VARIANCE TO STAGE 2 OF

CALIFORNIA’S ROADMAP TO MODIFY

THE STAY-AT-HOME ORDER COVID-19 VARIANCE ATTESTATION FORM

FOR City of Avalon (Los Angeles County)

May 18, 2020

Background

On March 4, 2020, Governor Newsom proclaimed a State of Emergency because of the

threat of COVID-19, and on March 12, 2020, through Executive Order N-25-20, he directed all

residents to heed any orders and guidance of state and local public health

officials. Subsequently, on March 19, 2020, Governor Newsom issued Executive Order N-33-

20 directing all residents to heed the State Public Health Officer’s Stay-at-Home order which

requires all residents to stay at home except for work in critical infrastructure sectors or

otherwise to facilitate authorized necessary activities. On April 14th, the State presented the

Pandemic Roadmap, a four-stage plan for modifying the Stay-at-Home order, and, on May

4th, announced that entry into Stage 2 of the plan would be imminent.

Given the size and diversity of California, it is not surprising that the impact and level of

county readiness for COVID-19 has differed across the state. On May 7th, as directed by the

Governor in Executive Order N-60-20, the State Public Health Officer issued a local variance

opportunity through a process of county self-attestation to meet a set of criteria related to

county disease prevalence and preparedness. This variance allowed for counties to adopt

aspects of Stage 2 at a rate and in an order determined by the County Local Health Officer.

Note that counties desiring to be stricter or move at a pace less rapid than the state did not

need a variance.

In order to protect the public health of the state, and in light of the state’s level of

preparedness at the time, more rapid movement through Stage 2 as compared to the state

needed to be limited to those counties which were at the very lowest levels of risk. Thus, the

first variance had very tight criteria related to disease prevalence and deaths as a result of

COVID-19.

Now, 11 days after the first variance opportunity announcement, the state has further built

up capacity in testing, contact tracing and the availability of PPE. Hospital surge capacity

remains strong overall. California has maintained a position of stability with respect to

hospitalizations. These data show that the state is now at a higher level of preparedness, and

many counties across the state, including those that did not meet the first variance criteria

are expected to be, too. For these reasons, the state is issuing a second variance

opportunity for certain counties that did not meet the criteria of the first variance attestation.

This next round of variance is for counties that can attest to meeting specific criteria

indicating local stability of COVID-19 spread and specific levels of county preparedness. The

criteria and procedures that counties will need to meet in order to attest to this second

variance opportunity are outlined below. It is recommended that counties consult with

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cities, tribes and stakeholders, as well as other counties in their region, as they consider

moving through Stage 2

Local Variance

A county that has met the criteria in containing COVID-19, as defined in this guidance or in

the guidance for the first variance, may consider modifying how the county advances

through Stage 2, either to move more quickly or in a different order, of California’s roadmap

to modify the Stay-at-Home order. Counties that attest to meeting criteria can only open a

sector for which the state has posted sector guidance (see Statewide industry guidance to

reduce risk). Counties are encouraged to first review this document in full to consider if a

variance from the state’s roadmap is appropriate for the county’s specific circumstances. If

a county decides to pursue a variance, the local health officer must:

1. Notify the California Department of Public Health (CDPH), and if requested, engage

in a phone consultation regarding the county’s intent to seek a variance.

2. Certify through submission of a written attestation to CDPH that the county has met

the readiness criteria (outlined below) designed to mitigate the spread of COVID-19.

Attestations should be submitted by the local health officer, and accompanied by a

letter of support from the County Board of Supervisors, as well as a letter of support

from the health care coalition or health care systems in said county.1 In the event

that the county does not have a health care coalition or health care system within its

jurisdiction, a letter of support from the relevant regional health system(s) is also

acceptable. The full submission must be signed by the local health officer.

All county attestations, and submitted plans as outlined below, will be posted publicly on

CDPH’s website.

CDPH is available to provide consultation to counties as they develop their attestations and

COVID-19 containment plans. Please email Jake Hanson at Jake.Hanson@cdph.ca.gov to

notify him of your intent to seek a variance and if needed, request a consultation.

County Name: City of Avalon

County Contact: Denise Radde, City Manager

Public Phone Number: 310.510.0220 Ext. 122

Readiness for Variance

The county’s documentation of its readiness to modify how the county advances through

Stage 2, either to move more quickly or in a different order, than the California’s roadmap to

modify the Stay-at-Home order, must clearly indicate its preparedness according to the

criteria below. This will ensure that individuals who are at heightened risk, including, for

example, the elderly and those with specific co-morbidities, and those residing in long-term

1 If a county previously sought a variance and submitted a letter of support from the health care

coalition or health care systems but did not qualify for the variance at that time, it may use the

previous version of that letter. In contrast, the County Board of Supervisors must provide a renewed

letter of support for an attestation of the second variance.

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care and locally controlled custody facilities and other congregate settings, continue to be

protected as a county progresses through California’s roadmap to modify the Stay-at-Home

order, and that risk is minimized for the population at large.

As part of the attestation, counties must provide specifics regarding their movement through

Stage 2 (e.g., which sectors, in what sequence, at what pace), as well as clearly indicate

how their plans differ from the state’s order.

As a best practice, if not already created, counties will also attest to plan to develop a

county COVID-19 containment strategy by the local health officer in conjunction with the

hospitals and health systems in the jurisdiction, as well as input from a broad range of county

stakeholders, including the County Board of Supervisors.

It is critical that any county that submits an attestation continue to collect and monitor data

to demonstrate that the variances are not having a negative impact on individuals or

healthcare systems. Counties must also attest that they have identified triggers and have a

clear plan and approach if conditions worsen to reinstitute restrictions in advance of any

state action.

Readiness Criteria

To establish readiness for a modification in the pace or order through Stage 2 of California’s

roadmap to modify the Stay-at-Home order, a county must attest to the following readiness

criteria and provide the requested information as outlined below:

Epidemiologic stability of COVID-19. A determination must be made by the county

that the prevalence of COVID-19 cases is low enough to be swiftly contained by

reintroducing features of the stay at home order and using capacity within the health

care delivery system to provide care to the sick. Given the anticipated increase in

cases as a result of modifying the current Stay-At-Home order, this is a foundational

parameter that must be met to safely increase the county’s progression through

Stage 2. The county must attest to:

o Demonstrated stable/decreasing number of patients hospitalized for COVID-19

by a 7-day average of daily percent change in the total number of

hospitalized confirmed COVID-19 patients of <+5% -OR- no more than 20 total

confirmed COVID-19 patients hospitalized on any single day over the past 14

days.

The City of Avalon (City) attests that is has a demonstrated stable/decreasing

number of patients hospitalized for COVID-19. Upon a collaborative review of data

collected by the Catalina Island Medical Center (CIMC), Avalon has had zero

confirmed COVID-19 cases in the past 14 days (2 cases total) and, to date, has had

zero hospitalizations. Avalon has a total estimated population of 3,723 (2018).

The City works closely with the CIMC to monitor essential data and respond to any

potential hotspots or vulnerable populations by providing additional guidance,

quickly developing mitigation strategies, and taking any medical and policy

actions as needed.

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o 14-day cumulative COVID-19 positive incidence of <25 per 100,000 -OR- testing

positivity over the past 7 days of <8%.

NOTE: State and Federal prison inmate COVID+ cases can be excluded from

calculations of case rate in determining qualification for variance. Staff in State and

Federal prison facilities are counted in case numbers. Inmates, detainees, and staff in

county facilities, such as county jails, must continue to be included in the calculations.

Facility staff of jails and prisons, regardless of whether they are run by local, state or

federal government, generally reside in the counties in which they work. So, the

incidence of COVID-19 positivity is relevant to the variance determination. In

contrast, upon release, inmates of State and Federal prisons generally do not return to

the counties in which they are incarcerated, so the incidence of their COVID-19

positivity is not relevant to the variance determination. While inmates in state and

federal prisons may be removed from calculation for this specific criteria, working to

protect inmates in these facilities from COVID-19 is of the highest priority for the State.

o Counties using this exception are required to submit case rate details for

inmates and the remainder of the community separately.

The City has a testing positivity of the 14-day cumulative COVID-19 of less than 25

per 100,000 and over the past 7 days of less than 8%. There have been no COVID-

19 deaths to date and no acute care patients admitted to the hospital to date

with the diagnosis of COVID-19 in the City of Avalon.

Protection of Stage 1 essential workers. A determination must be made by the county

that there is clear guidance and the necessary resources to ensure the safety of

Stage 1 essential critical infrastructure workers. The county must attest to:

o Guidance for employers and essential critical infrastructure workplaces on how

to structure the physical environment to protect essential workers. Please

provide, as a separate attachment, copies of the guidance(s).

The City of Avalon, working in close collaboration with community stakeholders

(including the Catalina Island Chamber of Commerce and Visitors Bureau, CIMC,

first responders, and major businesses), has provided guidance to all employers,

businesses, and essential workers. The guidelines are based on the County of Los

Angeles Public Health’s reopening protocols and social distancing (Appendix A)

protocols (http://publichealth.lacounty.gov/media/Coronavirus/), the California

Department of Public Health’s (CDPH) COVID-19 Industry Guidance for businesses

and sectors (https://covid19.ca.gov/industry-guidance/), and other best safety

practices. (See Attachment A for the full listing of guidance by sector.) Any

additional guidance provided are intended to supplement, not replace any

guidance issued by CDPH.

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o Availability of supplies (disinfectant, essential protective gear) to protect essential

workers. Please describe how this availability is assessed.

Through the City and County Emergency Operations Centers, the City of Avalon

coordinates with Los Angeles County to maintain a list of vendors and checks status

of product availability to fulfill requests and provide information to businesses. The

City coordinates regular briefing calls with community stakeholders to determine

needs, disseminate policies, procedures, and protocols, and coordinate resources.

Supply levels of personal protective equipment (PPEs) for essential workers are

adequate and the City maintains a 30-day supply under surge conditions.

The City also works in close collaboration with the Catalina Island Medical Center to

gauge needs from the health sector and ensure an adequate supply of PPE is

maintained.

