Broward County is the second most populous county in Florida, 17^th most populous in the United States, with almost 1.9 million people and 10% of Florida's residents. We are home to an international airport, ranked 19^th in the U.S. in total passenger traffic and a seaport, which is the cruise ship capital of the world. We have 15.4 million annual visitors. We are a majority/minority community.  Our population is 37% White, 30% Black, and 30% Hispanic of any race (U.S. Census).  One-third of our residents are foreign born.  Nearly 15% of our residents are living below the poverty level.  The Florida Department of Health in Broward County (DOH-Broward) is part of the state of Florida’s integrated Department of Health.  Broward County saw its first case of COVID-19 in early March, 2020 and has seen more than 110,500 positive cases, 1,687 deaths and 6,824 resident and 97 non-resident hospitalizations to date.  DOH-Broward stood up its Incident Management Team (IMT) on January 29, 2020 and began public health testing on March 7, 2020.  In late March, we began planning for testing sites, utilizing our Mass Prophylaxis Plan as a planning guide for the identification of potential sites and community partnerships. Our initial goal was to provide testing opportunities for underserved and disproportionately impacted populations and later expanded to provide testing opportunities to anyone that needed a test.  We developed a proposal which was subsequently funded by Broward County Administration and supported with funding, test kits and lab capacity by State ESF 8.  We worked with our Mass Prophylaxis Plan partners to identify sites in underserved communities and to ensure geographic accessibility.  We conducted “pop-up” testing sites for as little as ½ day to up to several weeks in underserved communities.  We established our first two walk-up testing sites on April 17 and April 18 in population areas where COVID cases were high and transportation barriers exist.  We have expanded to 8 drive thru sites and 3 walk-up sites which are still in operation today.  We are now planning for conversion of some of these sites, and reopening of some previously used sites, in preparation for vaccine distribution, while still maintaining a testing capability to meet needs.  The success of the testing program is attributable to transparent and frequent communication with our state, county, and municipal partners, first responders, and the Broward County Healthcare Coalition and relationships with trusted partners that historically serve the populations disproportionately affected by COVID-19 and/or underserved communities.  These include the Urban League and faith community.  Staffing patterns at the sites are expanded and contracted based on demand.  The testing sites and lab capacity have allowed DOH-Broward to provide needed diagnostic services across Broward County and ensure that historically underserved populations have access to this needed service.  It has also assisted public health in tracking the virus’ spread and target health protective messaging to communities as needed.

Broward County has an estimated population of 1,952,778 with 63.1% white, 30.2% Black and 6.7% other.  Ethnicity for Broward County’s population is 31.1% Hispanic, 34.8% non-Hispanic, and 38.7 unknown.  Broward County’s COVID cases are 47.92% white, 23.07% Black, 14.71% other, and 14.31% unknown race.  Ethnicity for the cases is 38.74% Hispanic, 46.68% non-Hispanic, and 14.58% unknown.  COVID cases have disproportionately affected communities of color.  In March and April, COVID testing was not widely available.  Initial testing sites were large drive-through venues which required personal vehicle transportation.  This presented barriers to communities of color and other disproportionately affected populations in Broward due to the lack of public transportation access.  Broward County is a designated and funded Cities Readiness Initiative County.  We first reviewed our existing Mass Prophylaxis Plan and the Memoranda of Agreements (MOA) with community and municipal partners.  We identified 2 geographic areas in Broward County that have health equity issues, high numbers of COVID cases, deaths and poverty with limited transportation access.  We worked with State ESF 8 to provide us with test kits and lab capacity and support from the Florida National Guard for staffing augmentation.  We began conversations with the Urban League of Broward County, a trusted provider in one community and the City of Pompano Beach, a Cities Readiness Initiative partner in the process of signing an MOA with us to provide mass prophylaxis in the event of an emergency.  Both partners were enthusiastically supportive of the project.  We also worked with Broward County Administration and submitted a proposal to them to expand testing opportunities, targeting on hard to reach and medically underserved populations.  We then reviewed existing site layout designs used for traditional walk-through points of distribution (POD) and modified them to support a testing POD.

