination Required
Environmental Mitigation Ventilation throughout indoor spaces Strongly recommend to ensure and maintain improved ventilation throughout indoor spaces Strongly recommend to ensure and maintain improved ventilation throughout indoor spaces Strongly recommend to ensure and maintain improved ventilation throughout indoor spaces Strongly recommend to ensure and maintain improved ventilation throughout indoor spaces Strongly recommend to ensure and maintain improved ventilation throughout indoor spaces
(1) CDC recommends use of COVID-19 Community Levels to determine the impact of COVID-19 illness on health and healthcare systems and the prevention measures to use for individuals, households, and communities. The CDC Community Level can be Low, Medium, or High and is determined by the higher of the new COVID-19 admissions and inpatient beds occupied by COVID-19 patients metrics, based on the current level of new cases per 100,000 population in the past 7 days.

(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.

(3) Individual preference means that no person can be prevented from wearing a mask as a condition of participation in an activity or entry into a business.

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 three (3) community-wide measures (variants of concern, Emergency Department COVID-19 visits, cumulative case rate in high poverty communities) and four (4) sector specific measures (outbreaks at Skilled Nursing Facilities [SNFs], outbreaks at kindergarten 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 as outlined in the Priority Sector Response table below.

Indicator Thresholds Low Concern Medium Concern High Concern LA County's Current Values
Percent of specimens sequenced that are identified as a new subvariant of interest* (based on WHO, CDC, or local designation)1
Currently tracking: XBB.1.5		 < 10% 10%-20% > 20% 70%
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 29 per 100,000
Current SARS-CoV2 wastewater concentration as a percentage of the Winter 2022-2023 peak concentration value4 < 30% 30-60% > 60% 43%
Number of new outbreaks in skilled nursing facilities over the past 7 days5 ≤10 11-20 >20 11
Number of new outbreaks in TK-12 school classrooms over the past 7 days5 ≤ 10 11-20 >20 1
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 14
*A “new” variant or subvariant of interest is defined as a variant or subvariant that has been detected in LA County for less than 12 weeks from the date it was first detected locally for the 5th time. If a new variant of interest is also designated a Variant of High Consequence based on WHO or CDC designation, it will result in immediate designation at the level of “High Concern.”

(1) Current 7-day period is 2/12/23 – 2/18/23.
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 2-3 weeks after specimen collection. Variant proportions are calculated in weekly intervals using date of specimen collection. Weekly estimates may be revised as additional data is reported.

(2) Current 7-day period is 3/11/23 – 3/17/23.
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 3/11/23 – 3/17/23.
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 2/26/23 – 3/4/23.
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 3/13/23 – 3/19/23.
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). As of 6/16/22, the threshold for opening an outbreak in a Persons Experiencing Homelessness (PEH) setting changed from at least 1 case or 2 persons under investigation to at least 2 cases or 3 persons under investigation. As of 7/8/22, the threshold for opening an outbreak in a PEH setting changed from at least 2 cases or 3 persons under investigation to 3 cases or 3 persons under investigation.

(6) Current 7-day period is 3/13/23 – 3/19/23.
Worksite clusters are 3 or more cases within 14 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. As of 5/10/22, the reporting cutoff for the last day of 7-day reporting period was adjusted from 11:59PM to noon. 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 four (4) sectors, the table below provides additional general mitigation measures and other measures that should be implemented based on the level of concern triggered in the LA County Early Alert Signals table above. Further measures might be considered beyond what is listed in the table below.

NOTE: All sectors should follow the minimum requirements related to indoor masking, testing, vaccination verification, and ventilation measures set forth in the Community Safety Protection Measures and Prevention Strategies section above.

