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WC CWF Health District Board Minutes - 03/13/2020WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES March 13, 2020 Wichita Falls -Wichita County Public Health District 1700 Third Street — Parker Conference Room Wichita Falls, Texas BOARD MEMBERS PRESENT: Keith Williamson, M.D., Vice -Chair Julie Gibson, D.V.M., Secretary Tonya Egloff, D.D.S. Melissa Plowman Paris Ward BOARD MEMBERS ABSENCE: David Carlston, Ph.D., Chair - Unexcused Lauren Jansen. Ph.D., R.N. - Excused OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. ArthurJ. Szczerba, M.D. Michael Smith Woodrow W. Gossom, Jr. Mark Beauchamp Physician - City Appointment Veterinarian - City Appointment Dentist - County Appointment Restaurant Association - City Appointment Citizen At -Large - City Appointment Citizen At -Large - County Appointment Registered Nurse - City Appointment Director of Health Assistant Director of Health Health Authority City Council Liaison County Judge County Commissioner I. CALL TO ORDER Keith Williamson, MD, Vice -Chair called the meeting to order at 12:10 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Dr. Williamson Vice -Chair asked for an amendment to the January 10, 2020 minutes in his statement "they stood up and lied one by one to Congress in 1996 and said it is not additive" to read not addictive. Dr. Williamson called for the approval of minutes as amended. Melissa Plowman introduced a motion to approve the minutes as amended Paris Ward seconded the motion. The motion passed unanimously. At this time, it was noted the excused absence of Lauren Jansen, Ph.D., R.N. and the unexcused absence of David Carlston, Ph.D., Chair, III. MEMBER RE -APPOINTMENT Re -appointment of Julie Gibson, D.V.M. to the City appointed Veterinarian position was commenced by Woodrow W. Gossom, Jr., County Judge. IV. RABIES TESTING A letter from Dr. Clark a local Veterinarian was addressed and presented to each Board Member. Lou Kreidler spoke with Dr. Clark on the issue of an individual in his clinic that was bitten, had the Rabies test and in his perception was a delay in getting the results. Through the process to address a response was the discovery of many issues. DSHS send the positive notifications timely as required within the 48 hours of being positive. The negatives are not reported over the phone, with the DSHS system down negative results are faxed but sometimes a month after the bite occurred. Lou's concern is staff assumes the results are negative when not received in 72 hours a bad assumption, results need to be back within the 10-day quarantine period. If someone in the community has been bitten the head is sent off for testing and the result is needed for the individual within that 10-day period. A process has been put into place to ensure when the head is sent off results are received in a timely matter. Dr. Clark's concern is understandable a response letter was sent to convey that the issue was addressed and the implementation of a new process in place. Councilor Smith asked if it would be good to send a copy of the letter along with the concerns to the State Representative or Committee associated with the issue. Lou Kreidler replied that it actually is the rabies testing laboratory division and Amy can speak on the issues found in her 2-year period spent with them to straighten out. Amy Fagan said about 2-years ago DSHS transitioned over to an electronic process that had substantial issues. The Health District Lab uses the DSHS Lab for HIV and clinical specimens, rabies testing and COVID-19. Part of the issue was the DSHS Lab entry of results into the system took months, now the electronic system is not used. DSHS works a 1996 process to only fax results and the Health District Lab manually enters the results into the Lab system. It is very antiquated and the answer from the State is probably about a year duration before resolved. Lou Kreidler sits on the DSHS Policy and Funding Committee the data issues have been addressed and followed. DSHS realizes the critical issues and the laboratory system is being converted to resolve the issues. Dr. Gibson said her clinic never receive the results always has to call to find out, her thoughts are within 2 days should have the results. Another problem is when the bite happens on a Friday afternoon after the Health District closes it is not picked up until Monday. Two days are already gone in finding out the results would it be 10 days after the 2 days. Lou Kreidler replied the positives are received, the goal is to receive the negative results by the end of the 10 days same as the 10-day dog quarantine period. Now with the DSHS processes in place not sure if able to get results within 2 days. Lou personally does not want a 2-day notification after the sendoff knowing of the State issues would put pressure on staff. The 10 days start from time of bite, if it happens on a Friday it is picked up on Monday, DSHS receives on Tuesday, a call would be made before the end of the 10-day period if no results are received. The 10-day period is the window that occurs from the time of the bite not when the head is picked up. Bites that occur late afternoon or after hours have missed the shipping window, also specifications are in place to be able to ship Amy Fagan said it is the same shipping window with other samples that are submitted to the State Lab. Dr. Gibson asked if another shipping company could be used and Lou stated no other shipping company would accept because of the content. Judge Gossom asked how fast, when do the shots start. Lou Kreidler said when that 10-day window 10-day quarantine period ends the shots start. It is the process being worked on to ensure results are received prior to the end of the 10-day period. The goal is to get the process in order to include veterinarians. V. COVID 19 Yesterday Lou Kreidler with the Mayor, County Judge, Emergency Management and Legal Department Manager listened to the Governor call, followed with a discussion of