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Testing picked up after Clinical Services Team stepped out; coordinated with Nursing Team. Strong, competent staff. Ability to execute 3rd party contractors to support kiosk testing, mobile unit, etc. Three contracts were required to support this effort, especially during Omicron surge. Very helpful to have additional testing sites.

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Plans for spreading out testing sites, especially serving vulnerable populations, were successfully implemented.

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Advice, feedback, and general support from leadership was very helpful.

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Two projects - vending machines throughout the county, two in rural areas. 3 24 hour sites.
Distribution - Health Equity Index - vulnerable population zip codes. Kits distributed to community-based organizations that support those zip codes.
Use of trusted agencies for distribution of test kits.
NAACHO Preparedness Submit - Spring Symposium 2023

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Early days - not enough tests and testing locations. Prior to executing contracts, it was hard to find testing sites and it was a challenge to keep up with the volume. Some tests in early days were not effective, but have improved since that time.

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In particular in rural areas, there was some skepticism and mistrust about PCR tests, whether covid was "real."
Some challenges with security at test sites. Some testing/vaccine co-located sites caused some staffing and security concerns. National Guard helped diffuse security concerns.

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Developed partnership with community leaders and community service organizations. Knowing who to turn to has been a huge help.

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Opportunity to examine and improve contracts during an emergency. Having contracts in place that could be quickly implemented to avoid delays would be helpful.

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Staff brought in during Covid for Surveillance were very valuable. Once grant expires, staffing will no longer be available. It would be good to be able to find a way to fund staff that have demonstrated their ongoing value. Documenting activities that extra staff have been able to accomplish would be helpful to show that they should be kept for non-emergency activities as well.

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Staff pressure, stress, fatigue, dealing with criticism from public and media. Loss of staff due to quitting, retirements, loss of knowledge from staff who left. Loss of perspective and valuable resource of long-term staff.

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Unhappy public, angry public - threats of physical harm, verbal abuse.

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Limited, temporary, grant funding.

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Investigations and actions taken by other states have an impact on SNHD operations and trust of SNHD. Challenge to maintain support of political leaders across the nation, not unified.

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Impact to SNHD operations and funding and public health policies. Impact to public perception.