Testing capacity. A determination must be made by the county that there is testing

capacity to detect active infection that meets the state’s most current testing criteria,

(available on CDPH website). The county must attest to:

o Minimum daily testing capacity to test 1.5 per 1,000 residents, which can be

met through a combination of testing of symptomatic individuals and targeted

surveillance. Provide the number of tests conducted in the past week. A

county must also provide a plan to reach the level of testing that is required to

meet the testing capacity levels, if the county has not already reached the

required levels.

The City of Avalon and the Catalina Island Medical Center attests that there is

capacity to meet the minimum daily testing capacity of 1.5 per 1,000 residents.

Based on the City of Avalon’s population of 3,723 (2018), the 1.5/1,000 residents

requirement would be fulfilled by a minimum capacity of 6 tests per day. CIMC has

the capacity to expand surge testing as needed.

Three (3) antigen tests and four (4) antibody tests were conducted in the past week.

o Testing availability for at least 75% of residents, as measured by the presence of a

specimen collection site (including established health care providers) within 30

minutes driving time in urban areas, and 60 minutes in rural areas. Please provide

a listing of all specimen collection sites in the county and indicate if there are any

geographic areas that do not meet the criteria and plans for filling these gaps if

they exist. If the county depends on sites in adjacent counties, please list these

sites as well.

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As the City of Avalon is only approximately 2.88 square miles of land, all residents in

Avalon are able to reach a test site in under 10 minutes. Testing is provided by

Catalina Island Medical Center, located at 100 Falls Canyon Road, Avalon, CA

90704.

o Please provide a COVID-19 Surveillance plan, or a summary of your proposed

plan, which should include at least how many tests will be done, at what

frequency and how it will be reported to the state, as well as a timeline for rolling

out the plan. The surveillance plan will provide the ability for the county to

understand the movement of the virus that causes COVID19 in the community

through testing. [CDPH has a community sentinel surveillance system that is being

implemented in several counties. Counties are welcome to use this protocol and

contact covCommunitySurveillance@cdph.ca.gov for any guidance in setting up

such systems in their county.]

CIMC reports all positive COVID-19 cases to the California Department of Public

Health and Los Angeles County Public Health. CIMC follows the COVID-19

Surveillance plan as developed and implemented by Los Angeles County Public

Health and monitors health status daily for all positive COVID-19 cases. Testing

information is located on the CIMC website at

https://cimedicalcenter.org/coronavirus/ and includes antigen testing and

antibody testing numbers.

Los Angeles County Public Health has developed a public surveillance dashboard

(http://dashboard.publichealth.lacounty.gov/covid19_surveillance_dashboard/)

that includes tables, maps, graphs, and charts (cases, counts, deaths, and tests

performed) to monitor and assess movement of COVID-19 within the community.

Containment capacity. A determination must be made by the county that it has

adequate infrastructure, processes, and workforce to reliably detect and safely

isolate new cases, as well as follow up with individuals who have been in contact with

positive cases. The county must attest to:

o Enough contact tracing. There should be at least 15 staff per 100,000 county

population trained and available for contact tracing. Please describe the

county’s contact tracing plan, including workforce capacity, and why it is

sufficient to meet anticipated surge. Indicate which data management platform

you will be using for contact tracing (reminder that the State has in place a

platform that can be used free-of-charge by any county).

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The City of Avalon and CIMC utilizes Los Angeles County Public Health to initiate

contact tracing protocols and services.

o Availability of temporary housing units to shelter at least 15% of county residents

experiencing homelessness in case of an outbreak among this population

requiring isolation and quarantine of affected individuals. Please describe the

county’s plans to support individuals, including those experiencing homelessness,

who are not able to properly isolate in a home setting by providing them with

temporary housing (including access to a separate bathroom, or a process in

place that provides the ability to sanitize a shared bathroom between uses), for

the duration of the necessary isolation or quarantine period. Rooms acquired as

part of Project Roomkey should be utilized.

The City of Avalon’s point-in-time count of all unsheltered and sheltered (public and

private) homelessness for the 2020 Homeless Census & Survey indicated that there

were 26 individuals who met the HUD definition of homelessness.

To support individuals experiencing homelessness, the City will work with the Los

Angeles Homeless Services Authority, the Gateway Cities Council of Governments,

Los Angeles County, Project Roomkey, and area service providers to ensure

homeless individuals are able to safely isolate or quarantine. Currently, the City has

enough beds within existing housing options to shelter homeless individuals.

Hospital capacity. A determination must be made by the county that hospital

capacity, including ICU beds and ventilators, and adequate PPE is available to

handle standard health care capacity, current COVID-19 cases, as well as a potential

surge due to COVID-19. If the county does not have a hospital within its jurisdiction,

the county will need to address how regional hospital and health care systems may

be impacted by this request and demonstrate that adequate hospital capacity exists

in those systems. The county must attest to:

o County (or regional) hospital capacity to accommodate COVID-19 positive

patients at a volume of at a minimum surge of 35% of their baseline average daily

census across all acute care hospitals in a county. This can be accomplished

either through adding additional bed capacity or decreasing hospital census by

reducing bed demand from non-COVID-19 related hospitalizations (i.e., cancelling

elective surgeries). Please describe how this surge would be accomplished,

including surge census by hospital, addressing both physical and workforce

capacity.

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CIMC monitors bed counts on a daily basis. To date, there have been no acute

care patients admitted to the hospital with the diagnosis of COVID-19 in the City of

Avalon. While CIMC does not have an ICU, CIMC has contracted relationships to

transfer any patient in need of ICU care. CIMC also has contracted services with UC

Irvine Emergency Medicine for additional staffing and is supported by the medical

center’s laboratory and diagnostic imaging departments to meet the acute

medical needs of Avalon’s residents and visitors.

Further, CIMC has implemented the following measures:

Enhanced screening procedures of patients outside the facility prior to being

admitted for treatment to limit patient and employee exposure.

Modifications to the existing facility dedicated to treat suspected or

confirmed COVID-19 patients while minimizing risk and exposure.

Development of a procurement strategy to ensure PPE supplies are sufficient

to protect hospital staff

CIMC maintains an adequate 30-day supply of PPEs and has a total of four (4)

ventilators in its inventory. Additionally, they are utilizing approved PPE conservation

measures (as developed by the CDC - https://www.cdc.gov/coronavirus/2019-

ncov/hcp/ppe-strategy/index.html) when applicable. All PPEs, vendors, and supply

chain channels, are carefully tracked and monitored.

o County (or regional) hospital facilities have a robust plan to protect the hospital

workforce, both clinical and nonclinical, with PPE. Please describe the process by

which this is assessed.

Protecting hospital workforce, both clinical and nonclinical, with an adequate

supply of PPEs is critical. The following measures have been implemented to ensure

employees are protected:

CIMC screens and universally masks every employee and patient who enters

the facility.

Visitors are prohibited from entering.

All workforce are provided with an adequate supply of PPE. A procurement

strategy has been implemented to source PPE needed to protect workplace

Development and implementation of a readiness plan to handle surge.

CIMC provides training and education for infection control, donning and

doffing PPE, and screening for COVID-19.

All employees are checked and monitored for COVID-19 symptoms.

CIMC has contracted services with UC Irvine Emergency Medicine for

additional staffing to assure appropriate ratios in care are available

Vulnerable populations. A determination must be made by the county that the

proposed variance maintains protections for vulnerable populations, particularly

those in long-term care settings. The county must attest to ongoing work with Skilled

Nursing Facilities within their jurisdiction and describe their plans to work closely with

facilities to prevent and mitigate outbreaks and ensure access to PPE:

o Describe your plan to prevent and mitigate COVID-19 infections in skilled nursing

facilities through regular consultation with CDPH district offices and with leadership

from each facility on the following: targeted testing and patient cohorting

plans; infection control precautions; access to PPE; staffing shortage contingency

plans; and facility communication plans. This plan shall describe how the county

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will (1) engage with each skilled nursing facility on a weekly basis, (2) share best

practices, and (3) address urgent matters at skilled nursing facilities in its

boundaries.

The City has one (1) skilled nursing facility with six (6) patients located within the

Catalina Island Medical Center (100 Falls Canyon Road, Avalon, CA 90704). The

contact phone number is 310.510.0700.

CIMC is in regular communication and consultation with CDPH, their district offices,

and leadership. Currently, CIMC is developing a comprehensive mitigation plan for

the skilled nursing portion of the medical facility. The mitigation plan outlines the

rapid response instructions and coordination with the community’s emergency

response system, facility profile and contact information, testing and cohorting

procedures, infection prevention and control, emergency staffing strategies, PPE

supply and procurement for the maintenance of a 30-day inventory supply,

designated space to isolate COVID-19 patients, and communication.

CIMC is submitting a mitigation plan to CPHD for approval.

o Skilled nursing facilities (SNF) have >14-day supply of PPE on hand for staff, with

established process for ongoing procurement from non-state supply chains.

Please list the names and contacts of all SNFs in the county along with a

description of the system the county must track PPE availability across SNFs.

As mentioned in the section above, the City has one (1) skilled nursing facility with six

(6) patients located within the Catalina Island Medical Center (100 Falls Canyon

Road, Avalon, CA 90704). The contact phone number is 310.510.0700.

CIMC monitors and procures all PPEs for staff and has implemented a procurement

strategy to ensure the facility maintains a minimum 30-day supply. CIMC has

procured PPEs through CDPH, Los Angeles County Public Health, and private

vendors.

Sectors and timelines. Please provide details on the county’s plan to move through

Stage 2. These details should include which sectors and spaces will be opened, in

what sequence, on what timeline. Please specifically indicate where the plan differs

from the state’s order. Any sector that is reflective of Stage 3 should not be included

in this variance because it is not allowed until the State proceeds into Stage 3. For

additional details on sectors and spaces included in Stage 2, please see

https://covid19.ca.gov/industry-guidance/ for sectors open statewide and

https://covid19.ca.gov/roadmap-counties/ for sectors available to counties with a

variance.

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The City of Avalon’s reopening plan aligns with the State’s reopening plan. While

the City fully supports the efforts of Los Angeles County (County) to request a county

variance and to continue to move through the stages at a slower pace, the City

requests to move more quickly than the County restrictions allow.

