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BACKGROUND In December 2019, an outbreak of a respiratory illness due to a novel coronavirus (a disease known as 2019 Novel Coronavirus or COVID-19) was first identified in Wuhan City, Hubei Province, China. As of July 13, 2020, the number of reported COVID-19 cases has risen to more than 12.9 million confirmed cases and resulted in more than 570,400 deaths worldwide. The United States has reported more than 3.3 million confirmed cases with California reporting more than 320,800 cases. On January 23, 2020, the CDC activated its Emergency Response System to provide ongoing support for the response to COVID-19 across the United States. In addition, the Secretary of the US Department of Health and Human Services declared a public health emergency in the United States on January 31, 2020. In Alameda County, the Board of Supervisors (Board) adopted a resolution ratifying the declaration of a local health emergency by the County Health Officer on March 10, 2020. According to the United States Centers for Disease Control and Prevention (CDC), testing for individuals who are at high risk for contracting the virus is an important strategy to reduce community transmission of COVID-19, especially as the County relaxes shelter-in-place restrictions and expands contact tracing. To support efforts by cities to expand testing services, the Board adopted the Alameda County & City COVID- 19 Testing Partnership Framework on June 30, 2020 to coordinate resources and provide technical assistance to cities to increase equitable access to testing and lab processing services for residents most impacted by COVID-19. The Cities of Dublin, Livermore and Pleasanton partnered with Stanford Health Care - ValleyCare to provide COVID-19 testing services at the Fairgrounds beginning April 28, 2020 and ending August 28, 2020. The goals of these testing services were to alleviate pressure off of hospital emergency rooms; provide quicker answers for recently exposed first responders, health care workers, and persons with recent suspected exposures to COVID-19; and to enhance the region's capacity to suppress new transmissions through isolation after testing. The scope of the testing services later expanded to include any resident from Dublin, Livermore or Pleasanton. Between April 27 and July 10, 2020 Stanford Health Care —ValleyCare tested 9,003 residents with an average 3.22 percent rate of positive results on finalized tests. 7,000 additional tests are expected to be collected and processed through August 28th to support Alameda County residents. DISCUSSION The Alameda County Board of Supervisors delegated authority to the Alameda County Health Care Services Agency (HCSA) to negotiate and execute the MOU with the City, who will act on behalf of the three Tri-valley cities to incur the approved Stanford Health Care - Valley Care testing costs and submit required documentation to HCSA for reimbursement. The primary terms of the proposed MOU include: • testing for first responders, health care workers, persons with recent suspected exposures to COVID-19, and other County residents, Page 2 of 3