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WC CWF Health District Board Minutes - 05/08/2020WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES May 8, 2020 Wichita Falls -Wichita County Public Health District 1700 Third Street — Zoom Video Conference Wichita Falls, Texas BOARD MEMBERS PRESENT: David Carlston, Ph.D., Chair Keith Williamson, M.D., Vice -Chair Julie Gibson, D.V.M., Secretary Tonya Egloff, D.D.S. Lauren Jansen, Ph.D., R.N. Melissa Plowman Paris Ward NO BOARD MEMBERS ABSENCE OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. Arthur J. Szczerba, M.D. Michael Smith Mark Beauchamp Citizen At -Large - County Appointment Physician - City Appointment Veterinarian - City Appointment Dentist - County Appointment Registered Nurse - City Appointment Restaurant Association - City Appointment Citizen At -Large - City Appointment Director of Health Assistant Director of Health Health Authority City Council Liaison County Commissioner I. CALL TO ORDER David Carlston, Ph.D., Chair called the meeting to order at 12:00 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Dr. Carlston called for the approval of minutes as amended. Keith Williamson introduced a motion to edit the minutes to more accurately reflect his intentions, Lauren Jansen seconded the motion. The motion passed unanimously. Julie Gibson, D.V.M., Secretary joined the meeting late. III. COVID-19 Lou Kreidler stated from the last meeting had 1 person monitored that had been exposed to an active case that had been on a trip to Italy, today have 71 cases and another new case. It has been an interesting journey the last couple of months from 1 individual monitored to shelter in place orders by the State to the Governor orders to precede all local orders then locally coordination between our local cities and the county judge for his orders. It has made it difficult from an enforcement standpoint. A lot of time was spent early on, conversations with Wal Mart, Home Depot and Sam's not following guidance, United and all restaurants that continues, information sheets are available on what can and cannot be done. One grant at $300,000 in two separate parts was received from the Department of State Health Services. Signage will be available free for business doors, the public and City. The grant funding made it possible to reimburse the City for a $7,000 freezer purchased for the lab to maintain assessments. Other considerations for grant funding is possibly testing for those that cannot afford the test. Thankful not had a positive in the homeless population or someone that does not have a place adequately to quarantine also the cost can be done with the funding. All available Nursing staff was pulled into response, the hot line is open Monday to Friday, initially was 7 days a week but the weekend calls was not sufficient to sustain or justify staff cost. Donations of masks are taken, the United Way agreed to help with distribution and drop off sites are at the fire houses. It has been an interesting process from the time we started to the night at 5:00 pm got in 10 positives, staff was called told not going home will order dinner but we got to do contact tracing. Really proud of the team we have now everyone pulled together no matter what division, it has been an exhausting process, the staff has been amazing, no matter what Amy and I have asked it has been done. Every case has been case managed, the nurses build a relationship some take a long time to get 2 negatives to be cleared. Lauren Jansen asked if dogs are being tested. Lou Kreidler responded animals are not being tested that she was aware, that would have to be done through a veterinarian office. Dr. Gibson arrived late and Lauren asked had she had any animals test positive for COVID. Would there be any treatment or treat the animal like a human. Dr. Gibson replied so far not testing animals, tests are available but do not see any reason to test animals at this time. Only if there is a positive in a family that wants to know if their animal has exposure, they are not showing that animals are transferring it to humans. The animal would be treated as for any viral respiratory infection, already seen corona in animals. Lou Kreidler stated on the last respiratory outbreak at the shelter several came back positive for coronavirus, so like in humans different strains of coronavirus have been around for quite some time it is the same thing in animals. Amy Fagan said had a couple of issues but been able to work those out. To her knowledge all are doing testing at this time, still have the ones that have not reported to us but feel confident that the numbers are reflected of those tested within our jurisdiction. Also support those outside the jurisdiction because lots of people come to Wichita county for their medical problems, many people test outside the jurisdiction. Only positives are reported to the regional office. Those areas that do not have a local Health Department like Archer, Cook and Montague county do have a local Health Authority, much like our local Health Authority Dr. Szczerba, those jurisdictions healthcare functions are provided by the region office. There was a case shared with Sheppard that was reported in our numbers, but no longer report because of the Public Defense Standards that came out a month ago. Sheppard did announce an incident at the mini mall by which one of the workers tested positive it was closed for a period of time, the worker lives in the jurisdiction so was able to open a case it was one of the clusters. The other cluster was at a medical facility a healthcare worker, within the medical group there are negative/positive cases that would account a third of the cases at this point. Prior to this week people that asked about testing it was yes if symptomatic and no if asymptomatic do not see any reason that to change. The Governor amended anytime a long term Senior Care facility, Rehab facility, those type of facilities that have the most vulnerable population, anytime there is a positive patient or employee the entire facility has to be tested whether their systematic or not. In the last cluster Sheridan Medical Lodge in Wichita Falls a Senior Health and Rehab with 2 facilities had an outbreak in the sister facility in Midland. Wichita Falls staff was asked to volunteer to go help at the Midland facility the 2 cases here were the 2 that went to help. The newest case #73 worked at Sheridan Medical there was mandatory testing due to an outbreak. All those caveats today show what is going on in the