COVID-19 Response Plan

page last updated on 02/22/2024

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 COVID-19 mitigation strategies in response to an increase in hospital admission levels when new hospital admissions move into the High 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.

For certain high-priority healthcare sectors, LA County will implement COVID-19 mitigation strategies immediately when the County’s CDC COVID-19 hospital admission level moves into the Medium Level and will revert strategies when the hospital admission level has fallen back into the Low Level for at least 2 weeks.

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 5.0
*Data was posted by CDC on 2/16/24 using data for the 7-day period ending on 2/10/24.

(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
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
  • by individual sites, including some businesses, health facilities, schools, and workplaces.
  • by Public Health when managing an outbreak, including in workplaces and congregate settings.
  • by Cal/OSHA ATD Standards and Non-ETS regulations as applicable for employers, employees, and places of employment.
For those confirmed positive Regardless of the level:
  • Wear a mask if there is a need to be in the same room with others while staying home for 10 days.
  • People with no fever for at least 24 hours without the use of fever reducing medicine AND have no other symptoms or their symptoms are mild and improving after Day 5, may stop wearing their mask sooner (between Day 6-10) if they have two sequential negative COVID-19 tests taken at least one day apart. Note that people returning to the workplace after a COVID-19 infection are required to mask around others through Day 10 per Cal/OSHA.
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. Required for healthcare workers and visitors in licensed healthcare facilities providing inpatient care. Required for healthcare workers providing patient care and in patient care areas.

Required for all patients and visitors.
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.
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.
(1) 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. Individuals are encouraged to choose to wear a mask based on their preference and personal risk.