Partnering with trusted community partners and utilizing trusted neighborhood locations, we were able to identify sites that were comfortable for the communities we wanted to reach.  We developed a flyer in collaboration with the Urban League to provide information about the testing site which was posted on various social media platforms and websites as well as being hand-delivered throughout the neighborhood.  A similar process was used with the City of Pompano Beach, with a trusted community park chosen as the testing site.  These sites opened several weeks after the initial conversation with the Pompano site in continuous operations since April 17, 2020. We were able to provide internet connectivity and a secured network at each site.  Laptop computers were utilized to register clients.  A registration database was developed and implemented for use at the sites and necessary lab requisitions and specimen labels were printed at the site.  Informational resource bags about other health and supportive service availability as well as cloth masks were provided to clients after their testing.  With the initial success of the two walk-up sites, DOH-Broward added one more walk-up and 8 drive-through geographically and population-based sites throughout the county. 

Layouts for drive-through PODs were reviewed and modified from the quick moving “pill in people” type of POD to a testing site layout.  Utilizing the Mass Prophylaxis plan, job action sheets were reviewed to ensure applicability to a testing site POD.  DOH-Broward provides a POD manager, IT specialist, and registration staff to all eleven of our sites.  When the Urban League was ready to close the site, DOH-Broward worked with them and the municipality to relocate the site in close proximity.  The Urban League walk-up closed August 29 after serving 21,236 residents.  A new walk-up location was opened and continues today in the City of Hollywood. Using the lessons learned from our walk-up locations, DOH-Broward has been able to apply our knowledge to quickly open “pop-up” sites in hard hit locations to respond to epidemiological investigation of outbreaks.  This has been successfully implemented in a variety of locations, some for as little as a day and others, such as at 2 different faith-based community locations for several weeks at a time.  

Our initial goal was to provide testing opportunities for underserved and disproportionately impacted populations and later expand to provide testing opportunities to anyone that needed a test.  We first reviewed our existing Mass Prophylaxis Plan and the MOA with community and municipal partners.  We identified 2 geographic areas in Broward County that have health equity issues, high numbers of COVID cases, deaths and poverty with limited transportation access.  We worked with State ESF 8 to provide us with test kits and lab capacity and support from the Florida National Guard for staffing augmentation.  We began conversations with the Urban League, a trusted provider in one community and the City of Pompano Beach, a Cities Readiness Initiative partner in the process of signing an MOA with us to provide mass prophylaxis in the event of an emergency.  Both partners were enthusiastically supportive of the project.  We also worked with Broward County Administration and submitted a proposal to them to expand testing opportunities, targeting on hard to reach and medically underserved populations.  We then reviewed existing site layout designs used for traditional walk-through PODs and modified them to support a testing POD.  The Urban League, the City of Pompano Beach and the Broward County government assisted us to promote and advertise the testing site locations.  Partners participated in the decision making for the site layouts and physically walked each location with DOH-Broward to discuss the best use of the space being provided. The Pompano Beach site opened on April 17 and the Urban League site opened on April 18.  The sites have been extremely well received in the communities.  Leveraging the successes and experience gained from these two sites, a third walk-up site was added in Coral Springs.  This also allowed us to open and operate pop-up testing opportunities in response to epidemiologic investigations in a timely and efficient manner.  These locations included our homeless assistance center, two area churches, the cities of Dania Beach, Hallandale Beach, Lauderhill, Deerfield Beach, Lauderdale Lakes, and Tamarac. As cases continued to rise, additional testing sites were needed.  Again, utilizing our mass prophylaxis plan, existing site layout designs used for traditional drive-through PODs were modified to support a drive-through testing POD.  Partners participated in the decision making for the site layouts and physically walked each location with DOH-Broward to discuss the best use of the space being provided.  Through this joint planning and partnership with our municipalities and partners, DOH-Broward opened eight drive-through testing sites.  We recently signed an MOA with Broward County Parks and Recreation to provide mass prophylaxis in public PODs as part of the Cities Readiness Initiative.  We worked with Broward County to identify which of its large county parks identified in the MOA would best serve as drive-through sites.  Six locations were identified.  We also worked with the City of Fort Lauderdale and identified two of its municipal parks that would be utilized as testing sites.   We are currently operating eleven testing sites as well as offering drive-thru public health testing at our main campus.  Combined, the sites provide testing for between 5,000 and 10,000 people daily.  Our partners contributed resources based on their capabilities.  All partners provide a physical location for the testing sites.  Some contribute municipal workers to direct traffic and people through the testing site. Others contribute generators, tents, air-conditioned buildings for staff to respite, ice, water and security.  All partners assist us to promote the testing site to their communities.  Partners participated in the decision making for the site layouts and physically walked each location with DOH-Broward to discuss the best use of the space being provided.  These partnerships have become stronger as a direct result of the joint planning and implementation process utilized in the testing strategy.  Operating these 11 testing sites has increased access to testing for Broward County residents and provide health equity through strategic location of both drive-through and walk-up testing through geographic and population-based decision-making with our state, county, municipal, community and trusted partners.  Conversations with our partners have begun regarding the conversion of some of the testing sites to vaccination sites.  The lessons learned from operating the testing sites has assisted DOH-Broward and our partners in preparing for vaccine administration.  DOH-Broward and Broward County government successfully operated 2 separate closed flu vaccination PODs September 18 and October 5, 2020 each on a day that the testing site was closed.  One day flu vaccines were provided to DOH-Broward employees and the second day vaccines were provided to first responders.  These flu PODs provided an opportunity to practice providing vaccination in a drive-through setting.  Lessons learned from these two exercises have assisted us to be able to understand the modifications that need to be implemented when converting a testing site to a vaccine administration site.