During the early stages of the COVID-19 pandemic, the Avalon City Council

imposed more restrictive measures than the state and County, including further

limiting business activities and extending resident and business protections. These

measures, along with the City’s adherence to restrictions imposed by the State and

County’s Stay at Home Order and the City’s isolated geography, has enabled the

City to have a significantly lower incidence rates than other cities within Los Angeles

County. This has ensured that the COVID-19 pandemic has remained manageable

for the City’s healthcare system, emergency and first responders, and other critical

community resources.

As restrictions across the state begin to ease, Avalon residents continue to adhere to

social distancing protocols and many local businesses (including several essential

businesses such as hotels and lodging) have remained closed. Of those businesses

that remain open, operations have been significantly altered to abide by state,

county, and local orders. Through these extraordinary community efforts and

sacrifices (particularly to our community’s economy), we have made great strides in

flattening the curve.

As an isolated, rural community, the City’s businesses and their employees are

struggling significantly under the slower reopening and more restrictive measures put

in place by the County. Without a city variance, many businesses will be forced to

close and the City will suffer disproportionate economic consequences than other

cities within Los Angeles County.

Following successful attestation, businesses within accelerated Stage 2 and early

Stage 3 will be permitted to reopen if and when they have implemented

appropriate health and safety measures in accordance with an appropriate facility-

specific reopening plan. All businesses must implement and comply with the State’s

sector-specific guidelines and County reopening protocols. These businesses

include:

Destination Retail Dine-in restaurants and outdoor patio dining (other facility

amenities such as bars are not permitted)

Outdoor dining within the public rights-of-way

Piers, to allow for modified business and access and operations, including the

Harbor Department, that are located on the pier (with appropriate social

distancing measures in place)

Full beach access for passive recreation with enforced social distancing

measures and protocols

Parks (with limitations on passive recreation and the continual closure of all

playground equipment)

Hair and nail salons and barbershops

Tours (with modified operations) and outdoor recreation activities (such as zip

lines, fishing, guide services, pack operations)

Hotels/lodging for leisure and tourism – non-essential travel

Indoor museums

Office-based businesses (telework continues to be strongly encouraged)

Campgrounds (with social distancing measures)

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Additional water-based activities

Childcare will expand from serving children of essential service workers only to

broader workforce. Childcare may be broadened to include summer day

camps that are able to operate in accordance with childcare safety protocols

outlined in Health Officer Orders

Schools

Triggers for adjusting modifications. Please share the county metrics that would serve

as triggers for either slowing the pace through Stage 2 or tightening modifications,

including the frequency of measurement and the specific actions triggered by metric

changes. Please include your plan, or a summary of your plan, for how the county will

inform the state of emerging concerns and how it will implement early containment

measures.

City will follow applicable guidelines, recommendations, and mandates of the State

and Los Angeles County Public Health, including triggers for slowing the pace

through Stage 2 and early Stage 3 or tightening modifications. This includes the

following metrics:

o Seven-day moving average of new cases increases for more than three

consecutive days.

o Positivity rate of tests (three-day moving average) exceeds 10 percent for

more than three consecutive days.

o CIMC and its regional partner facilities exceed licensed bed capacity, have

implemented their surge plans, and the need for hospital or ICU beds is

increasing.

CIMC will notify CDPH, the Los Angeles County MHOAC Duty Officer, and City

Executive Leadership is one or more metric is triggered.

COVID-19 Containment Plan

Please provide your county COVID-19 containment plan or describe your strategy to

create a COVID-19 containment plan with a timeline.

City and CIMC will follow applicable guidelines, recommendations, and mandates of

the Los Angeles County Public Health COVID-19 Containment Plan.

The City and CIMC is in frequent communication with Los Angeles County Public

Health, Los Angeles County Board of Supervisors, and the CDPH district office.

While not exhaustive, the following areas and questions are important to address in any

containment plan and may be used for guidance in the plan’s development. This

containment plan should be developed by the local health officer in conjunction with

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the hospitals and health systems in the jurisdiction, as well as input from a broad range of

county stakeholders, including the County Board of Supervisors. Under each of the areas

below, please indicate how your plan addresses the relevant area. If your plan has not

yet been developed or does not include details on the areas below, please describe

how you will develop that plan and your timeline for completing it.

Testing

Is there a plan to increase testing to the recommended daily capacity of 2 per 1000

residents?

Is the average percentage of positive tests over the past 7 days <8% and stable or

declining?

Have specimen collection locations been identified that ensure access for all

residents?

Have contracts/relationships been established with specimen processing labs?

Is there a plan for community surveillance?

CIMC follows the attached guidelines developed by the CDC and have adequate

testing capabilities for the community when meeting the criteria.

Contact Tracing

How many staff are currently trained and available to do contact tracing?

Are these staff reflective of community racial, ethnic and linguistic diversity?

Is there a plan to expand contact tracing staff to the recommended levels to

accommodate a three-fold increase in COVID-19 cases, presuming that each case

has ten close contacts?

Is there a plan for supportive isolation for low income individuals who may not have a

safe way to isolate or who may have significant economic challenges as a result of

isolation?

City will follow applicable guidelines, recommendations, and mandates of the Los

Angeles County Public Health COVID-19 Containment Plan.

Living and Working in Congregate Settings

How many congregate care facilities, of what types, are in the county?

How many correctional facilities, of what size, are in the county?

How many homelessness shelters are in the county and what is their capacity?

What is the COVID-19 case rate at each of these facilities?

Is there a plan to track and notify local public health of COVID-19 case rate within

local correctional facilities, and to notify any receiving facilities upon the transfer of

individuals?

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Do facilities have the ability to adequately and safely isolate COVID-19 positive

individuals?

Do facilities have the ability to safely quarantine individuals who have been exposed?

Is there sufficient testing capacity to conduct a thorough outbreak investigation at

each of these facilities?

Do long-term care facilities have sufficient PPE for staff, and do these facilities have

access to suppliers for ongoing PPE needs?

Do facilities have policies and protocols to appropriately train the workforce in

infection prevention and control procedures?

Does the workforce have access to locations to safely isolate?

Do these facilities (particularly skilled nursing facilities) have access to staffing

agencies if and when staff shortages related to COVID-19 occur?

The City does not have any congregate care facilities or correctional facilities. While

there is one facility, through a local church, to shelter homelessness, there are no

confirmed or suspected COVID-19 cases.

The City’s one (1) skilled nursing facility has the ability to adequately and safely isolate

COVID-19 individuals, safely quarantine individuals who have been exposed, possess

sufficient testing capacity to conduct a thorough outbreak investigation, have

sufficient PPE for staff and access to suppliers for ongoing PPE needs, and has policies

and protocols to appropriately train the workforce in infection prevention and control

procedures. CIMC is submitting a mitigation plan to CPHD for approval.

Additionally, the City will follow applicable guidelines, recommendations, and

mandates of the Los Angeles County Public Health COVID-19 Containment Plan.

Protecting the Vulnerable

Do resources and interventions intentionally address inequities within these

populations being prioritized (i.e. deployment of PPE, testing, etc.)?

Are older Californians, people with disabilities, and people with underlying health

conditions at greater risk of serious illness, who are living in their own homes, supported

so they can continue appropriate physical distancing and maintain wellbeing (i.e.

food supports, telehealth, social connections, in home services, etc.)?

The City will follow applicable guidelines, recommendations, and mandates of the Los

Angeles County Public Health COVID-19 Containment Plan.

Acute Care Surge

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Is there daily tracking of hospital capacity including COVID-19 cases, hospital census,

ICU census, ventilator availability, staffing and surge capacity?

Are hospitals relying on county MHOAC for PPE, or are supply chains sufficient?

Are hospitals testing all patients prior to admission to the hospital?

Do hospitals have a plan for tracking and addressing occupational exposure?

Hospital capacity is being tracked by CIMC and regularly reported to the City and

County Emergency Operations Centers. These data include numbers of COVID-19

cases, overall hospital census, ICU census, ventilator availability, staffing, and surge

capacity. CIMC PPE supply chains are sufficient. CIMC tests all patients prior to

admission to the hospital and a plan is in place for tracking and addressing

occupational exposure.

Essential Workers

How many essential workplaces are in the county?

What guidance have you provided to your essential workplaces to ensure employees

and customers are safe in accordance with state/county guidance for modifications?

Do essential workplaces have access to key supplies like hand sanitizer, disinfectant

and cleaning supplies, as well as relevant protective equipment?

Is there a testing plan for essential workers who are sick or symptomatic?

Is there a plan for supportive quarantine/isolation for essential workers?

The City of Avalon has approximately XX essential workplaces, including City

Government, Southern California Edison, Catalina Broadband, AT&T, Verizon, Los

Angeles County Fire and Baywatch, Vons, CIMC, Los Angeles County Sheriffs, Post

Office, US Bank, Avalon Freight Services, Catalina Express, municipal operations such

as landfill, trash, and wastewater treatment, Long Beach Unified School District

(Avalon Schools), and many others.

Business guidance and reopening protocol links to CDPH and Los Angeles County

Public Health are available on the City and Catalina Island Chamber of Commerce &

Visitors Bureau (Chamber) websites. The City, Chamber, and Los Angeles County

Sheriff’s Department have also disseminated guidance procedures and resources to

all essential and non-essential workplaces, including reviewing all required key supplies

and relevant PPEs (such as hand sanitizers, disinfectant and cleaning supplies, face

coverings, and gloves (where applicable)).

The county provided guidance to all businesses and employers, to include public and

private entities. Part of that guidance includes the necessity for employers to have PPE

available and have an established supply chain.

CDPH COVID-19 VARIANCE ATTESTATION FORM

15

Special Considerations

Are there industries in the county that deserve special consideration in terms of

mitigating the risk of COVID-19 transmission, e.g. agriculture or manufacturing?

Are there industries in the county that make it more feasible for the county to increase

the pace through Stage 2, e.g. technology companies or other companies that have

a high percentage of workers who can telework?