concern on the actions taken. The City Manager, Mayor and Council are to send out a memo today on updates of the Health District actions. Met early on with community partners, over 6-weeks had 3 meetings with Hospitals, Emergency Management Coordinators and Dr. Williamson to discuss supplies, PPE issues that turned severe with the pandemic announcement. Closely working with other City departments on events as whether to cancel such as the weekend downtown St. Patrick's Day event. Early on the MPEC was proactive to ask about what to do from a cleaning prospective to put out hand sanitizer and banners. Appreciative of the advertising company generosity to run free the 2017 Germs Are Nasty campaign commercials, also on billboards. When an individual is asymptomatic it is not criteria for testing. Travel locations are given a risk level (level of monitoring) based on DSHS guidelines. Individuals that return from travel are assigned a risk level to undergo that level of monitoring. All individuals monitored are to take their temperature twice a day then it depends on the monitor level whether to contact us daily or end of the week, contact is made if a call is not received. A process is in place whereby information on individuals monitored that only the address is put into the CAD (computer aided dispatch) system with a medical alert and 24/7 phone number. A call from the address sets off a medical alert, only at that time can information be shared, it is not searchable in the CAD system it is confidentiality protected. Direction and guidelines are provided so first responders are notified to take 2 appropriate precautions. Amy Fagan said the Judge and Commissioner are to work with the 9 Volunteer Fire Departments that act as First Responders in the Burkburnett, Electra, and Iowa Park communities, as well as work with Wichita County Emergency Management. As part of the planning responders are to use an advanced screening criteria of 5 questions derived from the AMR's 21 questionnaire. A Continuity of Operations Plan developed during the H1 N1 is out on the website HEALTH.WICHITAFALLSTX.GOV for businesses. All traffic is being directed to the revamped website that contains specific information for a business to continue to function, cleaning and list of materials that work on coronavirus. Biggest issue is rumor control a lot of quality time has been spent on rumor control to assure people have the right information. As the Health Board knows the truth can help with rumor control to convey the truth. Councilor Smith asked whether the St. Patrick's activity is going to take place. Lou Kreidler replied she had been working with the coordinators, believes an announcement would be made later today. The Health District and Dr. Szczerba the Health Authority recommendation was to cancel the event. Melissa Plowman asked what kind of test is it, PCR? Lou Kreidler said a viral swab the PCR ran in the lab. In the State of Texas DSHS asymptomatic individuals cannot be tested. The DSHS criteria is to have fever, traveled and symptoms, there is symptomology that must be met. It has been phone call after phone call with area Clinicians running through scenarios for patients in their office to determine whether or not that patient meets the criteria for testing. In the last couple of days Clinicians are able if felt necessary for the patient that does not meet DSHS criteria to go through LabCorp for testing. Dr. Gibson questioned what about carriers. Lou Kreidler answered there is still so much unknown that is something talked about a lot. DSHS are strict and will not test individuals in contact that are asymptomatic. Melissa Plowman asked what is the difference in this virus situation it is a SARS virus, why is this happening now when it did not happen before, do we know. Dr. Szczerba said there is not a 100% explanation, any virus introduced during the life of every human is building immunity or creating memory in the immune system, this is globally a new virus. From previous epidemics including Hong Kong flu immunity memory was built. The inflammatory response of some people will be severe respiratory distress syndrome and death. Someone exposed maybe a carrier but not have symptoms, it is not known exactly when contact was made, but does attribute to the spread in the community. People infected that avoid contact, in isolation can break and flatten the curve. It is good that probably close to 90% or maybe higher people have mild to moderate symptoms or even asymptomatic. The mortality rate is much lower than actually projected. Lou Kreidler stated being a new virus with no vaccine, people do not have immunity. Mark Beauchamp noted far more deaths from the flu and the world does not shut down. What separates COVID- 19 from H1N1 or others experienced that had a very high mortality rate in supposed to COVID-19. Dr. Williamson conveyed Dr. Fauci said it is an order of magnitude higher case fatality ratio compared to flu, we just have not caught up with the overall case load that the flu has manifested so far this year. This could be a very serious thing, to speak on Dr. Szczerba point, our ability to accommodate has to do with flattening out the curve, so the hospital does not have to deal with 50 people who need a ventilator all at the same time. Dr. Szczerba said all would be amazed of how many sick patients during the regular mild or moderate flu. Elderly end up in the hospital on a ventilator or with pneumonia not related to the flu, may die no matter what done because approaching end of life that cannot be reversed. Always as expected the most vulnerable of the population will be dying. Mark Beauchamp said the COIVD-19 seems to be more dangerous for the elderly and susceptible population. Dr. Szczerba said with exposure over time the population will have the disease but probably not that severe because of immunity, with any flu are severe cases. Scariest is how fast coronavirus has spread through the 3 world from Country to Country. The same happened with the