The practice was continually improved in a variety of ways.  Initially, bottlenecks were occurring at the registration areas, with swabbing stations waiting for clients.  The staffing pattern was changed to add more registration areas to increase throughput at the sites.   In the case of our drive-through Flu PODs, there were bottlenecks at the medical screening station, so additional screeners were added to increase throughput.  We also learned at the drive-through PODs that we needed to provide additional spacing between the vaccination stations so that traffic could move in and out easier when they had completed the immunization process.  While designed as a plan to provide medication, our existing mass prophylaxis plan was easily modified to a testing site operation.  The existing partners identified in the plan understood the POD concept, participated in exercises and training in POD operation and assisted us to initiate and increase testing operations in Broward County and specifically target underserved, high-risk and disproportionately impacted populations. The job action sheets were easily modified from mass prophylaxis activities to testing activities.  The POD kit items purchased, assembled, and distributed to all of our partners that had signed MOAs as part of the Cities Readiness Initiative and Mass Prophylaxis Plan, were already pre-positioned with their agencies.  This provided an initial cache of supplies for many of our selected sites.  The sites are scalable and have been expanded and contracted and expanded again based on need.  DOH-Broward conducts an annual back to school immunization event for twelve days at a community mall.  It is operated as a vaccination POD.  DOH-Broward staff applied their real-world experience of working at the annual vaccination activity to working at a testing site and a drive-through vaccination event.  DOH-Broward utilizes the Incident Command System to manage a variety of events throughout the year, including providing Hepatitis A vaccine in response to increases of Hepatitis A, outbreaks in facilities including schools and daycares, environmental issues and as the lead for ESF – 8 in Broward County.  As such, DOH-Broward staff have significant experience and expertise in effectively managing emergencies.  DOH-Broward assigned a POD manager to each site as well as team leads for the specimen collection stations, registration, and greeter/flow monitor.  We worked with our law enforcement partners to provide 24 hours site security.  Our EMS partners provided EMS access during site operations.  Weekly virtual meetings were held with our EMS partners, Municipalities, and the Broward County and State Emergency Operations Centers to exchange information and address any issues or gaps.  We have learned that our mass prophylaxis plan is a living document that can be easily modified to meet both oral medication, vaccination, or testing needs and is scalable based on need.