Sector General Mitigation Measures Low Concern Medium Concern High Concern
SNFs*
The measures in this table are general information for the public. Healthcare facilities must follow specific LAC DPH guidance and CDPH and CMS requirements.
  • Strongly recommend that those that are eligible are up-to-date with their COVID-19 vaccines (required for SNF employees).
  • Ensure adequate testing capacity to meet routine screening and response testing requirements as defined by the state’s All Facility Letters (AFLs), county HOOs, and CMS QSO 20-30, whichever is more stringent.
  • Ensure access to therapeutics.
  • Test all symptomatic staff and residents.
  • Report all cases among staff and residents. Continue aggressive management of outbreaks and expanded infection control measures. Conduct contact tracing and assure proper isolation of cases and quarantining of close contacts based on the county HOO. Test contacts within facility as required after exposure.
  • Continue to provide consultation, education and information on optimal infection control practices.
  • Prioritize DPH assistance with outbreaks.
  • Require N95 respirators for all staff during the entire time while in the facility.
Transitional Kindergarten (TK)-12 Grade
  • Strongly recommend that all eligible staff and students are up-to-date with their COVID-19 vaccines.
  • Strongly recommend that symptom screenings be conducted for staff and students.
  • Follow COVID-19 exposure management guidance for TK-12 schools.
  • Ensure response testing capacity at K-12 schools.
  • Continue offering group contact tracing option to schools as an alternative to individual contact tracing in TK-12 schools.
  • Report clusters of cases among staff and students. Prioritize DPH assistance with outbreak management. During an outbreak, the Public Health outbreak response team may require changes in safety protocols. This may include more stringent guidance on masking, testing, and isolation periods.
  • Strongly encourage school-based health centers to enroll as COVID-19 vaccine providers.
  • Actively encourage students and staff to stay home when sick.
  • Actively encourage students and staff to stay home when sick.
  • Recommend testing before/after large school events and before return to school after breaks as resources allow.
  • Actively encourage students and staff to stay home when sick.
  • Strongly recommend masking indoors for high- risk activities, including indoor medium- and high-contact sports, singing, band/orchestra.
  • Strongly recommend periodic testing for those participating in high-risk indoor activities, including indoor medium- and high-contact sports, singing, band/orchestra as resources allow.
  • Strongly recommend testing before/after large school events and before return to school after breaks as resources allow.
Persons Experiencing Homelessness (PEH)
  • Strongly recommend that those that are eligible are up-to-date with their COVID-19 vaccines.
  • Ensure capacity for asymptomatic screening and response testing of residents at shelters using point-of-care or other tests.
  • Ensure access to therapeutics.
  • Test all symptomatic persons for COVID-19 regardless of vaccination status.
  • Continue to provide consultation, education, and information on optimal infection control practices.
  • Provide cohorting/isolation space onsite at congregate facilities where possible.
  • Cohort and quarantine close contacts while onsite in congregate facilities and allow them to move about the community with no restrictions.
  • Assure proper isolation of cases based on the county HOO.
  • Report all cases among staff and residents to DPH.
  • Prioritize DPH assistance with outbreak management.
  • Continue aggressive management of outbreaks and expanded infection control measures.
  • Offer high-quality masks to all residents.
  • Offer high quality masks to all residents.
  • Consider conducting weekly screening testing with point-of-care or other tests for residents if resources allow
  • Offer well-fitting medical masks or respirators to all residents.
  • Strongly recommend conducting, at minimum, weekly screening testing of all residents and staff, regardless of vaccination status. If resources allow, conduct screening testing twice a week for shelter staff and residents, regardless of vaccination status.
Worksites
  • Employers required to offer well-fitting medical masks and respirators to employees working indoors in close contact with other workers and/or customers.
  • Ensure information regarding vaccinations, testing and therapeutics to employees.
  • Encourage worker vaccination.
  • Require symptomatic workers to isolate and test.
  • Workers who have a close contact or are exposed to a COVID-19 case must test within 3-5 days as soon as possible and wear a well-fitting mask while indoors around others.
  • Employers required to report to DPH if 3 or more COVID-19 cases are known or reported at a worksite within a 14-day period.
  • Investigate workplace outbreaks; employers to implement safety measures that limit transmission.
  • Continue to provide consultation, education, and information on optimal infection control practices.
  • Optimize ventilation at worksites.
  • Actively encourage and support employees to stay home when sick.
  • Strongly recommend masking indoors for workers at elevated risk with significant contact with the public or other workers.
  • Strongly recommend masking indoors and in shared vehicles for all workers.
  • Increase risk messaging at high-risk worksites such as manufacturing and warehousing.
  • Encourage physical distancing in communal areas, such as breakrooms and cafeterias.
  • Strongly recommend masking indoors and in shared vehicles for all workers.
  • Increase risk messaging to high-risk worksites such as manufacturing and warehousing.
  • Encourage remote work where operationally feasible, especially for workers at elevated risk.
  • Strong recommendation to implement physical distancing in communal areas such as breakrooms and cafeterias.
Highly Impacted Communities
  • Increase vaccination and booster coverage.
  • Ensure access to vaccinations, testing and therapeutics in communities hardest-hit by COVID-19.
  • Continue investment in community-based organizations (CBOs) and faith-based organizations (FBOs) working in communities hardest hit to provide resource linkages, conduct COVID-19 outreach and education, and facilitate access to vaccination opportunities.
  • Continue Public Health Councils program to provide critical support to low-wage essential works; consider broader efforts to support other essential, low-wage worker industries not previously included in the pilot program.
  • Prioritize community and workplace outreach and vaccination efforts in communities showing increased rates of transmission.
  • Begin to assess quarantine and isolation (QI) housing capacity if rates of transmission and/or illness severity continue to increase.
  • Expand PH Council outreach in essential low-wage worker industries. disproportionately impacted by outbreaks.
  • Support access to PPE and screening testing in priority sectors and communities.
  • Tailor CBO/FBO messaging for communities of concerns.
  • Continue to prioritize community and workplace outreach and vaccination efforts in communities showing increased rates of transmission and/or illness severity.
  • Promote enhanced and targeted outreach by CBOs and other partners to support growing demand for education resources.
  • Explore increased QI housing capacity, if necessary.
  • Support targeted PPE and screening testing access in priority sectors and communities.
  • Amplify CBO/FBO messaging for communities of concern; convene CBO/FBO partners to discuss strategies and resources to mitigate the spread of COVID-19.

