Harris County, TX, is the third-most populous county in the United States and one of the most diverse. In 2019, the county had over 4.7 million residents, of which 29% White non-Hispanic, 20% Black non-Hispanic, 7% Asian, and 44% Hispanic/Latinx. Over a quarter of the residents are under the age of 18, 25% are foreign-born, and an estimated 16.5% live in poverty. Zika and Hurricane Harvey had adverse impacts on maternal and child (MCH) populations in Harris County, specifically those that lived in under-resourced areas and those that were Black, Indigenous, and people of color (BIPOC). Through these events, Harris County Public Health (HCPH) identified and prioritized the need to utilize data and communication strategies to penetrate their community and understand how infectious disease and natural diseases impact their population. During Hurricane Harvey, HCPH developed a resilience and equity branch to focus on communications tools that reach specific communities and provide safety information for each of their populations. In this vein, HCPH developed the COVID-19 Equity Testing Strategy to ensure equitable testing opportunities, specifically for children and infants, regardless of testing barriers.
The Equity Testing Strategy utilizes data to identify areas that lack COVID-19 testing opportunities, also referred to as testing deserts. Those living in testing deserts face barriers such as transportation or lack of knowledge around testing. To reduce the burden of testing, HCPH deploys focused testing teams, outreach workers, and communication plans to targeted areas to increase testing. It has even created an at-home testing initiative to reach those that may not be able to leave their homes or do not have access to transportation. HCPH found that the general population was most likely to access testing in places of worship and other community centers as opposed to traditional clinic testing sites. HCPH has also been able to provide free testing to children of any age throughout multiple sites across the county, acknowledging that throughout the county and nationally there were gaps in places that offered testing for children.
Harris County holds some of the highest rates of COVID-19 in Texas, with just under 208,737 confirmed cases and a daily average of 1,154.9 as of December 15, 2020.1 Children aged 0–9 account for 8,701 of the confirmed cases. Data on COVID-19 among pregnant people are scarce. However, 51% of confirmed COVID-19 cases in Texas are among women and among those 31% are among women aged 20–39.2
“We know that pregnant women are at higher risk for hospitalization and poor outcomes for COVID-19… of all the children 0-1-year-old are most likely to become seriously ill and/or be hospitalized if they contract COVID-19” – Maria E. Rivera, MD, MPH, Nutrition & Chronic Disease Prevention Physician, HCPH
Since March 2020, HCPH has tested over 250,000 people for COVID-19. Of those, approximately 25,000 and 1,500 were under 18 years and 12 months old, respectively. Due to targeted communication and school reopening guidelines, testing among children has increased significantly.
Collaborations and partnerships have informed communications, data, and guidance around testing for COVID-19 among HCPH’s MCH population. In preparation for school reopening, HCPH assembled both an internal group of experts to guide decisions and convened regional advisory board. This advisory board consists of pediatricians, partners at Texas Children’s Hospital, officials from Southeast Texas Regional Advisory Council (SETRAC) and the University of Texas School of Public Health, regional and state health officials, and medical directors and physicians from federally qualified health centers. The group shares data and information aim to provide consistent messaging about COVID-19. For example, Texas Children’s Hospital currently administers PCR testing to children throughout their 100 clinics within the region. At the convening, they share their testing data, trends, identified gaps, and next steps with the larger advisory group. This information sharing aims to reduce the deduplication of efforts by partners and to disseminate accurate and consistent information cohesively to the Harris County community.
HCPH continues to combat the impacts of the pandemic within their MCH populations. Their annual flu vaccination clinics have begun and currently average around 250 flu vaccinations each clinic. HCPH works with community leaders and partners to administer clinics within the community. Before COVID-19, the vaccination clinics were held as mobile health villages where the individuals would get vaccinated at a community site (church, school, etc.) and receive additional information on nutrition and general health. As a result of COVID-19, this has become an appointment-based initiative. HCPH focuses its vaccination clinics on specific areas of need and serve as a “stop-gap” to address the vaccination gaps in their community. They aim to implement the same approach once the COVID-19 vaccine is accessible. Furthermore, they are currently launching success metrics for testing, communications, and epidemiology to advance the identification of COVID-19 trends and with the hope of further understanding the COVID-19 response within their MCH community.
Thank you to Jennifer Kiger, MPH, Chief of the Office of Public Health Emergency Preparedness and Response, and Maria Rivera, MD, MPH, Nutrition & Chronic Disease Prevention Physician at Harris County Public Health.