While the City continues to adhere to restrictive measures and bans on non-essential

travel, the City of Avalon is a heavily dependent tourism-based economy. Avalon is a

year-round outdoor recreation destination; however, the peak of the City’s revenue is

made between the months of March through October. The City will continue to

prioritize public health and safety, working closely to monitor disease trends in places

visitors come from throughout Southern and Northern California and mitigate the

effects of such travel.

The City, in partnership with the Catalina Island Chamber of Commerce & Visitors

Bureau are working with all tourism and outdoor recreation-based business sectors to

implement best practices for reducing transmission, following all State and County

protocols and guidelines.

Community Engagement

Has the county engaged with its cities?

Which key county stakeholders should be a part of formulating and implementing the

proposed variance plan?

Have virtual community forums been held to solicit input into the variance plan?

Is community engagement reflective of the racial, ethnic, and linguistic diversity of

the community?

The City of Avalon has and continue to conduct and lead regular briefings with city

executive leaders and elected officials, city emergency managers, City and County

first responders (Avalon Fire Department, Los Angeles County Fire and Baywatch

Departments, Los Angeles County Sheriff’s Department), and community stakeholders

and leaders, including the Catalina Island Chamber of Commerce & Visitors Bureau,

CIMC, IEX (helicopter services), Vons, Catalina Island Conservancy, Santa Catalina

Island Company, Los Angeles County Board of Supervisors, United States Coast Guard,

United States Postal Services, Catalina Express (public ferry transportation), Long Beach

Unified School District, Southern California Edison, and Catalina Broadband (local

internet service provider).

Additional community input was solicited by virtual City Council meetings, emails, and

phone calls. Information is disseminated in English and Spanish.

Relationship to Surrounding Counties

Are surrounding counties experiencing increasing, decreasing or stable case rates?

Are surrounding counties also planning to increase the pace through Stage 2 of

California’s roadmap to modify the Stay-at-Home order, and if so, on what timeline?

How are you coordinating with these counties?

What systems or plans are in place to coordinate with surrounding counties (e.g.

health care coalitions, shared EOCs, other communication, etc.) to share situational

awareness and other emergent issues.

CDPH COVID-19 VARIANCE ATTESTATION FORM

16

How will increased regional and state travel impact the county’s ability to test, isolate,

and contact trace?

Avalon is the only municipality on Catalina Island and is geographically isolated. The

City has measure in place, through existing contracts with Los Angeles County Fire and

Baywatch, the Los Angeles County Sheriff’s Department, and U.S. Coast Guard,

including shared and coordinated Emergency Operations Centers, strategic and

regular communications, coordination of shared plans and investigations, and

participation on state, regional, and local coalitions and task forces to share

situational awareness and other emergent issues.

In addition to your county’s COVID-19 VARIANCE ATTESTATION FORM, please include:

Letter of support from the County Board of Supervisors

Letter of support from the local hospitals or health care systems. In the event that the

county does not have a hospital or health care system within its jurisdiction, a letter of

support from the relevant regional health system(s) is also acceptable.

County Plan for moving through Stage 2

All documents should be emailed to Jake Hanson at Jake.Hanson@cdph.ca.gov.

CDPH COVID-19 VARIANCE ATTESTATION FORM

17

I Denise Radde, hereby attest that I am duly authorized to sign and act on behalf of the City

of Avalon. I certify that the City of Avalon has met the readiness criteria outlined by CDPH

designed to mitigate the spread of COVID-19 and that the information provided is true,

accurate and complete to the best of my knowledge. If a local COVID-19 Containment

Plan is submitted for the City of Avalon, I certify that it was developed with input from the

County Board of Supervisors/City Council, hospitals, health systems, and a broad range of

stakeholders in the jurisdiction. I acknowledge that I remain responsible for implementing the

local COVID-19 Containment Plan and that CDPH, by providing technical guidance, is in no

way assuming liability for its contents.

I understand and consent that the California Department of Public Health (CDPH) will post

this information on the CDPH website and is public record.

Printed Name Denise Radde

Signature

Position/Title City Manager

Date May 28, 2020

CITY OF AVALON

Avalon City Hall - 410 Avalon Canyon Road - P.O. Box 707 - Avalon, CA 90704 (310) 510-0220 1

SECTOR PLAN FOR MOVING THROUGH STAGE 2 AND EARLY STAGE 3

Stage Sectors Timeline Stage 2 Destination Retail Dine-in restaurants and outdoor patio dining (other

facility amenities such as bars are not permitted) Outdoor dining within the public rights-of-way Piers, to allow for modified business and access and operations,

including the Harbor Department, that are located on the pier (with appropriate social distancing measures in place)

Full beach access for passive recreation with enforced social distancing measures and protocols

Parks (with limitations on passive recreation and the continual closure of all playground equipment)

Hair and nail salons and barbershops Tours (with modified operations) and outdoor recreation activities

(such as zip lines, fishing, guide services, pack operations) Hotels/lodging for leisure and tourism – non-essential travel Indoor museums Office-based businesses (telework continues to be strongly

encouraged) Campgrounds (with social distancing measures) Additional water-based activities Childcare will expand from serving children of essential service

workers only to broader workforce. Childcare may be broadened to include summer day camps that are able to operate in accordance with childcare safety protocols outlined in Health Officer Orders

Schools

June 1, 2020

State and Los Angeles County Reference Guide

Industry Sector LA County Guideline Link State Guideline Link Agriculture and Livestock https://covid19.ca.gov/pdf/guidance-agriculture.pdf Auto Dealerships http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening-CarDealerships.pdf https://covid19.ca.gov/pdf/guidance-auto-dealerships.pdf Beaches http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_Beaches.pdf Bike Parks http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_BikeParks.pdf Car Washes http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_CarWashes.pdf Childcare https://www.cdss.ca.gov/Portals/9/CCLD/PINs/2020/CCP/PIN_20-06-

CCP.pdf Communications Infrastructure https://covid19.ca.gov/pdf/guidance-communications.pdf Community Gardens http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_CommunityGardens.pdf Construction https://covid19.ca.gov/pdf/guidance-construction.pdf Delivery Services https://covid19.ca.gov/pdf/guidance-delivery-services.pdf Dine-in Restaurants https://covid19.ca.gov/pdf/guidance-dine-in-restaurants.pdf Energy and Utilities https://covid19.ca.gov/pdf/guidance-energy.pdf Equestrian Centers http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_EquestrianCenters.pdf Food Packing https://covid19.ca.gov/pdf/guidance-food-packing.pdf Golf Courses http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening-GolfCourses.pdf Hair Salons and Barbershops https://covid19.ca.gov/pdf/guidance-hair-salons.pdf Hotels and Lodging https://covid19.ca.gov/pdf/guidance-hotels.pdf Life Sciences https://covid19.ca.gov/pdf/guidance-life-sciences.pdf Limited Services https://covid19.ca.gov/pdf/guidance-limited-services.pdf Logistics and Warehousing Facilities

http://publichealth.lacounty.gov/media/Coronavirus/docs/HOO/HOO_Safer_at_Home_Order_for_Control_of_COVID_5.13.20_APPENDIX_C.pdf https://covid19.ca.gov/pdf/guidance-logistics-warehousing.pdf

Manufacturing https://covid19.ca.gov/pdf/guidance-manufacturing.pdf Mining and Logging https://covid19.ca.gov/pdf/guidance-mining-logging.pdf Model Airplane Area http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_ModelAirplaneArea.pdf Outdoor Museums http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_OutdoorMuseumsGalleries.pdf https://covid19.ca.gov/pdf/guidance-outdoor-museums.pdf Outdoor Shooting Facilities http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_OutdoorShootingFacilities.pdf Office Workspaces https://covid19.ca.gov/pdf/guidance-office-workspaces.pdf Places of Worship https://covid19.ca.gov/pdf/guidance-places-of-worship.pdf Ports https://covid19.ca.gov/pdf/guidance-ports.pdf Public Transit and Intercity Passenger Rail

https://covid19.ca.gov/pdf/guidance-transit-rail.pdf

Real Estate Transaction https://covid19.ca.gov/pdf/guidance-real-estate.pdf Residential Swimming Pools http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_ResidentialSwimmingPools.pdf Retail http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_RetailEstablishments.pdf https://covid19.ca.gov/pdf/guidance-retail.pdf Shopping Centers https://covid19.ca.gov/pdf/guidance-shopping-centers.pdf Substance Use Disorder and Mental Health

http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_SUDMentalHealth.pdf

Tennis and Pickleball Courts http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_TennisPickleballCourts.pdf Trails http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening-Trails.pdf Vehicle Based Parade http://publichealth.lacounty.gov/media/Coronavirus/docs/protocols/Reopening_carparades.pdf

P O Box 217, Avalon, CA 90704 LoveCatalina.com 310.510.1520

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of the Catalina Island Tourism Authority, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely,

Jim Luttjohann President & CEO

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of a City of Avalon resident and a member of the business community, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We believe in safety first. We practice this in every part of our working environment and it applies to staff, guests and volunteers. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely, Tony Budrovich Tony Budrovich President and CEO Tel: 310-510-2595 x131; tbudrovich@catalinaconservancy.org

Catalina Passenger Service, Inc. 400 Main Street

Newport Beach, CA 92661

(949) 673-5245 Office (949) 673-8340 Fax

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Catalina Passenger Service, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely, Robert Black

Robert Black General Manager Catalina Passenger Service, Inc

From: Mesa BradleyTo: Michael ParmerSubject: AttestationDate: Thursday, May 28, 2020 1:09:15 PM

May 28, 2020

County of Los Angeles

Board of Supervisors

500 West Temple St, Suite 383

Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon

Dear County of Los Angeles Board of Supervisors:

On behalf of Brown’s Bikes and Ciao-Baci, I am supportive of the attestation plan presentedby the City of Avalon in order to modify the current Stay at Home Order.

We support the need to protect the vulnerable populations and to continue social distancingpractices; however, it is imperative for the community of Avalon to find the balance thatallows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority ofresidents have been furloughed and not able to work. The City of Avalon is unique in thatmany businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the CatalinaExpress to visit Catalina Island. The Catalina Express is public transportation. The CatalinaExpress travel boat has implemented strict guidelines to ensure the safety and security of theiremployees, crew, and passengers. We feel that visitors should be welcomed again in the Cityof Avalon as long as social distancing practices remain in place.

