Even before the coronavirus crisis broke out, the Berkeley Public Health Division (BPHD) had developed a playbook for how to respond to a pandemic flu emergency.
People in the division had crunched numbers, run scenarios, looked at the availability of hospital beds and discussed the methodology for how to trace the people with whom the infected had come into contact.
The pandemic flu scenario is just one routine emergency preparedness plan the BPHD develops each year.
Founded in 1880, the Berkeley Public Health Division is an anomaly. Berkeley is one of just three cities in California (Long Beach and Pasadena are the other two) that runs its own public health agency separate from the county. The Alameda County Health Department oversees the rest of the cities in the county.
The BPHD was established to help curb the spread of communicable diseases such as smallpox, cholera and tuberculosis. Just 38 years after its founding, the city’s emergency preparedness strategy was tested by the global influenza pandemic of 1918, prompting the BPHD to open a temporary emergency hospital for flu patients.
“The absolute, bottom-line function of governmental public health is communicable disease control,” said Dr. Poki Namkung, the health officer for BPHD from 1995-2005. “It all started with communicable disease control and that is our absolutely primary function.”
On March 16, Dr. Lisa Hernandez, Berkeley’s current public health officer, stood on a stage along with six other Bay Area health officers to issue a mandatory shelter-in-place order for Berkeley and most of the region. That was just the first of a number of orders Hernandez issued, orders that have reshaped the familiar outlines of city life.
The shelter-in-place order emptied normally bustling Berkeley streets to help contain the spread of COVID-19. While the city landscape is now eerily empty, early research indicates the social distancing guidelines helped flatten the infection curve by slowing the rate of new COVID-19 cases in the Bay Area.
Three days after the Bay Area announcement, Gov. Gavin Newsom issued a similar order for the entire state.
In January, around the time the first COVID-19 case was reported in the United States, the BPHD activated an emergency operations center in partnership with Berkeley’s fire and police departments and other city staff.
On March 31, Hernandez and the other health officers clarified the shelter-in-place order by adding restrictions on construction. On April 2, she suggested but did not mandate that all residents wear cloth face masks whenever they go outside. She was also instrumental in opening a COVID-19 testing site for Berkeley’s first responders, essential city workers and vulnerable members of the community.
The pandemic and Hernandez’s appearances on Mayor Jesse Arreguín’s virtual town hall meetings have made Hernandez one of Berkeley’s most visible public health officers ever.
The city has said Berkeley residents have generally been good about complying with shelter-in-place rules, although police have received reports of nearly 200 related violations. So far, there have been 40 lab-confirmed cases of COVID-19 in Berkeley. One man in his 40s has died. Twenty-seven people have recovered. But Hernandez is still worried the worst is yet to come.
“Based on our data, the data from the Bay Area and state and nation as well as what we’ve seen in other countries, I worry that we’re in the quiet before the storm,” Hernandez said.
Berkeley can tailor public health initiatives to its population
The BPHD is nested within Berkeley’s Health, Housing & Community Services Department and has the same standing with the state as a county health department, making it just as eligible for state funding as any county-level public health agency. Fifty-three people currently work in the division.
Having its own health agency is a benefit to Berkeley, according to Namkung, the former health officer.
“I think that people should understand that Berkeley having its own independent health department is actually very beneficial in terms of the level of service during ordinary times and the level of service they are getting now during this COVID-19 pandemic,” she said.
While federal and state governments can issue directives that shape the broader response to COVID-19, when it comes to affecting real change, the responsibility falls to local public health agencies.
“What’s important to understand is there are three levels of public health function: local, state and federal. We all work in concert, but the local level is where the action is,” said Namkung. “The local level is the boots on the ground. The Centers for Disease Control and Prevention may say they send out epidemiology teams and they do but, when it comes down to stopping an epidemic, that’s the responsibility of the locals.”
Multiple people told Berkeleyside one of the major upsides to having an independent public health agency is Berkeley’s ability to tailor its mandates to the unique needs of the community — which consists of a university with a large international population, as well as more than 1,000 unhoused individuals — the second-highest number of homeless individuals in the county after Oakland.
Public health researchers at the BPHD don’t have to split their focus between multiple cities within their jurisdiction, the way the Alameda County public health department does, so data about public health in Berkeley have a narrower and more specific scope, said Hernandez.
Evidence collected from research by the BPHD is used to build policy. Both Hernandez and. Namkung pointed to the sugar-sweetened beverage tax that Berkeley adopted in 2014. That is an example of a successful public health policy that started in Berkeley and was adopted widely, they said.
Another benefit, they said, is the ability to build programs that are tailored to the community. For example, Berkeley has a higher rate of sexually transmitted infections than elsewhere in Alameda County, according to data collected by the BPHD. This has led the division to create “targeted interventions” through the city’s nursing and community outreach teams, said Hernandez.
Berkeley Black Infant Health Program responded to city’s needs
The BPHD is also able to build programs that focus on Berkeley residents with the highest needs, as opposed to resources being split among vulnerable populations across the county. One example of this is the Berkeley Black Infant Health Program.