community. One of the things stressed from the beginning is testing by type. In the last 2 weeks, discussions with local medical partners at the 3 hospitals decided to start elective surgeries again, so certain standards had to be meet that included the ability to obtain an adequate supply of PPE for staff and others for 30 days without requiring or requesting State resources, report positive COVID tests and decline in cases for a period of 14 days. Last week saw testing numbers up, as of today no pre -op testing has come back positive. For the questions about what the difference is with total case count vs recovered. Once a case is received a case manager is assigned to do a preliminary; when was the person tested, were they hospitalized, any contact with a previous case, prior patient of monitoring. The case manager has 14 days to figure out what type of exposure the person had to indicate what type of spread, to check in with the case every day, any needs, told to go home and stay home pending test results, to take all pre -cautions, it is a very detailed list of what to do. The Food Bank has been generous to provide food boxes for us to distribute. The recovery piece is they have to meet a certain set of strict standards it is allowable to be stricter than the CDC recommendation which possibly has kept the case count relatively low. Once that set of requirements are met it is very specific to have 2 negative tests, a letter is sent signed by Dr. Szczerba that states considered recovered and can return to work. Contact is made with all different work environments to ensure their standards and Health department standards align. Follows are the studied demographics of community cases as of 5/8/20: Race: White 71 % * Black 13% * Hispanic11 % * Asian 4% * Other 1 % Status: Recovered 70% * Recovering at home 26% * Death 3% * Hospitalized 1 % Type (Contracted Virus): Close Contact 32% * Travel 28% * Close Contact 22% * Community Spread 18% Age: (40-49)18% * (50-59)17% * (30-39)15% * (60-69) & (20-29)14% ea * (70-79)11 % * (under 20)8% * (80+)3% Testing by Type: Conventional 91 % * Pre -Operative 9% The Public Information piece as shared with staff is to be firm, right and transparent that was committed to early on. New things are learned every day about the virus, how it spreads and adapt with the changes. As things open there are Phase 1 and 2 of the Governor's orders. People tend to think that once it opens back up every one is going to get sick that is not how it works, once everything opens between 7 to 14 days a good number of people will get sick. It was clearly seen when the orders went into place the case load was not as high as before and the opposite will be seen over time as it opens back up and people with the active virus are out spreading, it will be serious it is going to ramp back up. Lauren Jansen asked if COVID morbidity of people with the virus tracked and was it found that most have a COVID morbidity. Would underlying conditions make it more severe. Amy Fagan replied it is tracked also blood type from early on, information came out that Positive blood types are more likely to be sicker. An interesting dynamic where Family A and Family B with incomparable situations, each had one person bring COVID into the home. Family A had no one to get sick and Family B had everyone get sick. A thought was the blood type it was not but underlying health conditions. Several have had hypertension, heart disease, asthma and diabetes. It has not been seen that underlying conditions make it more severe. Hospitalizations are not only looked at but duration of illness, no ranking is assigned only watched subjectively. Some people have symptoms for more than 14 days and some no symptoms. Literally some as example on Saturday night come down with symptoms recover fine with no other symptoms for a week or two and now cannot get a negative for 2 weeks, it does not make sense it is not like any virus ever seen. 2 Lauren Jansen questioned if it was possible to have the test and it be false negative Amy Fagan responded there has been some concern about that. A hospitalized patient 18 years of age it appeared everything met up with all the different symptoms, the physician called he had 2 negative test. An issues folder is kept to follow up, so Brandi Smith called the District talked with the Infectious Control person to find out what was going on with the person was it 2 negatives that were wrong, there was 3 other things found that was going on. Melissa Plowman wondered about the antibody tests, are there tests more accurate, a positive with an antibody test where does that information go. Amy Fagan said several jurisdictions have used the rapid testing it is not reliable; the Health District has not recommended it from the beginning, the antibody testing is one that has been great. About 2 weeks ago the Community Med chain as a lot of the medical facilities would only do the swab test if you were symptomatic that changed over time. Community Med is one that will do what test is requested, if a swab a swab, if an antibody an antibody that is a send- off, now about 4 locations will do send-offs. The City early on came up on how to handle antibody it has changed over time the same reporting is required for antibody testing as done for swab testing, but we do not report out on it but do study it. Right now we have had no positive ITMs reported that were not already associated with a positive PPR so that is good news. Lauren Jansen is the antibody specific for COVID-19, since obviously there are 18 others, if someone had one of the others would it show a positive anti -body or specifically 19. Amy Fagan there is still a debate about that, now is not enough consensus to agree if you have a positive for COVID-19 that it is not cross objective with other things. If your ITM positive in order for you to be counted as a case you will have to have the PPR which is done via swab, that is the only way to really be sure it is true COVID-19. Dr. Williamson said part of the problem with antibody testing is the prevalence in society is so low that the pretest likelihood that it is a true positive is extraordinarily low; it is the Bayesian theory as applied to this testing. What that means is if we tested large swatches of the population, if the specificity is not very high then we will get several false positives. It's very difficult to interpret right now. I think it only belongs in carefully controlled studies of population in clinical circumstances that physicians specifically need that