Sincerely,

Mesa Bradley , Owner/Operator

Brown’s Bikes (Opened August, 1986)

310-510-0986

Ciao-Baci (Opened October, 2008)

107 Pebbly Beach Road

PO Box 2680

Avalon, CA 90704

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Catalina Comedy Island, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely,

Ben Villalobos Catalina Comedy Island LLC

May 28, 2020 County of Los Angeles Board of Supervisors

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Catalina Island Vacation Rentals, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. Please review some of the many steps that we are taking to keep safety at the front of our priorities for travelers, residents and employees:

• We will be leaving a gap of 24 hours between reservations • We have ordered more than 300lbs of PPE including face shields, masks et cetera • All guidelines from California Department of health are being followed strictly if not

further enhanced. • We already have much • Additionally, we have ordered fogging machines and sanitizer liquid • We are treating the surfaces with antimicrobial fluid that will protect surfaces for up to 90

days • All housekeepers and staff will be held accountable for practicing what we have already

trained them on • Temperature checks will be mandatory

Please also see the attachment for a quick primer infographic that is being using for all staff. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely, Thomas Salinas Catalina Island Vacation Rentals Inc.

6 feet

We care about your health and safetyOranj Palm is making sure that we do everything in our power to ensure that we practice healthy habits and follow

CDC guidelines to ensure the health and safety of our staff and clients. Here is what we are doing:

All staff members will be required to wear

personal protective equipment when entering

a home or in guest presence. They will also

frequently wash hands with soap and carry

sanitizer to disinfect anything they come in

contact with.

There will be 24 hour spacing between

reservations to ensure proper cleaning and

sanitizing is performed. Housekeepers will use

cleaning products and protocols that meet with

CDC guidelines and are approved for use and

effective against viruses, bacteria and other

airborne and blood-borne pathogens.

All staff members will be required to practice

social distancing. Those who can perform telework

will do so from home. Contact-less check-ins will

be performed to avoid physical interaction.

Service team members will not enter properties if

occupied unless the repair requires to maintain

safety of the guest.

Our goal is to provide the best vacation rental experience while ensuring that your safety and

health is a priority. If you have any further questions or would like details of our procedures, please

do not hesitate to call or email us.

We request that staff, owners and guests stay

home if they do not feel well. Self screening

should be performed at home prior to any shift.

If symptoms are present, its imperative that a

test is completed and self-quarantine at home

until cleared of good health.

Frontdesk@catalinavacations.com 1-855-631-5280

From: Doug NelsonTo: Michael ParmerSubject: Letter of support for Attestation ProposalDate: Thursday, May 28, 2020 1:52:46 PM

I Douglas Nelson owner of Shades of Catalina/Sugarloaf Books due wholeheartedlysupport the Proposal of Attestation.Without our ability to open our businesses, the Town of Avalon will be hard pressed to existsafelyin the way a top tourist town needs to operate.We don't have the luxury of any random and drive by traffic relying solely of boats so withoutyour support the towns lifeblood will be irreputably harmed.RespectfullyDoug Nelson

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Mountain and Sea Adventures, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely, Annie MacAulay President CEO Mountain and Sea Educ Adventures PO Box 2290 Avalon, Ca 90704 Annie@MountainAndSea.org

May 28th, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Catalina Sea Spa (#1 spa in Catalina) I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. We as a seasonal travel destination only have mid spring-mid fall to earn 12 months of income in order to survive. Since we have already missed all of spring we beg to be opened soon so we don’t have a continued unemployment tragedy throughout the winter when most businesses will have permanently closed for good. Sincerely, Michelle Bray Catalina Sea Spa www.catalinaseaspa.com

From: scuba luvTo: Michael ParmerSubject: reopening AvalonDate: Thursday, May 28, 2020 1:11:23 PM

Please reopen our city of Avalon. Many business rely on the spring/summer tourist season to get them by for theslow winter season. We have lots of tattle tales if someone is not doing something correctly. (not to mention Facebook)Our town cares about its visitors and townspeople. One won't survive without the other.Tina Kennedy

May 28, 2020

Michael Parmer Assistant City Manager City of Avalon Avalon, CA 90704

To Whom it may concern

RE: Reopen City of Avalon Safely

We need our City to be allowed to be evaluated by the rules applied to a “County” separate from LA County, in order to move more quickly through the Covid re-opening stages outlined by the State to save our island community and City.

We are unique and as such respectfully ask for your support in asking for this concession, although located within Los Angeles County, we have very unique attributes and request special consideration as such as it relates to Covid 19 measures.

We hope you can agree that thus far our city has taken a very cautious approach in our efforts towards the COVID-19 pandemic additionally we we can positively meet all the criteria as laid out in the “VARIANCE TO STAGE 2 OF CALIFORNIA’S ROADMAP TO MODIFY THE STAY-AT-HOME ORDER COVID-19 COUNTY VARIANCE ATTESTATION FORM”.

Avalon is unique:

Due to our island local, our size, our small resident population and our unique ability to monitor and control the number of people that can occupy Avalon, coupled with the fact that we have experienced 0 fatalities due to Covid 19. We would like this special consideration that would allow us to be the example and sanctuary city in this difficult time. This could be a WIN for the state to put forward an example of best practices of how we can begin traveling in a safe and thoughtful way and a WIN for our City that is unfairly disadvantaged by the Phased plan that was meant to allow 70% of businesses to re-open in the State of California..

Avalon’s economy is solely supported by the visiting public to survive. Unlike most locations in California, the local population cannot support the local economy. Most importantly, Avalon’s business community is dependent upon the summer months, as they are absolutely crucial to the local economy to survive the rest of the year.

Unfortunately for Avalon, the Stay at Home Order, negates California’s Phase 2 of the states re-opening strategy, forcing our local businesses to wait for Phase 4 due to the unique necessity for non-essential visitors to support local retail, restaurants, hotels, and outdoor recreational

activities. For this reason, we propose that the state allow Avalon the ability to create a unique plan, to allow by variance, visitors seeking recreation to travel to the Island via non-essential travel.

When the survivability of our City, community, economy and population is incapable of being self supporting and relies on the visiting public, we humbly request approval to become a sanctuary city and begin to safely re-open. We are aware of our responsibility to ensure our population is protected and have thus far successfully taken every necessary step to do so.

To briefly review our City’s actions in response to COVID-19: on March 17, 2020 we proclaimed a local emergency; on March 25, 2020, we shut our harbor to mooring vessels, limited all travel to the island and hotel occupancy to essential service providers and based on your guidance, we closed all bars and limited restaurants to take out orders only, on March 27, we issued the closure of our beaches and trails, issued the requirement for all citizens to wear a face covering when interacting with any other group of people or entering a building as well as implemented safe social distancing protocols. These decisions were not taken lightly, but done willingly as we understand the importance of protecting our community and are steadfast in our intentions to protect our citizens and those that travel between the mainland and the island.

Last week, our Community re-opened our Harbor and is diligently working towards a phased reopening plan that we hope to implement with the blessing of the State in cooperation with LA County. The first stage of our multi-staged approach would include limited public access, as an island destination we are uniquely positioned to monitor and control numbers and access to our community as a whole as required in the attestation checklist.

We believe that if allowed to work toward this goal we can submit a plan with a responsible and cautious approach to re-opening our community to the public. We respectfully request that you allow us sanctuary status and direct LA County to work with us to reopen in stages, as soon as possible so that our City is afforded the same survivability as communities not burdened by being located on an island.

Sincerely,

Laura Whitby Seaport Village Inn 310.991.3771 cc: Asst City Manager (mparmer@cityofavalon.com), Mayor of Avalon (amarshall@cityofavlon.com), Senator Ben Allen (senator.allen.senate.ca.gov), Congressman Alan Lowenthal

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Island Water Charters/Parasail, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely, Doug Shelton Island Water Charters/Parasail.

May 28, 2020

County of Los Angeles

Board of Supervisors

500 West Temple St, Suite 383

Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon

Dear County of Los Angeles Board of Supervisors:

On behalf of Helmut Heiligenmann, Indie Dolly Systems Inc, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order.

We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place.

Sincerely,

Helmut Heiligenmann

Indie Dolly Systems Inc

May 28, 2020 County of Los Angeles Board of Supervisors 500 West Temple St, Suite 383 Los Angeles, CA 90012

Re: Support for Attestation plan by the City of Avalon Dear County of Los Angeles Board of Supervisors: On behalf of Shelton’s on the Island, I am supportive of the attestation plan presented by the City of Avalon in order to modify the current Stay at Home Order. We support the need to protect the vulnerable populations and to continue social distancing practices; however, it is imperative for the community of Avalon to find the balance that allows businesses to re-open. The City of Avalon has a population of approximately 4,000. The primary work available for citizens is in the tourist industry; therefore, the majority of residents have been furloughed and not able to work. The City of Avalon is unique in that many businesses rely solely on revenue from tourists alone. Unfortunately, with the non-essential travel ban in place, potential guests are discouraged from traveling on the Catalina Express to visit Catalina Island. The Catalina Express travel boat has implemented strict guidelines to ensure the safety and security of their employees, crew, and passengers. We feel that visitors should be welcomed again in the City of Avalon as long as social distancing practices remain in place. Sincerely, Regina Shelton Shelton’s on the Island Vacation Rental VRBO.com/183424 Airbnb

From: Levent AlkibayTo: Michael ParmerSubject: support letterDate: Thursday, May 28, 2020 1:06:38 PM

Levent Alkibay | President/CEOOffice: 310-510-0620 Ext 103| Fax : 310-510-2587Mobile: 619-990-3383 | Email: levent.alkibay@catalinabeverage.com

The Avalon Hotel supports the re-open of the town and renewed efforts to continue.