Aligned with CDC Community Levels

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.

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 300 610
(3/10/23-3/17/23)
Access to vaccines: Number of fixed vaccination sites Less than 900 900-1,100 More than 1,100 1,004
(3/8/23-3/14/23)
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%
(2/12/23-2/18/23)
Vaccine uptake: Percentage of residents 65+ who have received an updated booster dose1 Less than 60% 60%-90% More than 90% 38%
(as of 3/12/23)
Outbreak management: Percentage of high-risk worksite outbreaks2 that have had at least one site visit by DPH Less than 75% 75%-85% More than 85% 100%
(2/7/23-3/7/23)
Testing access for the Public: Average wait time across all County-run testing sites More than 1 hour Between 30-60 minutes Less than 30 minutes 10 minutes
(3/5/23-3/11/23)
Testing access at Schools: Percentage of TK-12 public schools that have capacity for response testing3 Less than 80% 80%-90% More than 90% 93%
(as of 3/14/23)
Testing access at SNFs: Percentage of Skilled Nursing Facilities (SNFs) that have capacity for routine response testing Less than 90% 90%-99% 100% 100%
(3/5/23-3/11/23)
Access to therapeutics: Number of sites in the most vulnerable communities4 that dispense therapeutics5 Less than 150 sites 150-250 sites More than 250 sites 575
(as of 3/10/23)
Access to therapeutics: Percentage of eligible residents using the call center who received recommended therapeutics Less than 80% 80%-90% More than 90% 100%
(2/28/23-3/6/23)
Surveillance – Sequencing: Number of positive case specimens that are sequenced per week Less than 300 300-1,200 More than 1,200 300
(2/12/23-2/18/23)
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 3/4/23)
Surveillance – EDs: Percentage of EDs reporting COVID-like illness data Less than 80% 80%-90% More than 90% 81%
(as of 3/12/23)


(1) An updated booster dose is a bivalent booster dose administered on or after 9/1/2022.

(2) High-risk worksite outbreaks are defined as 1) manufacturing or warehousing work settings with at least 50 employees; 2) airline/airport setting; or 3) any industry with 5 or more epidemiologically linked cases. High-risk worksite outbreak definitions may change at higher levels of community transmission and/or when number of outbreaks exceed local investigation capacity.

(3) Response testing is conducting testing among individuals who have signs or symptoms consistent with COVID-19 or who are asymptomatic but have had a recent known or suspected exposure to COVID-19.

(4) 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.

(5) Therapeutics include oral and injectable medications used to prevent infection or disease progression among those with infection.
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    • Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.

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