In the early 1990s, black mothers and infants were among Berkeley’s most vulnerable residents. When Dr. Vicki Alexander was director of maternal and child health at the BPHD in 2000, she established the program to address the disparities in birth weight among black babies born in Berkeley.
Between 1993-1995, black infants born in Berkeley were five times more likely to have a lower birth weight than white infants. That racial disparity still exists today, but the gap has narrowed substantially as a result of the city’s program, Alexander said. Now, black infants are 2.5 times as likely to have a lower birth weight.
The program has always been free to any black woman (18+) who is pregnant or parenting in Berkeley. It has parenting classes, counseling and social support, as well as referrals and help with navigating a variety of complex bureaucratic systems.
One reason for the program’s success, Alexander said, is that it hired people from the community to serve as health workers. They worked directly with vulnerable mothers to address their needs. The work went beyond providing prenatal and postpartum care or leading parenting classes. Many community health workers also served as navigators, driving a client in her personal car to multiple appointments, helping her fill out complicated government forms, apply for different benefits, and more, said Alexander.
The program not only reduced the racial disparity in low-birth-weight infants, it also reduced the rate of preterm birth and increased the number of women who got prenatal care. In 2016, for the first time since the city started tracking it in 1990, there was no significant racial disparity between the women who received prenatal care in the first trimester in Berkeley, according to the BPHD Health Status Report of 2018, although there continue to be some disparities in low birth weight and preterm birth.
“I just really love the community health worker kind of model, and that’s the model the Berkeley Black Infant Health program is built on,” said Alexander.
The approach to coronavirus
Hernandez and her public health team are using their knowledge of the city to turn emergency preparedness plans into action.
When it comes to curbing COVID-19 cases, the BPHD is focused on the following, the city said:
- Scaling up access to testing; the city set up a dedicated testing site last week
- Connecting with COVID-19 patients at home or in the hospital to monitor their health and ensure people are self-isolating
- Contact tracing for exposed individuals, which has become more manageable due to shelter-in-place rules
- Protecting vulnerable populations who are likely to be disproportionately impacted by this pandemic. Public health nurses have been going out to homeless encampments to identify people who may be sick or have underlying medical conditions.
- Keeping in regular communication with shelters and senior living communities
Matthai Chakko, city spokesman, said Berkeley’s response reflects the advantage of the city having its own health department. For the past three months, ever since the emergency operations center was set up, Berkeley has been able to deploy its employees in a cohesive manner.
Concerns about the amount of data released
Berkeley’s public health division has been criticized for the paucity of data it has released about those affected by COVID-19, however. At a time when the public is hungry for information, the city has shared minimal details about cases in the city.
The city does not release the ages of those infected, their gender or their race. Other counties have created online, regularly updated dashboards that provide this data to the public. Berkeley also puts its statistics at the bottom of its COVID-19 information page, while other jurisdictions put them at the top, where they are easier to find.
During Arreguín’s first virtual town hall meeting on March 28, Hernandez said Berkeley would soon start providing more granular information. She cautioned in a later interview with Berkeleyside, however, that the cases in Berkeley are so low that it might be hard to provide numbers that are statistically significant.
On Friday, Hernandez promised in a subsequent town hall that more data was forthcoming in the next week or so. She pointed people to a new dashboard from Alameda County that does have additional statistics, but that dashboard has had incorrect and old data for Berkeley on numerous occasions.
Chakko said Berkeley is working on developing its own dashboard, but he did not have an estimate Monday about when that would be completed.
Breaking down the BPHD budget
Today about 45% of BPHD’s $10.5 million budget comes from the general fund and 38% comes from the state. The remainder of the budget consists of grants from the Alameda County health department. This money is used to fund essential public health services, such as subsidized health care for low-income individuals and communicable disease monitoring as well as the COVID-19 response.
But Berkeley is being flexible about funding during the COVID-19 emergency and is allocating extra money where needed, said Kelly Wallace, deputy director of the Health, Housing & Community Services Department.
For example, this year, the BPHD was awarded three grants totaling $267,000 to fund emergency preparedness services. In other years, Berkeley might have used the money to run drills through its emergency operations center, or fund flu clinics or citywide vaccination campaigns. This year the money is being used to pay for the COVID-19 response.
The state also provided another $234,000 in emergency grant funding for COVID-19, which the BPHD is using, in part, to set up services for the unsheltered and other vulnerable populations in Berkeley.
Wallace said there has been a lot of discussion with some of the big funders about how much leeway they are willing to give local public health agencies to reinvest some of the money that was earmarked for specific public health projects related to COVID-19.
California allocates state funding to local public health departments according to population. The scope of governance for the county program includes 13 cities — excluding Berkeley — and six unincorporated areas. So, when the county allocates funding for public health programs, that money is shared across many different cities, and not always proportionally.
The fact that Berkeley stands alone and does not have to compete with 19 different areas for the bulk of its public health funding is a substantial benefit to the city and the community it serves, the city said.
“What public health really does when it’s at its best is change the environment, create the conditions to be healthy, and bring everybody to the same table to work together,” said Namkung. “It is the great, trusted convener of communities.”