Sincerely,

Rock & Kathleen Gosselin

Laurie Sanchez

Erica Hernandez

S A R S - C o V - 2 ( C O V I D - 1 9 ) F a c t S h e e t

O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H

Guidance – Proposed Use of Point-of-Care (POC) Testing Platforms for SARS-CoV-2 (COVID-19)

Overview Certain tests to detect COVID-19 may be performed at the point-of-care, or POC, meaning that the process of medical diagnostic testing occurs at the time and place of patient care, e.g. bedside, physician’s office, etc. POC testing offers additional benefits including speed of diagnosis, and simplicity of use (push button, single cassette, etc.). Various types of technologies may be utilized in POC tests, such as:

• nucleic acid amplification (molecular) tests that detect the presence of a pathogen, • antigen tests that also detect the presence of a pathogen, • and serological tests that can determine whether or not an individual has immunological evidence

of exposure to a pathogen. (Note that there are currently no FDA authorized serological point of care tests; however, they may become available in the future.)

POC tests are a useful component of the diagnostic strategy in response to the SARS-CoV-2 (COVID-19) outbreak. Nucleic Acid Amplification POC Tests Mobile platforms Mobile platforms are small and portable, and are optimal for deployment to remote, outbreak and crisis situations. These POC instruments are lower throughput (i.e., process fewer samples in a specified timeframe) than other platforms (instruments), and typically run one sample at a time in 5-30 minutes. For this reason, it may not be feasible to test, for example, an entire manufacturing facility of thousands of employees for COVID-19 with a POC platform. In such a situation, the POC instrument could be used to test the highest priority (symptomatic) individuals, while test orders for asymptomatic individuals could be sent out for processing at an offsite laboratory using high throughput platforms. The Abbott ID NOW is an example of a mobile molecular POC device for COVID-19. Facility-based platforms Larger POC platforms, such as the Cepheid GeneXpert® Xpress, another example of a POC device that can be used for COVID-19, are often based in hospitals and medical centers. They have higher throughput than the mobile platforms, but still return results in less than an hour. The components are often self-contained, requiring fewer laboratory resources (i.e., hands-on personnel) than other laboratory-based instruments. Using a rapid, facility-based POC platform to test healthcare providers and symptomatic patients enables maintenance of workforce (rapid return to work), reduces PPE usage, and rapid diagnosis for critically ill patients. Antigen POC tests These diagnostic tests quickly detect fragments of proteins found on or within the virus by testing samples collected from the nasal cavity using swabs. The Quidel Corporation’s Sofia 2 SARS Antigen FIA received an EUA from the FDA on May 8, 2020, and is approved for point-of-care-testing by facilities operating under a CLIA Certificate of Waiver. The antigen test can provide results in minutes; however, antigen tests may not detect all active infections, based on their mechanism of action. These tests are very specific for the virus, but are not as sensitive as molecular PCR tests. Therefore, positive results from antigen tests are highly accurate, but there is a higher chance of false negatives, so negative results do not rule out infection. With this in mind, negative results from an antigen test may need to be confirmed with a PCR test prior to making treatment decisions or to prevent the possible spread of the virus due to a false negative.

S A R S - C o V - 2 ( C O V I D - 1 9 ) F a c t S h e e t

Serological POC Tests Currently, there are no FDA authorized COVID-19 serology point-of-care tests. This section is included to inform future planning. POC serologic testing technologies include, but are not limited to, single-use, low through-put lateral flow tests where the presence of antibody is demonstrated by a color change on a paper strip. Some samples for this type of test can be collected through the use of a fingerstick. There are different types of antibodies. IgM is one of the first types of antibody to be produced after a pathogen has entered the body, and is most useful for determining recent infection. In most infections, IgG generally develops after IgM, and may remain detectable for months or years. These are the types of antibodies that are often targeted by serological tests. Whenever possible, laboratories should rely on molecular tests to diagnose the presence of SARS-CoV-2 infections. Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infections or to inform infection status. CDC, NIH and FDA and other parts of the federal government are evaluating the performance of commercially manufactured antibody tests for SARS-CoV-2 (COVID-19). FDA has authorized emergency use of several of these antibody tests. It should be noted that there are many serological tests being marketed to laboratories that neither have FDA authorization, nor have they been evaluated by the FDA. Presently, a positive test result from a POC serological test for SARS-CoV-2 (COVID-19) shows that an individual has antibodies that likely resulted from an infection with SARS-CoV-2, or possibly a related coronavirus. Negative results from antibody testing do not rule out SARS-CoV-2 infections, particularly for those individuals who have been exposed to the virus and are still within the estimated incubation period. It is unclear if those antibodies can provide protection (immunity) against re-infection. Appropriately validated serology tests, when used broadly as part of seroprevalence studies, can be useful in understanding how many people have been infected and how far the pandemic has progressed. These tests may also be useful to examine demographics and geographic patterns, to determine which communities may have had more cases. Proposed Uses of Point-of-Care Diagnostic Tests for SARS-CoV-2 (COVID-19) POC rapid tests are envisioned to supplement laboratory testing, enabling testing to be available for communities and populations that cannot readily access laboratory testing or need to quickly address emerging outbreaks. Laboratory testing remains the primary testing mechanism for the nation because of the ability to perform a high volume of tests at one time. Examples of potential uses for POC instruments for COVID-19 diagnostic purposes include:

• Deployment to rural hospitals or other critical care sites that lack widely available testing. • Use at public health department testing sites performing CLIA-waived testing for other purposes. • Deployment to long-term care facilities or correctional institutions. Regulatory requirements and

necessary CLIA documentation need to be considered when deploying instruments to these settings if they are not currently performing other POC testing.

• Rapid deployment to aid in the investigation of a newly identified case cluster. This potential use would require careful consideration to ensure the feasibility of rapidly standing up testing.

• Placement in public health laboratories to test high-priority specimens requiring a rapid result. Regulatory Considerations

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There are regulatory considerations that must guide the use of POC instruments for SARS-CoV-2 diagnostic purposes. Testing sites operating a POC diagnostic instrument must have a current certificate via the Clinical Laboratory Improvement Amendments of 1988 (CLIA). During the COVID-19 public health emergency, the Centers for Medicare & Medicaid Services (CMS) will permit a Certificate of Waiver laboratory to extend its existing certificate to operate a temporary COVID-19 testing site in an off-site location, such as a long-term care facility. The temporary COVID-19 testing site is only permitted to perform waived tests, consistent with the laboratory's existing certificate and must be under the direction of the existing lab director. Frequently Asked Questions (FAQs) concerning CLIA Guidance during the COVID-19 Emergency is available here. For Additional Information CDC Coronavirus Disease 2019 (COVID-19) – Test for Past Infection - https://www.cdc.gov/coronavirus/2019-ncov/testing/serology-overview.html CDC Coronavirus Disease 2019 (COVID-19) – COVID-19 Serology Surveillance Strategy https://www.cdc.gov/coronavirus/2019-ncov/covid-data/serology-surveillance/index.html CMS Frequently Asked Questions (FAQs), CLIA Guidance During the COVID-19 Emergency - https://www.cms.gov/files/document/clia-laboratory-covid-19-emergency-frequently-asked-questions.pdf FDA FAQs on Diagnostic Testing for SARS-CoV-2 - https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2 FDA Coronavirus (COVID-19) Update: FDA Authorizes First Antigen Test to Help in the Rapid Detection of the Virus that Causes COVID-19 in Patients - https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-first-antigen-test-help-rapid-detection-virus-causes

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O F F I C E O F T H E A S S I S T A N T S E C R E T A R Y F O R H E A L T H

Nasal (Anterior Nasal) Specimen Collection for SARS-CoV-2 Diagnostic Testing

Nasal (Anterior Nasal) Specimen

• Nasal sampling is less invasive and results in less patient discomfort than sampling from other upper respiratory anatomical sites.

• A self-administered nasal swab is similar to a nasopharyngeal swab in detecting coronavirus. • Collection of nasal swab specimens is less technically complex, so can reduce the risk of the

spread of infection to healthcare providers, by (1) reducing the duration of the procedure, and (2) allowing the patient to perform self-collection while under supervision.

• It also lessens PPE utilization, given that the patient can perform self-collection under supervision (versus the health care provider performing the collection).

• The procedure for nasal (anterior nasal) sampling is as follows: o Using a flocked or spun polyester swab, insert the swab at least 1 cm (0.5 inch) inside the

nostril (naris) and firmly sample the nasal membrane by rotating the swab and leaving in place for 10 to 15 seconds.

o Sample both nostrils with same swab. Protective Practices for Healthcare Providers Performing Nasal (Anterior Nares) Specimen Collection

• For healthcare providers collecting nasal (anterior nares) specimens, or within 6 feet of patients suspected to be infected with SARS-CoV-2:

o Maintain proper infection control and use recommended personal protective equipment (PPE), which includes an N95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown, when collecting specimens.

• For healthcare providers who are observing patient self-collection of nasal (anterior nares) samples, so are therefore handling specimens, but are not directly involved in collection and not working within 6 feet of the patient:

o Follow Standard Precautions o Gloves are recommended. Note that healthcare personnel are recommended to wear a

form of source control (facemask or cloth face covering) at all times while in the healthcare facility.

o PPE use can be minimized through patient self-collection while the healthcare provider

maintains at least 6 feet of separation.

For Additional Information FDA FAQs on Diagnostic Testing for SARS-CoV-2 - https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2

CDC Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19), updated as of April 29, 2020 - https://www.cdc.gov/coronavirus/2019-ncov/lab/guidelines-clinical-specimens.html

CDC Laboratory Biosafety and COVID-19: Questions and Answers - https://www.cdc.gov/coronavirus/2019-ncov/lab/biosafety-faqs.html

5/26/2020 Interim Guidance: Healthcare Professionals 2019-nCoV | CDC

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html 1/3

Coronavirus Disease 2019 (COVID-19)

Evaluating and Testing Persons for Coronavirus Disease2019 (COVID-19)

CDC guidance for COVID-19 may be adapted by state and local health departments to respond to rapidly changing localcircumstances.

No vaccine for COVID-19 is currently available; however, vaccine trials are inprogress . The National Institutes of Health recently published guidelines onprophylaxis use, testing, and management of COVID-19 patients. For moreinformation, please visit: National Institutes of Health: Coronavirus Disease 2019(COVID-19) Treatment Guidelines .

The CDC clinical criteria for considering testing for COVID-19 have been developedbased on what is known about COVID-19 and are subject to change as additionalinformation becomes available.