information for some reason. Lauren Jansen asked for recovery in order to go back to work it is all is handled through the Public Health District Lou Kreidler that is correct. Dr. Williamson asked had there been any discussions about the threshold triggers that would cause us to return to greater social distancing. A study done at Columbia University the Mailman School of Public Health puts Texas at the bottom that predicts because of opening up Texas is about to have a big increase in activity. Lou Kreidler said that has been discussed at the beginning of the Governor orders prior to the last order that he clearly stated his orders are to precede any local orders so it really ties hands locally. It is hard to say whether the Governor would put another shelter in place order or what Amy and I call pull the band -aide off and see how bad it gets. It is the balance of what is good for public health and economic devastation. She does not know if there is a way to predict what is to come, whether at some point have a greater disease burden in the community, whether the Mayor and Judge would do something at that point or not. Councilor Smith was asked if he had any feelings. Councilor Smith said data from Public Health, State, Federal and CDC would continue to be looked at. What he is concerned about is all the statements about the need to have a plan for testing it is being said but nothing done to implement it already been almost 2 months. He is afraid there will be a rebound, a second wave that is going to be a large vast number because the correct testing is not being done. Not until the money is put on the table, some organization, it is not going to happen. That feeling he thinks is wide spread, not getting the leadership needed. Lou Kreidler said locally she had not heard anyone say that if they wanted to get the test they could not get tested. The community, medical providers have done a great job of having testing sites available with drive up testing at several locations in the community. A reporter in Houston emailed and called wanting to know what was so special about Wichita Falls, why we were able to do many more tests per capita than what they were seeing in the Houston area, and insinuated we had connections to someone that was allowing our providers to be able to get medical testing here that they were not able to get in other areas. She has sit in on calls and test groups with other Health Directors around the State and even today some locations are having difficulty getting providers to do the 2 negatives for a return to work, those are just not issues in our community that is being seen in other areas around the State. The data and charts done by the State 3 are looked at and per capita locally are doing much better than some of the other areas, we will see what the opening up has to do with that. Amy and I and staff are holding our breath to see what comes out of the Governor beginning to open the economy up but we will have to wait and see. Councilor Smith is proud of what has been done locally but then to get the leadership of Austin say to do what I say, he does not see that the leadership has taken the experience into an area like Wichita County and put the money on the table given statewide and nationwide, it is going to be regretted. Dr. Williamson said he thought Councilor Smith was right. He stated Wichita Falls has done well and it is thanks in large part to a smart and diligent approach by the Health department, Amy and Lou and everybody they work with have done a fantastic job. He went looking for a metric on how much is enough testing and the best metric he found was at least 10% or fewer of your tests should be returning positive if you are doing enough testing. Wichita Falls has been around 7-8% returning positive so it is being done well here. The average in Texas is greater than 11 % returning positive so the State as a whole is not doing well. He thinks unfortunately our leaders at higher levels are using a blunt instrument to manage what is going to require a scalpel because even as Texas is opening up, seeing a blossom. Right now the Panhandle is experiencing its own mini epidemic and Dallas is surging again there are several areas around Texas that are individually having problems. He thinks that is what is going to be seen for the next 3 or 4 months until the real second wave which is going to hit in November. Dr. Gibson asked if you are suggesting that everyone be tested even if they are asymptomatic. Dr. Williamson replied no, he thought enough testing was being done as long as 10% or fewer return positive, it is at that stage when it starts to get an increased number there would be the need to test everyone that gets a sniffle or any symptom that might be remotely COVID. Lou Kriedler can say at the Health department any time anyone is out with a respiratory illness that it is required that they be tested. The City has COVID leave the employee can access to be able to stay off and get paid until their test results come back. Thankfully no positives have come back all have been negative but have been cautious with some things in place, if sick you are not wanted in the building, it had to be done to protect the workforce. Dr. Szczerba has been great about when orders are needed that is appreciated, all the control orders are sent over to him, the release letters, anything of need Dr. Szczerba has been there to help, I do not want that to go unnoticed or unrecognized he has been a valuable asset for Health department throughout this. Lou gave her appreciation to the Board for doing the Zoom today, felt it was the safest option at this point, for the Board being flexible and attending the meeting. Dr. Carlston echoed what Dr. Williamson said that the Health District have certainly done an incredible job in terms of the type and frequency of information that has been shared out and certainly have been shaping the measure of response we have had here in Wichita Falls, unfortunately I think things are going to ramp up, anyway we can be helpful as a Board to please let them know. Otherwise we will go ahead and adjourn and see what format the next meeting is, certainly hope everybody can stay safe between now and then. IV. MEETING DATE Friday July 10, 2020 was noted as the next meeting date. V. ADJOURN Dr. David Carlston adjourned the meeting at 1:00 pm. Signature Print Name David Carlson, PhD, Chair, Keith Williamson, MD, Vice -Chair, Julie Gibson, DVM, Secretary Wichita Falls -Wichita County Public Health Board City -County Board 51