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WC CWF Health District Board Minutes - 11/08/2019WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES November 8, 2019 Wichita Falls, -Wichita County Public Health District 1700 Third Street — Parker Conference Room Wichita Falls, Texas BOARD MEMBERS PRESENT: David Carlsto,n, Ph.D., Chair Tonya Egloff, D.D.S. Julie Gibson, D.V.M., Vice -Chair Paris Ward Keith Williamson, M.D. I 41"1!A1F111j;&t4 - -iiii Melissa P'l�oiwman BOARD MEMBERS UINEXCUSED ABSENCI Lauren Jansen, Ph.D., R.N. OTHERS PRESENT: Lou Kreidler, Amy K. Fagan, M.P.A. Arth u r i . Szczerba, M. D, Amy Gardner Woodrow W. Gossom, Jr. Mark Beauchamp Citizen At -Large -County Dentist -County Veterinarian -City Citizen At -Large -City Physician City Restaurant Association -City Registered Nurse -City Director of Health Assistant Director of Health Health Authority Mlunicipal Court Prosecutor County Judge County Commissioner I. CALL TO ORDER Dr. David Carlston called the meeting to order at 12:00 pm after a quorum of members was attained. 111. APPROVAL OF MINUTES AND ABSENCES Dr. David Carlston called for the review and approval of minutes from the September 13, 20191 meeting, Dr, Keith. Williamson introduced a motion to approve the minutes as presented and Dr. Tonya Egloff seconded the motion. The motion passed unanimously. At this time, it was noted the excused absence of Melissa Plowman and unexcused absence of Lauren Jansen, Ill. NEW MEMBER APPOINTMENT Wichita County, Judge Woodrow W, Gossom, Jr. administered the appointment of Paris Ward to the City Citizen At -Large position vacated by Robin Moreno whom moved out of town, IV. ANIMAL, ORDINANCE UPDATE Lou Kreidler, Director of Health stated the Animal Ordinance passed on Tuesday November 5�, 2019 at City Couincit' with modifications that becomes effective December 5, 2019. Explanation of modifications: 1 ) Animals in the back of the truck was removed, however language was added to animals confined in a vehicle to provide protection to those animals while the vehicle was parked. Animals in the back of a vehicle must be provided water, some type of shade and protection from the metal on the truck, 2) Addition of language so that Wild Life Rescue individuals can, release wildlife in the City limits. 3) In the livestock ordinance, removal of the livestock production area was an issue so it remains, in the ordinance. Livestock identification is not a requirement but incentive for a reduced permit fee. Officers have to spend a lot of time out in, the middle of the night to locate where livestock belong, so hopefully individuals will provide livestock identification, Thanks to the Health Board for all the work, it could not have been done without the Board. 'V. "GAPING UPDATE Lou Kreidler commenced with a discussion on E-cigarette or Vaping product use - Associated Lung Injury (EVALI). Most patients report a history of using (tetra h yd rocan nabinol) THC containing products with notable products obtained off the street or from other informal sources (friends, family members, illicit dealers) and there is no identified cause. As of October 15, 2019 the CDC reported, 86% used THC products, 34% exclusive use of THC products, 64% used nicotine products, 11 % exclusive use of nicotine products. lit has been hard for CDC to determine the, exact cause or exact product because of the large variance. According to CDC the clinical signs and symptoms individuals experienced are: 95% respiratory symptoms inciuding cough, chest pain, shortness of breath, 77%, abdominal pain, nausea, vomiting, diarrhea, 85% constitutional symptoms as fever, chills, weight loss. Chest radiographs demonstrated bilateral opacification and CT imaging demonstrated diffuse ground glass opacification. Commissioner Mark Beauchamp asked what does, that mean in layman terms. Lou Kreidier said a chest x-ray looks black or clear able to see through the fields, any opacity appears as a white haze the fields are not clear. CDC is testing: plasmalserum, urine, BAL, lung biopsy tissues, aerosol emissions from e-cigarette/vapingl products. FDA is testing e-ci�garefte,/vaping products and the Texas submission is under investigation. A confirmed case is defined as, using an e-cigarette (vaping) or dabbing in 90 days prior to symptom onset. Pulmonary infiltrate, such as opacities, on plain film chest radiograph or ground glass opacities on chest CT. A negative respiratory viral panel, so have to have no other reason for why the chest x-rays or symptoms are presenting. All other clinically respiratory infectious disease testing has been ruled out. No evidence in, medical record of alternative plausible diagnoses. Commissioner Mark Beauchamp questioned what is dabbing, Dr, Keith Williamson answered that dabbing is where you take butane and force it through, marijuana leaves to produce an extraction of the tetrahydrocan nab! nod that looks like ear wax to h,im. It is a very concentrated form of THC they can put in the vaping products and heat it to aerosolize. Dr. Arthur Szczerba said any oil based substance goes to the lungs, hangs there, hard to rhythm, quickiy causes local inflammatory. Lou Kreid,Ier stated that is part of what has been looked at, it is not an infectious response but a chemical or inflammatory response caused by elements in the lung that should not be. Amy Gardner remarked the