During the first year of the pandemic, Environmental Health Services (EHS) Division played a critical role in King County’s COVID-19 emergency response by leading two successful, but separate, efforts in King County:
1. SSTAR provided technical assistance (TA), compliance, PPE and safety supplies, and financial assistance to the restaurant sector.
2. AIR VENT provided ventilation TA and HEPA air cleaners to homeless shelters and service sites.
As the new year began with vaccines coming online and restrictions and mandates lifting, we turned our attention to recovery. On May 13, 2021, Washington Governor Inslee announced plans for the state to fully reopen by June 30, 2021. However, this did not mean the state of emergency sparked by the coronavirus pandemic would end on that date. All the while, the King County Health Officer had been strongly encouraging improving ventilation and air filtration as one of the most important interventions to reduce transmission risks of COVID-19 moving forward, particularly in situations where vaccination status is unknown and mask wearing is not required.
With prior messaging around cleaning and physical barriers, the community still had little awareness about the link between poor ventilation and the airborne transmission risk of COVID-19 – and what protective actions they can take. Most small businesses also did not have access to outdoor set ups and/or resources to install new HVAC systems or make costly repairs or upgrades to existing systems. Furthermore, companies were aggressively marketing many unproven alternative technologies to “clean” air.
During the spring lull period in 2021, we began planning to address the unmet needs around ventilation and IAQ as a key environmental health intervention strategy for COVID-19. By June 2021, as a new unexpected surge from the Delta variant began to emerge, we pivoted and adapted to the growing concern by quickly restructuring and launching the EHS COVID-19 Recovery Program on Ventilation and Indoor Air Quality. The program integrated key components from both SSTAR and AIR VENT: technical assistance, community education, and air cleaner supply distribution.
Our new goal was to the support the safe reopening of the economy by raising awareness and offering direct technical assistance and supplies to help improve ventilation and indoor air quality across multiple priority sectors:
· Restaurants (small, independently owned/operated food businesses)
· Other small businesses and organizations (e.g., gyms, retail, event spaces, community centers, youth activity programs, CBOs, etc.)
· Childcares and preschools
· K-12 schools
· Faith organizations
· Congregate settings (e.g., homeless shelters, behavioral health facilities, etc.)
· Outbreak sites (from the sectors above) referred by our COVID-19 Investigation Team
With only a few core staff remaining from the prior programs, we innovated by building upon the learnings and successes from SSTAR and AIR VENT and quickly implemented a unified and expanded program within a few months. By the end of summer 2021, we:
· Advocated for and received new COVID-19 funding for the expanded effort.
· Created a streamlined program structure with multiple key functional teams and a unifying reporting structure to EHS leadership.
· Collaborated with agencies on webinar trainings.
· Designed protocols and procedures to center equity into decision-making and prioritization, while still being nimble to adapt where the need is greatest.
· Initiated program activities and tools to reach our target groups, such as a multilingual intake online form to request TA, educational materials/activities (e.g., newsletters, webinars, stakeholder engagements).
· Established partnerships with 17 BIPOC-led CBOs to increase our outreach and supply distribution.
· Hired and trained 4 new environment and health investigators to conduct ventilation assessments and provide consultation and guidance.
· Procured an initial bulk purchase of 5050 HEPA air cleaners and 600 box fan filter kits.
· Created the database to manage the intake request and track program results.
· Laid out the logistical plans for the supply distribution.
From an equity standpoint, we prioritized those most in need, from areas highly impacted by COVID-19 and longstanding health and social inequities, and/or most at risk for outbreaks. We considered contextual characteristics including:
1. Sector-specific factors (e.g., local small independently operated or owned business, small home-based childcare provider, etc.).
2. Site-specific factors (e.g., vulnerable employees, outbreak site, poor building conditions, etc.).
3. Geography - we targeted South Seattle, South King County and Southeast King County based on COVID-19, vaccination, and inequity data at the time (June 2021):
· King County’s Social & Economic Vulnerability Risk Index Map identified these regions as high social and economic risk.
· King County COVID-19 dashboard indicated:
- COVID vaccine uptake was higher among White residents in King County compared to Black/African American and Latinx residents. These two latter groups were projected to meet the 70% vaccination goal nearly 3 months after the June 30 reopening date.
- South King County had the lowest vaccination rate, compared to Seattle, East King County, and North King County.
- Incidence was highest in the cities in South King County, South Seattle, and Southeast King County.
From June to December 2021, we accomplished the following towards reducing COVID-19 related health inequities:
· Completed 525 technical assistance (phone consultations/site visits), including assisting 37 outbreak sites
· Created 8 educational materials with translations into at most 12 languages
· Organized 6 webinars with about 200 total participants
· Launched 1 communications and social media campaign
· Distributed a total 951 HEPAs to eligible recipients (70% of whom are in the Tier 1 top priority group)
· Delivered 1464 HEPAs to our CBO partners for further distribution to childcare sites
· Distributing over 530 BFF kits to individual households
· Received over 200 referrals of small businesses or organizations from our CBO partners
· Delivered 240 HEPAs to a high priority school district for placement in high-risk areas (e.g., isolation rooms, health rooms, cafeterias, special needs rooms, and music rooms)
· Surveyed King County schools to determine needs around ventilation improvements during COVID-19, with plans to distribute up to 1500 HEPA units to schools
· Designed a study with the University of Washington to evaluate the effectiveness of HEPA air cleaners in shelters