Recent Changes

Revisions were made on May 3, 2020 to re�ect the following:

Updated recommendations for testing, specimen collection, and reportingpatients and reporting positive test results

Speci�cation of testing priorities

Summary of other changes

CDC Health Advisory

Update and Interim Guidance onOutbreak of Coronavirus Disease2019 (COVID-19)

CDC continues to closely monitoran outbreak of respiratory illnesscaused by COVID-19 that wasinitially detected in Wuhan City,Hubei Province, China. This HANUpdate provides a situationalupdate and guidance to state andlocal health departments andhealth care providers.

Contact your local or state health departmentHealthcare providers should immediately notify their local or state  health department in the event of theidenti�cation of a PUI for COVID-19. When working with your local or state health department check theiravailable hours.

PRIORITIES FOR COVID-19 TESTING(Nucleic Acid or Antigen)

High Priority

Hospitalized patients with symptoms

Healthcare facility workers, workers in congregate living settings, and �rst responders with symptoms

Residents in long-term care facilities or other congregate living settings, including prisons and shelters, withsymptoms

Priority

Persons with symptoms of potential COVID-19 infection, including: fever, cough, shortness of breath, chills, musclepain, new loss of taste or smell, vomiting or diarrhea, and/or sore throat.

5/26/2020 Interim Guidance: Healthcare Professionals 2019-nCoV | CDC

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html 2/3

Clinicians considering diagnostic testing of people with possible COVID-19 should continue to work with their local and statehealth departments to coordinate testing through public health laboratories , or work with commercial or clinicallaboratories using diagnostic tests authorized for emergency use by the U.S. Food and Drug Administration.

Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 andwhether the patient should be tested. Asymptomatic infection with SARS-CoV-2, the virus that causes COVID-19, has beenreported. Most patients with con�rmed COVID-19 have developed fever and/or symptoms of acute respiratory illness (e.g.,cough, di�culty breathing) but some people may present with other symptoms as well. Other considerations that may guidetesting are epidemiologic factors such as the occurrence of local community transmission of COVID-19 in a jurisdiction.Clinicians are encouraged to test for other causes of respiratory illness.

Other considerations that may guide testing are epidemiologic factors such as known exposure to an individual who hastested positive for SARS-CoV-2, and the occurrence of local community transmission or transmission within a speci�csetting/facility (e.g., nursing homes) of COVID-19. Clinicians are strongly encouraged to test for other causes of respiratoryillness, for example in�uenza, in addition to testing for SARS-CoV-2. Another population in which to prioritize testing ofminimally symptomatic and even asymptomatic persons are long-term care facility residents, especially in facilities where oneor more other residents have been diagnosed with symptomatic or asymptomatic COVID-19.

SARS-CoV-2 can cause asymptomatic, pre-symptomatic, and minimally symptomatic infections, leading to viral shedding thatmay result in transmission to others who are particularly vulnerable to severe disease and death. Even mild signs andsymptoms (e.g., sore throat) of COVID-19 should be evaluated among potentially exposed healthcare personnel, due to theirextensive and close contact with vulnerable patients in healthcare settings. Additional information is available in CDC’sInterim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure ina Healthcare Setting to Patients with Coronavirus Disease 2019 (COVID-19).

Recommendations for Viral Testing, Specimen Collection, andReportingUpdated May 3, 2020

Clinicians should immediately implement recommended infection prevention and control practices, including use ofrecommended personal protective equipment (PPE), if a patient is suspected of having COVID-19. They should also notifyinfection control personnel at their healthcare facility if a patient is classi�ed as a Patient Under Investigation (PUI) for COVID-19.

For diagnostic testing for COVID-19 see the Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens fromPUIs for COVID-19 and Biosafety FAQs for handling and processing specimens from possible cases and PUIs.

Clinicians should report positive test results to their local or state health department only.

Recommendations for Antibody TestingUpdated May 25, 2020

CDC does not recommend using antibody testing to diagnose acute infection. It is recommended to use a viral (nucleic acid orantigen) test to diagnose acute infection.

Read CDC’s interim guidelines for using antibody tests in clinical and public health settings.

Persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but notlimited to: public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according tostate and local plans.

1

2

5/26/2020 Interim Guidance: Healthcare Professionals 2019-nCoV | CDC

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html 3/3

Additional Resources:Nasal (Anterior Nasal) Specimen Collection for SARS-CoV-2 Diagnostic Testing [1 page]

Guidance – Proposed Use of Point-of-Care (POC) Testing Platforms for SARS-CoV-2 (COVID-19) [2 pages]

State health department after-hours contact list

Directory of Local Health Departments

World Health Organization (WHO) Coronavirus

WHO guidance on clinical management of severe acute respiratory infection when COVID-19 is suspected

NIH Coronavirus Disease 2019 (COVID-19) and Treatment Guidelines

CMS Guidelines

FAQs on Diagnostic Testing from the FDA

FootnotesFever may be subjective or con�rmed

Close contact is de�ned as—

a) being within approximately 6 feet (2 meters) of a COVID-19 case; close contact can occur while caring for, living with,visiting, or sharing a healthcare waiting area or room with a COVID-19 case

– or –

b) having direct contact with infectious secretions of a COVID-19 case (e.g., being coughed on)

Additional information is available in CDC’s Interim Infection Prevention and Control Recommendations for Patients withCon�rmed COVID-19 or Persons Under Investigation for COVID-19 in Healthcare Settings.

1

2

Summary of other changes

Revisions were made on April 27, 2020 to re�ect the following:

Updated priorities for testing patients with suspected COVID-19 infection

Revisions were made on March 24, 2020 to re�ect the following:

Updated priorities for testing patients with suspected COVID-19 infection

Revisions were made on March 9, 2020, to re�ect the following:

Reorganized the Criteria to Guide Evaluation and Laboratory Testing for COVID-19 section

Revisions were made on March 4, 2020, to re�ect the following:

Criteria for evaluation of persons for testing for COVID-19 were expanded to include a wider group of symptomaticpatients.

Page last reviewed: May 5, 2020

Coronavirus Disease 2019Public HealthLaboratory

Page Updated 4-13-20LAC DPH Public Health Lab (PHL) COVID-19 Testing Criteria

COVID-19 testing – general information

Testing through PHL is prioritized for the detection and prevention of outbreaks in acute- and subacute-care health facilities andnon-healthcare congregate living settings.

If the patient meets the criteria below, call LAC DPH:Call 213-240-7941 from 8:00am-5:00pm Monday to Friday and 213-974-1234 (After Hours Emergency Operator)DO NOT collect or send specimens to PHL until the case is discussed and testing is approved by DPH

3-24-20: COVID-19 diagnostic testing through the DPH Public Health Lab (PHL) will be accepted for patients admitted tointensive care units if your facility is experiencing substantial delays in obtaining a test result from a commercial clinicallaboratory. PHL aims to maintain a turnaround time of ~1-2 business days after receiving specimen. Therefore, thisrecommendation will be regularly reassessed based on the volume of test requests through PHL and on the availability ofCOVID-19 commercial clinical laboratory capacity

Clinical Features and Epidemiologic Risk

Fever or signs/symptoms of lower respiratory illness (e.g. cough orshortness of breath)

AND Any healthcare worker (defined as a person providing directclinical care to pa�en ts) who worked while symptoma�c inan acute or long-term care facility

-or-A resident of a long-term care facility

-or-Paramedic personnel and Emergency Medicine Technicians(EMTs)

Part of a cluster of 2 or more cases of a presumed infec�ous acut erespiratory illness within a 72-hour period

AND Any congregate living se�ng (e. g. senior assisted-livingfacility, homeless shelters)

1

Before you begin...

Please read these instructions carefully as issues with specimens, forms, and labeling can lead to specimen rejection ortesting delays. DO NOT collect or send specimens to the Public Health Lab (PHL) until approved by DPH.

PHL aims to result tests within 2 business days of receipt of specimen, but delays could occur based on volume and capacity.

APPROPRIATE TESTS

For all patients: Collect TWO* upper respiratory specimens - one oropharyngeal (OP) swab and one nasal specimen (either

nasopharyngeal (NP) swab, nasopharyngeal wash/aspirate or nasal aspirate swab,)For patients with a productive cough: [only for hospital settings] collect one lower respiratory specimen (sputum,bronchoalveolar lavage or tracheal aspirate) in addition to the upper respiratory specimens.

*If supplies are limited: Submission of ONE upper respiratory specimen is acceptable—either an NP swab alone, or NP/OP swabscombined in a single vial. The combined NP/OP specimen has better sensitivity over a single NP swab alone. The BiofireRespiratory panel can only be run on the single NP swab, not on the NP/OP specimen.

SPECIMEN COLLECTION

Oropharyngeal Swab - Swab the posterior pharynx, avoiding the tongue. Immediately place swab in transport media.Nasopharyngeal (NP) swab - Insert a swab into the nostril parallel to the palate. Leave the swab in place for a few secondsto absorb secretions. Immediately place swab in transport media.Nasopharyngeal wash/aspirate or nasal aspirate - Collect 2-3 mL into a sterile, leak-proof, screw-cap sputum collectioncup or sterile dry container.Sputum: Have the patient rinse the mouth with water and then expectorate deep cough sputum directly into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container.Bronchoalveolar lavage or tracheal aspirate: Collect 2-3 mL in a sterile, leak- proof, screw-cap sputum collection cup orsterile dry container.

Note About NP and OP swabs

Viral transport media is preferred but E-swab transport systems are acceptable.Use synthetic fiber swabs with plastic shafts such as ones used to collect specimen NP swabs for influenza testing (see figure).Do not use calcium alginate swabs or swabs with wooden shafts - Use sterile tubes with at least 1ml of transport media.

FORMS AND SPECIMEN LABELING

Complete a COVID-19 PHL H-3021 Test Requisition form for each specimen. The following information must bein the "other" field of the test request form:

For NP swabs - novel coronavirus 2019 PCR and Biofire RP panel.For OP swabs, NP/OP swabs, sputum, BAL, and endotracheal aspirates - novel coronavirus 2019 PCR.