vaping is an oil and the dabbing a wax, but once the wax is heated it is an oil based product inhaled, Dr, Arthur Szczerba said the wax is much heavier than the oil, very strong irritants in terms of chemical neuritis. As of October 29, 2019 at 1,888 cases reported from 49 states (excluding Alaska), D,C., and the Virgin Islands, Deaths: 37 with a median age of 53 years (range of 17-75) in D C. and 24 states. Demographics: 70% male with a median age of 24 years (range of 13-75), Patients: 14% are under 18 years,40% are 18-24 years, 25% are 25-34 years, 21% are 35 years or older. In Texas as of October 28, 2019 at 217 cases reported: 88, confirmed, 77 probable, 52 not a case and 1 death in the metroplex area in our region. Demographics (confirmed and probable cases): 74% male, median age of 22 years (range of 13-75), same as the National range. Reported use of THC products at 94%, 0 The Public Health Region 2/3 reported 82 cases (50%). Wichita Falls is in Region 2 that includes Dallas and Fort Worth and Region 3 is further west. In Wichita County as of November 6, 2019 reported 4 cases: 1 probable, 1 not a case, 2 under investigation. Demographics, all male aged 18, 20, 35 and 49 years. E-cigarette/vaping history: 1 former smoker, 1 used THC and nicotine products, 2 used only nicotine products. In the early stages of a new disease process there is a continuous change in the case definition from CDC. The Health District sends all the case information received from the hospital or clinician to the Regional office, The Region and State identify whether a confirmed case, probable case or not a case, that is not done locally, and the determination is send back to the Health District. Amy Fagan the Assistant Director stated the Health District sends out all the health advisory information to local physicians, medical providers, and District website to continuously have the most recent information. Lou Kreidler said almost 50% of the cases have come from Region 2/3 ouir region it is alarming. Mark Beauchamp said even more alarming is 54% is college age and younger, a healthy group targeted, you should not see these kind of problems manifest, Dr. Keith Williamson said it is not a chronic disease breakdown type of problem. Dr. David Carlston said it is self-inflicted. 1/I1. LODGING, ORDINANCE Susan Morris, Environmental Health Administrator stated the ordinance was written in 2006. The revision is needed; to know what to do with all the short term rentals known as Air B&B's, address common problems, and specific guidelines on the Health Department expectations on how to deal with bed bug infestations, which has become a real problem. First change is in the Lodging establishment definition an addition of short terra rentalsi.e. Air B&Bs, The last line to rea& The term "lodging establishment" does not include duplexes, quadriplexes, dormitories, and apartment complexes, or short term rentals i.e. Air B&Bs. The Texas Food Establishment Rules define B&B's as: 1) General B&B has more than 7 rooms for rent or provides food service other than breakfast to overnight guests requires a food permit, 2) Limited B&B has 7 or less rooms that only serves breakfast to overnight guests, is not a retail food establishment. Except when food service is provided to others than to the overnight guests, must comply with the rules and regulations applicable to retail food: establishments. There are real differences between an Air B&B and Bed & Breakfast (B&B), As Google defines the major difference between B&Bs and Air B&Bs is the on-siite staff. Hosts greet you as you arrive at a IB&B, fix you breakfast, be on site. In contrast you are renting a house or room, in an Air B&B you are not going to have that service. It can move forward once the, difference is defined between a true Bed' & Breakfast and Air B&B decided. Lou Kreidler said the City started to develop an ordinance for the regulation of short term rentals that in areas i intersected with the current lodging ordinance. Concern was to understand the intentions of the regulation since the lodging ordinance was written so that code enforcement actually would regulate and do safety inspections. In the preparation to have a meeting was told the only intention was for the collection of hotel/motel tax. Amy Gardner said also would be problems with, enforcement of short term rentais,wfth a city our size, some cities, have an honor system voluntarily pay. Larger cities possibly have the personnel to do sting operations, or stay online to browse the listings then go out to ensure everything, is done correctly. Initial thought was to have it on the books, a look toward the future if it was to become a big problem but still in discussions not sure yet. Again for larger cities with enough business for Air B&B's to want to remain in that community would come to an agreement with the city and collect the tax, typicallly something done in large metropolitan areas, Lou, Kreidler stated currently B&B's with 7 rooms, or less are not regulated in any form, not for food or as a lodging establishment. Another question for the Board is what makes the B&B less dangerous than a public health threat or issue, to have someone cook food for someone else in a business establishment and a B&B is a business establishment. Feedback is sought from the Board on whether or not the B&B issue is a sufficient public health issue that needs to be regulated. In her mind someone is preparing food for someone else so that is an issue. N Susan Morris responded to regulate the food end the Texas Food Establishment rules the B&B have more than 7 rooms and prepare more than breakfast. Lou Kreidler said in that same sense lots of the Health District ordinance standards are more stringent then what the State does. That is the State law but there are lots of areas even in the food ordinances that are more stringent than, the State law. 111TOM ff X4 M T-T-Ti tV. RM5 9%, = TaXi V 1011 =-- &A V "m i M1 Susan Morris answered no idea of why the 7 rooms. When B&B's started and served breakfast all the cities wanted to permit them as kitchens, but could not because the regular kitchens did not fall under the standards, It came to be that B&B's with more than 7 rooms would have to upgrade to a commercial kitchen and have to be regulated. Second! change is the, requirement to post the permit. A current lodging establishment permit shall be posted at all times in a prominent and conspicuous place in the lodging establishment where it may be readfly observed by lodging establishment patrons. Third change came about with the, arrival of Suite Hotels in the area to allow corded appliances. Corded cooking or heating devise such as portable hot plates or crackpots shall not be allowed in rooms unless they are property of the lodging establishment and the room has a kitchenette. The operator shall either post signs; state this policy verbally, provide in writing during check -in procedures; or provide this information within the guest services book within each guest room to comply with this section. Fourth change is to set up bed bug protocol for every lodging establishment to do routine inspections of the premises that shall be constructed to control and minimize the presence of pests and harborage conditions. Professional pest services shall be used for preventive maintenance, control, and elimination of pests or the Health District official can approve heat treatment. Heat treatment if done correctly for bed bugs is very effective, if not done correctly to be effective can be revoked and a professional pest control service will be required for treatment. Frequent removal from the premises of dead or trapped birds, insects, rodents, and other pests to prevent their accumulation, decomposition, or the attraction of pests. If bed bug evidence is found in a guest room a thorough inspection of the room is required to determine where bed bugs are harboring. The room must be closed and treated. The treated room should be inspected again after 48 hours to determine if there are any surviving bed bugs. If live bed bugs are found, the room should remain empty and be inspected again at 72 hours, The surrounding units (on either side, above and below) must be inspected for bed bugs also as bed bugs can easily move through walls to adjacent rooms. Each room that has evidence of bed bugs is to be closed and treated until no evidence of bedbugs is found. Bed bugs go into walls and travel through the electrical plates. Dr, Julie Giibson, asked if nothing like fumigating would kill them, 20 years ago you did not hear about bed bugs. Susan Morris replied the same pesticides for roaches are used for bed bugs. Bed bugs have a hard access skeleton, the eggs are incased as roach eggs unable to kill the eggs, so several treatments and removal are needed. Now being world travelers bed bugs are everywhere; airplanes, buses, movie theatres, waitingi rooms, hospitals. Judge Gossom asked what do bed bugs do to you. Susan Morris said as far as known they do not carry diseases but make your fife miserable Lou Kreidler said if an infestation is severe enough, people can get anemia because the bed bugs attach on to you and suck blood. Cases have been documented that people had anemia because infestation in the home was so bad. Dr. Keith Williamson stated a classic finding he has seen in patients with bed bugs are 3 mosquito bites slightly bruised in appearance, always Sin a line of 3 or 4 biites, Basically bed bugs had been eliminated before Racheal Carson published the Silent Spring and DDT taken away, in these circumstances is there any chance for spot release or DDT to be used. It makes sense for it to be authorized for spot use under particular circumstances. Susan Morris, doubts it, there is a resistance to chemicals as in bed bugs and a lot of insects because of the Ell misuse of chemicals either use of not enough or too much. Now running out of chemicals for everything, still barely have organophosphate. Not until it is, said bed bugs cause disease, it is known mosquitoes cause and carry diseases. The chemical companies do not see it profitable to come up with new ones because of the expense. Last is to allow the Director of Health to authorize variances when it can be demonstrated that the deviation wiH not cause a health or safety concern. Lou Kreidller asked for any feedback from the Board on whether or not to regulate B&B's would be appreciative. At the time of the January Board meeting the ordinance should be ready for an recommendation, VII. NEXT MEETING DATE Friday January 10,2020 was noted as the next meeting date. Vill. ADJOURN Dr. David Carlston adjourned the meeting at 01:01 pm. ail Wichita Falls -Wichita County Public Health Board City -County Board 1.1