Hong Kong flu pandemic in 1957 and 1968 it was new not familiar, not sure at that time whether had PCR or other testing. Coronavirus came from bats it is now known the bats tested carry 400 different strains of coronavirus. This is so called intergenic spill over in which viruses are living in an animal that gets to one person and gradually spreads that is what is happening, completely new in human population. Everyone needs to keep good hygiene that is main thing to avoid the spread such as sneezing, kissing, touching surfaces, using disinfectants. Breaking the cycle will allow the population to adjust to the situation and process data because later may have another virus worse, this one is not pretty is new with a lot of similarities to other viruses. The severity of disease is seen in patients on ventilators with flu A or B those to the point that develop other respiratory distress syndromes. A chest x-ray with hazy infiltrates traits a ground glass appearance, the patients start to saturate to the point unable to think, breathe and lungs fill up with fluid, respiratory distress related to inflammatory response not infection. Lou Kreidler wants those present to please know the District is working very diligently. Judge Gossom asked whether the County or City can cancel any public gathering events. Lou Kreidler replied it depends if it is a City sponsored event the City has that ability, with other cities the Mayor set a limit of individuals that can gather in a community and that can be done in the County. Judge Gossom was unsure if not declared a disaster then Melissa Plowman said Governor Abbott just declared the State a disaster. Lou Kreidler stated probably the Governor reason was to free up funding for response which is the primary reason other places have done it because that is the trigger to free up money and resources for response. Dr. Gibson said being cold and flu season what is the recommendation if mu6tiple employees get sick and what about getting tested. Lou Kreidler said when sick stay home and see your primary care physician to make the determination on whether or not eligible for testing. Then Dr. Williamson said to call the physician first so they know you are coming in. Melissa Plowman asked if there is a place to go where individuals may meet the criteria to be tested versus the crowded walk in clinic. Lou Kreidler replied there is not, your primary care physician should be able to test and treat for the disease. One the individual needs to call ahead, two put on a facemask upon arrival at that point, do their individual process. Dr, Szczerba said from the Epidemiologist standpoint a test confirmed symptomatic patient if stays home not spreading maybe to family, would like to know forsake of family members can be tested. Do not encourage patient go to the hospital probably at home will do way better, more rest, good hydration, buying time, just make sure other family members do not spread to the community. The idea is to break the cycle of spreading to the community to flatten the curve. All practices the repetition of washing hands, covering cough, disinfect surfaces have been known to be used for years. It is unfortunate not a lot is known about coronavirus. Amy Fagan said the numbers are important, seen 1,000 in Wichita County but a more important piece is the education. The message the whole time is do not go out if sick, do not go to crowds or gatherings if sick or children sick and practice social distance about 6 feet from others. Specifically working with the larger events since it makes a difference if outside, inside, location, all those it has not been said very specifically at this point. Lou Kreidler said with the pandemic announcement and now the Governor's Disaster declaration, it certainly will be a conversation with the Judge, Mayor and Health Authority. Dr. Williamson's favorite quote he heard so far about COVID-19 was from Dr. Fauci that understanding is incomplete. He thinks we will learn more with that. Councilor Smith stated in the middle of all this, the Census is underway. The Census is safe, easy and most important is the funding, everybody needs to be counted, it is the law only happens every 10 years. It provides Wichita Falls with community programs, transportation, schools and federal funding for housing. In the Fall of 2018 speaker Laura Porter a facilitator from Washington State introduced Early Childhood Coalition resilience materials, research, first childhood experiences, the film "Resilience" with over 1,000 local people in attendance. She is to return Thursday April 2 on how to implement the research that other places already 4 implemented. About 100 people have signed up, but the date is in discussion. Mark Beauchamp encouraged everybody to spend just under an hour to watch it, Judge Gossom and Lou Kreidler agreed. VI. DISABILITIES INCLUSION At the last Board meeting Amy Fagan discussed NACCHO (National Association of County and City Health Officials) the big partner agency at the National level awarding the Health District 1 out of 2 in the Nation a grant. NACCHO was amazed at the progress made before the onset of COVID-15. The ARC as a partner formed a Disability Inclusion Coalition for disability services, mental and physical disabilities. A Disability Inclusion category was added to LIVEWELLWICHITACOUNTY.COM and a Disability component to the community surveys. Surveys started 2 weeks ago, the 200 done reveals 1 in 4 have a disability and 1 in 3 have someone in the household with a disability contrary to the estimate of 1 in 5 people in any given community have a disability. Hopefully at the next meeting the data can be reviewed. VII. MEETING DATE Friday May 8, 2020 was noted as the next meeting date. Vlll. ADJOURN Dr. Keith Williamson adjourned the meeting at 1:10 pm. ,Davie Cal-Ut011 Signature David Carlston Print Name David Carlson, PhD, Chair, Keith Williamson, MD, Vice -Chair, Julie Gibson, DVM, Secretary Wichita Falls -Wichita County ublic Health Board City -County Board 5