(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: BA.2.86 (including JN.1)
< 10% 10%-20% > 20% 79%
7-day average of the percent of Emergency Department (ED) encounters classified as coronavirus-related2 < 5% 5%-10% > 10% 3%
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 13 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 5
Number of new outbreaks in TK-12 school classrooms over the past 7 days5 ≤ 10 11-20 > 20 0
Number of new outbreaks in PEH settings over the past 7 days5 ≤ 10 11-20 > 20 0
Number of worksite cluster reports in the past 7 days6 < 150 150-350 > 350 2
*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 14-day period is 01/07/24 – 01/20/24.
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 02/12/24 – 02/18/24.
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 02/11/24 – 02/17/24.
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 02/04/24 – 02/10/24.
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 02/14/24 – 02/20/24.
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 02/14/24 – 02/20/24.
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
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.
  • Strongly recommend that those that are eligible are up to date with COVID-19 vaccines.
  • 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-20-38-NH (Revised 09/23/2022), whichever is more protective.
  • Ensure timely access to therapeutics.
  • Test all symptomatic staff and residents.
  • Report all cases among residents and report 3 linked cases within 7 days among staff. 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 Guidelines for Preventing & Managing COVID-19 in Skilled Nursing Facilities.
  • Follow all DPH requirements during an outbreak.
  • Require mask for all staff and visitors during the entire time while in the facility.
  • Require all visitors to test for COVID-19 within 24 hours before their visit. If not done prior to arrival at the facility, SNFs will offer over-the-counter antigen tests for visitors to self-test prior to entry.
SECTOR: Transitional Kindergarten (TK)-12 Grade
  • Strongly recommend that all eligible staff and students are up to date with their COVID-19 vaccines.
  • Follow COVID-19 exposure management guidance for TK-12 schools.
  • Report clusters of 3 or more linked confirmed cases among staff and students who were on campus at any point within the 7 days prior to illness onset date.
  • 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 to control further spread on site.
  • Optimize ventilation in indoor spaces in schools. Follow standard infection control guidance, including actively having sick students and staff remain home when sick, isolate when infected and wear a mask for 10 days after last exposure,
  • Strongly encourage school-based health centers to enroll as COVID-19 vaccine providers.
  • Adhere to any public health safety protections issued for schools.
  • Strongly recommend testing before attending large indoor gatherings and after engaging in higher risk activities, like travel or having been in crowded indoor spaces, as resources allow.
  • Increase messaging to students and staff about the importance of layering in additional precautions to protect against COVID-19.
Resources for Transitional Kindergarten (TK)-12 Grade and Other Educational Settings:
1)COVID-19 Prevention and Response Guidelines for Education Settings
SECTOR: Shelters and Interim Housing Serving Persons Experiencing Homelessness (PEH)
  • Strongly recommend that staff and residents stay up-to-date with their COVID-19 vaccines.
  • Offer well-fitting masks to all residents and staff.
  • Ensure adequate supply of tests for close contacts and symptomatic persons.
  • Test all symptomatic persons for COVID-19 regardless of vaccination status.
  • Ensure access to therapeutics.
  • Continue to provide consultation, education, and information on optimal infection control practices.
  • Provide cohorting/isolation space onsite at congregate facilities where possible.
  • Assure proper isolation of cases.
  • Report three or more cases among staff and residents within a 7-day period to DPH.
  • Prioritize DPH assistance with outbreak management.
  • Continue aggressive management of outbreaks and expanded infection control measures.
  • Masking strongly recommended or required depending on an assessment of local conditions at the time.
  • Strongly recommend weekly screening testing of all residents and staff, regardless of vaccination status. If resources allow, conduct screening testing twice a week.
Resources for Shelters and Interim Housing Facilities:
1)Guidance for Homeless Shelters
SECTOR: Worksites
  • Employers must provide a respirator to all employees who are working indoors or in vehicles with more than one person upon request for voluntary use.
  • Employers shall provide face coverings and ensure they are worn by employees when required by Cal/OSHA or DPH regulation or order and should make surgical masks or higher-filtration masks (e.g., N95s, KN95s, KF94s) with good fit available at all times.
  • Ensure information regarding vaccinations, testing and therapeutics is available to employees.
  • Encourage worker vaccination.
  • Exclude COVID-19 cases from the workplace until they are no longer an infection risk and meet the Cal/OSHA return-to-work criteria.
  • Workers who have a close contact or are exposed to a COVID-19 case should test as soon as possible to determine their status and test again within 3-5 days and should wear a well-fitting mask while indoors around others. During an outbreak, more protective measures are required.
  • Employers required to report to DPH if 3 or more linked COVID-19 cases are known or reported at a worksite within a 7-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.
  • Strong recommendation to implement physical distancing in communal areas such as breakrooms and cafeterias.
SECTOR: Highly Impacted Communities
  • Increase up to date vaccination 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 workers; 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 and/or illness severity.
  • Promote enhanced and targeted outreach by CBOs and other partners to support growing demand for education resources.
  • Expand PH Council outreach in essential low-wage worker industries disproportionately impacted by outbreaks.
  • Assess quarantine and isolation (QI) housing capacity if rates of transmission and/or illness severity continue to increase. Explore increased QI housing capacity, if necessary.
  • Support access to PPE and screening testing 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.

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 300 207
(1/27/24 - 2/02/24)
Access to vaccines: Number of fixed vaccination sites offering free vaccinations Less than 550 550-649 More than 650 688
(as of 02/20/24)
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% 83.3%
(1/21/24-1/27/24)
Vaccine uptake: Percentage of residents 65+ who are up to date on COVID-19 vaccines1 Less than 60% 60%-90% More than 90% 29%
(as of 2/18/24)
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 150,000 190,428
(2/12/24-2/18/24)
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%
(2/12/24-2/18/24)
Testing access at SNFs: Percentage of Skilled Nursing Facilities (SNFs) that have capacity for routine response testing Less than 90% 90%-99% 100% 100%
(2/12/24-2/18/24)
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 2/20/24)
Access to therapeutics: Percentage of eligible residents using the call center who received recommended therapeutics Less than 80% 80%-90% More than 90% 100%
(02/05/24-02/11/24)
Surveillance – Sequencing: Number of positive case specimens that are sequenced in the most recent two-week period Less than 150 150-300 More than 300 990
(1/7/24 - 1/20/24)
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 2/21/24)
Surveillance – EDs: Percentage of EDs reporting COVID-like illness data Less than 80% 80%-90% More than 90% 81%
(as of 2/21/24)


1 Percent of LAC residents who are 65+ and up to date with all recommended COVID-19 vaccines. LAC residents who are 65+ are considered up to date if they have received at least one 2023-2024 mRNA COVID dose or at least 1 or 2 2023-2024 Novavax doses, depending on previous vaccination history.

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.