Test request forms MUST include full patient name, date of birth, medical record number, sex, date/timecollected, specimen source, and the hospital or clinic where the specimen was collected.The specimen source on the tube MUST match the source on the form.

SPECIMEN STORAGE AND TRANSPORT

Refrigerate specimens at 2-8°C and transport on cold pack, preferably as Category B.Ship specimens by courier to: Los Angeles County Public Health Laboratory, Attn: Molecular Epidemiology Unit, 12750Erickson Avenue, Downey, CA 90242.PHL can receive specimens 24 hours a day, 7 days a week.Public Health will provide a courier only to facilities with no other alternate means of specimen transport.Specimens that arrive at PHL without prior DPH approval may experience significant delays in testing.

Testing Task Force 5/5/2020

COVID-19 Serology Testing: Indications While serological tests are becoming more widely available, there are important considerations for how serological tests should, and should not, be used. A clear understanding of the limitations of current serological tests is critical for appropriate interpretation of test results. No serologic tests are currently approved by the FDA for diagnosis of COVID-19. Detection of viral RNA remains the preferred test for diagnosis of active COVID-19 in individual patients. Given our current understanding of COVID-19 serology:

What should COVID-19 serology testing1 be used for?

Determine prevalence

Yes Surveillance studies to determine population-level estimates of exposure to SARS-CoV-2 (i.e., prevalence) in a community, typically through a serologic survey. A positive serology test cannot distinguish between ongoing (active) or past COVID-19 infection.

Identify Convalescent Plasma Donors

Possible Individuals who have recovered from COVID-19 infection (viral RNA negative) and are COVID-19 serology positive can potentially donate plasma.

Identify false negative PCR

Possible As an indicator of SARS-CoV-2 infection when viral RNA test is negative. If there is high clinical suspicion for COVID-19 and SARS CoV-2 viral RNA test is negative, a positive serology test would provide support for COVID-19 infection. However, a negative serology result does not exclude COVID-19 infection since it can take 2-3 weeks after symptom onset for antibodies to develop.

Indicator of prior COVID-19 infection

Possible Given the limited availability of COVID-19 viral RNA testing, many individuals who had symptoms suggestive of COVID-19 could not be tested at the time. A positive serology test would provide support for a prior COVID-19 infection.

1It is important to select a serology test that has been fully validated using plasma or serum from confirmed COVID-19 infected individuals or well-characterized reference samples. For a list of FDA EUA approved tests, see this link: https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance

Testing Task Force 5/5/2020

COVID-19 TEST

COVID-19 serology should not be used for the following:

Viral RNA

Serology

Diagnose COVID

Yes NO As the sole basis to diagnose or exclude SARS CoV-2. COVID-19 viral RNA testing is the gold standard for diagnosing COVID-19 infection.

Identify asymptomatic shedders

Yes NO To screen for asymptomatic shedders. COVID-19 viral RNA testing is the best method for screening asymptomatic individuals for an unsuspected active COVID-19 infection.

Prior to hospital admission

Yes NO To determine if an individual is protected against future COVID-19 infections. It is not known at this time if the antibodies are protective against future COVID-19 infection or how long the antibodies will last.

Prior to high-infectivity risk procedure**

Yes NO To guide PPE use or infection control measures. COVID-19 serology testing should not be used to make decisions about the use of personal protective equipment (PPE) or infection control measures. It is not known at this time if the antibodies are protective against future COVID-19 infection or how long the antibodies will last.

Return to congregant setting

Yes NO To determine return to congregant setting. COVID-19 viral RNA testing should be used to determine if the individual has an active COVID-19 infection.

Return-to-Work Yes NO To make decisions about employment. COVID-19 serology testing should not be used to make decisions about return-to-work, hiring, duty assignment, etc. • Unknown if antibodies are protective against future COVID-19

infection • Unknown how long antibodies will last • Cross-reactivity can lead to false positive results, meaning the

individual may not have COVID-19 antibodies even though the serology test is positive

• The likelihood that the individual has COVID-19 antibodies depends on the serology test used and the prevalence of COVID-19 in their community, e.g. in a population with a 5% prevalence of SARS CoV-2 infection, a serologic test with 95% sensitivity and 95% specificity will have 50% positive predictive value (i.e. only 50% of individuals who test positive will actually have or have had COVID-19).

What should COVID-19 serology NOT be used for?

Testing Task Force 5/5/2020

Yes

Maybe

Sole basis to diagnose or exclude COVID-19 Screen for asymptomatic shedders Determine COVID-19 immunity Guide PPE use or infection control

measures Return to congregant setting Make decisions about employment, i.e.

return-to-work, hiring, duty assignment, etc.

Epidemiologic studies to determine prevalence of COVID-19 in a community (serologic survey)

No

COVID-19 Serology Testing Guidelines for Use

Identify potential convalescent plasma donors

Identify false negative COVID-19 viral RNA results

Evaluate individuals with prior COVID-19 symptoms who could not be tested at the time they were ill

DO NOT USE COVID-19 SEROLOGY

COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH ORDER OF THE HEALTH OFFICER

Protocol for Social Distancing: Appendix A Page 1 of 3 Revised 5/13/2020

Protocol for Social Distancing: Appendix A

Business name:

Facility Address:

Approximate gross square footage of space open to the public:

Businesses must implement all applicable measures listed below and be prepared to explain why any measure that is not implemented is inapplicable to the business.

A. SIGNAGE ❑ Signage at each public entrance of the facility to inform all employees and customers that they should: avoid

entering the facility if they have a cough or fever; maintain a minimum six-foot distance from one another.

❑ Signage posting a copy of the Social Distancing Protocol at each public entrance to the facility. B. MEASURES TO PROTECT EMPLOYEE HEALTH (CHECK ALL THAT APPLY TO THE FACILITY)

❑ Everyone who can carry out their work duties from home has been directed to do so.

❑ All employees have been told not to come to work if sick.

❑ Upon being informed that one or more employees test positive for, or has symptoms consistent with COVID-19 (case), the employer has a plan or protocol in place to have the case(s) isolate themselves at home and require the immediate self-quarantine of all employees that had a workplace exposure to the case(s). The employer’s plan should consider a protocol for all quarantined employees to have access to or be tested for COVID-19 in order to determine whether there have been additional workplace exposures, which may require additional COVID-19 control measures.

❑ Symptom checks are conducted before employees may enter the workspace. Checks must include a check-in concerning cough, shortness of breath or fever and any other symptoms the employee may be experiencing. These checks can be done remotely or in person upon the employees’ arrival. A temperature check should be done at the worksite if feasible.

❑ All employees that have contact during their shift(s) with the public or other employees are offered, at no-cost, a cloth face covering to be used at work when interacting with them.

❑ All desks or individual workstations are separated by at least six feet.

❑ Break rooms, restrooms, and other common areas are being disinfected frequently, on the following schedule:

❑ Break rooms:

❑ Restrooms:

❑ Other:

❑ Disinfectant and related supplies are available to all employees at the following location(s):

COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH ORDER OF THE HEALTH OFFICER

Protocol for Social Distancing: Appendix A Page 2 of 3 Revised 5/13/2020

❑ Hand sanitizer effective against COVID-19 is available to all employees at the following location(s):

❑ Soap and water are available to all employees at the following location(s):

❑ Employees are allowed frequent breaks to wash their hands.

❑ Copies of this Protocol have been distributed to all employees.

❑ Optional—Describe other measures:

C. MEASURES TO PREVENT CROWDS FROM GATHERING (CHECK ALL THAT APPLY TO THE FACILITY)

❑ Limit the number of customers in the store at any one time, which allows for customers and employees to easily maintain at least six-foot distance from one another at all practicable times. Maximum number of customers in the facility:

❑ Post an employee at the door to ensure the maximum number of customers in the facility is not exceeded.

❑ Placing per-person limits on goods that are selling out quickly to reduce crowds and lines. Explain:

❑ Optional-Describe other measures:

D. MEASURES TO KEEP PEOPLE AT LEAST SIX FEET APART (CHECK ALL THAT APPLY TO THE FACILITY)

❑ Placing signs outside the store reminding people to be at least six feet apart, including when in line.

❑ Placing tape or other markings at least six feet apart in customer line areas inside the store and on walkways at public entrances with signs directing customers to use the markings to maintain distance.

❑ Separate order areas from delivery areas to prevent customers from gathering.

❑ All employees have been instructed to maintain at least six feet distance from customers and from each other, except employees may momentarily come closer when necessary to accept payment, deliver goods or services, or as otherwise necessary.

❑ Optional—Institute one-way aisles to facilitate Social Distancing.

❑ Optional—Describe other measures:

E. MEASURES TO PREVENT UNNECESSARY CONTACT (CHECK ALL THAT APPLY TO THE FACILITY)

❑ Preventing people from self-serving any items that are food-related.

❑ All items are pre-packaged in sealed containers by staff.

❑ Bulk-item food bins are not available for customer self-service use.

❑ Food samples are prohibited.

COUNTY OF LOS ANGELES DEPARTMENT OF PUBLIC HEALTH ORDER OF THE HEALTH OFFICER

Protocol for Social Distancing: Appendix A Page 3 of 3 Revised 5/13/2020

❑ Providing for contactless payment systems or, if not feasible, sanitizing payment systems regularly. Describe:

❑ Optional-Describe other measures (e.g. providing senior-only hours):

F. MEASURES TO INCREASE SANITIZATION (CHECK ALL THAT APPLY TO THE FACILITY)

❑ Restrooms normally open to the public shall remain open to the public.

❑ Disinfecting wipes that are effective against COVID-19 are available near shopping carts and shopping baskets.

❑ Employee(s) assigned to disinfect carts and baskets frequently, preferably after each use.

❑ Hand sanitizer, soap and water, or effective disinfectant is available to the public at or near the entrance of the facility, at checkout counters, and anywhere else inside the store or immediately outside where people have direct interactions.

❑ Disinfecting all payment portals, pens, and styluses after each use.

❑ Disinfecting all high-contact surfaces frequently.

❑ Optional- Describe other measures:

Any additional measures not included above should be listed on separate pages, which the business should attach to this document.

You may contact the following person with any questions or comments about this protocol:

Business Contact Name: Phone number:

Date Last Revised: