Outbreak of COVID-19 among vaccinated and unvaccinated homeless shelter residents — Sonoma County, California, July 2021

In July 2021, the Sonoma County Health Department was alerted to three cases of COVID-19 among residents of a homeless shelter in Santa Rosa, California. Among 153 shelter residents, 83 (54%) were fully vaccinated; 71 (86%) vaccinated residents had received the Janssen COVID-19 vaccine and 12 (14%) received an mRNA (Pfizer BioNTech or Moderna) COVID-19 vaccine. Within 1 month, 116 shelter residents (76%) received positive SARS-CoV-2 test results, including 66 fully vaccinated residents and 50 not fully vaccinated. 9 fully vaccinated and 1 unvaccinated were hospitalized for COVID-19. All hospitalized cases had at least one underlying medical condition. Two deaths occurred, one in a vaccinated resident and one in a non-vaccinated resident. Specimens from 52 residents underwent whole genome sequencing; all were identified as SARS-CoV-2, Delta Variant AY.13 lineage. Additional mitigation measures are needed in medically vulnerable congregate setting where limited resources make individual quarantine and isolation not feasible.

A Performance-Based Approach to Quantify Atmospheric River Flood Risk

Atmospheric rivers (ARs) are a class of meteorologic phenomena that cause significant precipitation and flooding on the US West Coast. This work presents a new Performance-based Atmospheric River Risk Analysis (PARRA) framework that adapts existing concepts from probabilistic risk analysis and performance-based engineering for application in the context of AR-driven fluvial flooding. The PARRA framework is a chain of physically based models that link the atmospheric forcings, hydrologic impacts, and economic consequences of AR-driven fluvial flood risk together at consistent “pinch point” variables. Organizing around these pinch points makes the framework modular, in that models between pinch points can be updated without affecting the rest of the model chain, and it produces a probabilistic result that quantifies the uncertainty in the underlying system states. The PARRA framework can produce results beyond analyses of individual scenario events and can look towards prospective assessment of events or system changes that have not been seen in the historic record. The utility of the PARRA framework is demonstrated through a series of analyses in Sonoma County, California. Evaluation of a February 2019 case study AR event shows that the individual component models produce simulated distributions that capture the observed precipitation, streamflow, inundation, and damage. The component models are then run in sequence to generate a first-of-its-kind AR flood loss exceedance curve for Sonoma County. The prospective capabilities of the PARRA framework are presented through the evaluation of a hypothetical mitigation action. It was found elevating 150 homes, selected based on their proximity to the Russian River, was able to reduce the average annual loss by half. The loss results from the mitigated building portfolio are compared against the original case. While expected benefits were minimal for the smallest events, the larger, more damaging ARs were expected to see loss reductions of approximately $50 million per event. These results indicate the potential of the PARRA framework for examining other changes to flood risk at the community level, including future changes to the hazard, through climate change; exposure, through development; and/or vulnerability, through flood mitigation investments.

A New Combination in Holodiscus (Rosaceae, Amygdaloideae, Spiraeeae)

Holodiscus dumosus var. cedrorum, The Cedars oceanspray, was described in 2011 in recognition of the distinct morphology of populations occurring on serpentine soils in The Cedars area in the Outer Coast Ranges of Sonoma County, California. Morphological and genetic data suggest that this taxon should instead be treated as a variety of Holodiscus discolor, here interpreted broadly as a widespread and highly variable species with several taxonomic varieties that intergrade. The new combination Holodiscus discolor var. cedrorum is made and a key to the varieties that occur in California is provided.

Estimating Migration Impacts of Wildfire: California’s 2017 North Bay Fires

This chapter examines a cluster of wildfire conflagrations that hit northern California during October 2017, which resulted in significant loss of housing units (6874 residential structures destroyed or damaged). To assess the magnitude of the migration response and network of destinations, a method to estimate migration drawing from a proxy universe of households with students enrolled in public schools was proposed, using data on school exits and re-enrollments from a longitudinal student database. The analysis finds that a small minority of households affected by the fires moved out of the area. Out of nearly 7800 persons displaced by the central fire complex in one city, this study estimated fewer than 1000 changed neighborhoods; of those, fewer than 500 moved out of Sonoma County. These findings are applicable to other wildfires and localized disasters where a substantial portion of housing is lost but public infrastructure in the region remains intact.

Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study (Preprint)

BACKGROUND People with complex needs, such as those experiencing homelessness, require concurrent, seamless support from multiple social service agencies. Sonoma County, CA has one of the nation’s largest homeless populations among largely suburban communities. To support client-centered care, the county deployed a Care Management and Coordination System (CMCS). This system was comprised of Watson Care Manager (WCM), a front-end system, and Connect 360, which is an integrated data hub that aggregates information from various systems into a single client record. OBJECTIVE This study evaluated the perceived impact and usability of WCM in delivering services to the homeless population in Sonoma County. METHODS A mixed methods study was conducted to identify ways in which WCM helps to coordinate care. Interviews, observations and surveys were conducted, and transcripts and field notes were thematically analyzed and directed by a grounded theory approach. Responses to the Technology Acceptance Model (TAM) survey were analyzed. RESULTS Sixteen participants were interviewed, including WCM users (n=8) and department leadership (n=8). Three interdisciplinary team meetings were observed, and WCM users (n=8) were surveyed. WCM provided a central shared platform where client-related, up-to-date, comprehensive, and reliable information from participating agencies was consolidated. Factors that facilitated WCM use were users’ enthusiasm regarding the tool functionalities, scalability and agency collaboration. Constraining factors included the (a) suboptimal awareness of care delivery goals and functionality of the system among the community, (b) sensitivities about data sharing and legal requirements and (c) constrained funding from government and non-government organizations. Overall, users found WCM to be a useful tool that was easy to use and helped to enhance performance. CONCLUSIONS WCM supports delivery of care to individuals with complex needs. Integration of data and information in a CMCS can facilitate coordinated care. Future research should examine WCM and similar CMCSs in diverse populations and settings.

Expansion of the invasive European mistletoe in California, USA

The horticulturist Luther Burbank introduced the European mistletoe (Viscum album L.) to Sebastopol, Sonoma County, California, USA, around 1900 to grow as a Christmas ornament crop and tincture for medicinal use. The mistletoe has since spread from the point of introduction on apple to other hardwood trees, especially non-native hardwoods in yards and farms of the region. Mistletoe surveys were previously conducted in 1971, 1986, and 1991. We re-surveyed the region in 2019, with emphasis on the 1991 perimeter, and documented the current farthest distribution of V. album. This represents a 120-year record of spread. We observed infected trees up to 24.6 km (15.3 miles) from the point of introduction, doubling the farthest distance reported in 1991. The estimated area encompassed by mistletoe-infected hosts increased from 184 km2 (71 miles2) in 1991 to 606 km2 (234 miles2) in 2019. We also updated the host species list including both native and non-native mistletoe hosts. Viscum album spread appears to be limited by available habitat and hosts, but within the survey area it is intensifying, concentrated in urban and semi-urban yards, streets, and farms. However, V. album was also commonly found in riparian areas, which have a large number of native hosts.

Empowering Caseworkers to Better Serve the Most Vulnerable with a Cloud-Based Care Management Solution

Background Care-management tools are typically utilized for chronic disease management. Sonoma County government agencies employed advanced health information technologies, artificial intelligence (AI), and interagency process improvements to help transform health and health care for socially disadvantaged groups and other displaced individuals. Objectives The objective of this case report is to describe how an integrated data hub and care-management solution streamlined care coordination of government services during a time of community-wide crisis. Methods This innovative application of care-management tools created a bridge between social and clinical determinants of health and used a three-step approach—access, collaboration, and innovation. The program Accessing Coordinated Care to Empower Self Sufficiency Sonoma was established to identify and match the most vulnerable residents with services to improve their well-being. Sonoma County created an Interdepartmental Multidisciplinary Team to deploy coordinated cross-departmental services (e.g., health and human services, housing services, probation) to support individuals experiencing housing insecurity. Implementation of a data integration hub (DIH) and care management and coordination system (CMCS) enabled integration of siloed data and services into a unified view of citizen status, identification of clinical and social determinants of health from structured and unstructured sources, and algorithms to match clients across systems. Results The integrated toolset helped 77 at-risk individuals in crisis through coordinated care plans and access to services in a time of need. Two case examples illustrate the specific care and services provided individuals with complex needs after the 2017 Sonoma County wildfires. Conclusion Unique application of a care-management solution transformed health and health care for individuals fleeing from their homes and socially disadvantaged groups displaced by the Sonoma County wildfires. Future directions include expanding the DIH and CMCS to neighboring counties to coordinate care regionally. Such solutions might enable innovative care-management solutions across a variety of public, private, and nonprofit services.