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WC CWF Health District Board Minutes - 07/10/2020WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES July 10, 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 Melissa Plowman Paris Ward, MA, BS BOARD MEMBERS ABSENCE EXCUSED: Tonya Egloff, D.D.S. Lauren Jansen, Ph.D., R.N. OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. Arthur J. Szczerba, M.D. Citizen At -Large - County Appointment Physician - City Appointment Veterinarian - City Appointment Restaurant Association - City Appointment Citizen At -Large - City Appointment Dentist - County Appointment Registered Nurse - City Appointment Director of Health Assistant Director of Health Health Authority I. CALL TO ORDER David Carlston, Chair called the meeting to order at 12:26 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES David Carlston called for the approval of minutes. Julie Gibson introduced a motion to approve the minutes, Lauren Jansen seconded the motion. The motion passed unanimously. III. COVID-19 UPDATE Amy Fagan, Assistant Director of Health stated that a month ago today on a Friday a substantial number of cases dropped that has not let up since, substantial developments have been in the last month. The promise and commitment to Be First, Be Right and Be Transparent has been true throughout. Lindsay Barker, Director of Communication and Marketing provides daily updates to the citizens to include all case numbers, ages, type of spread and hospitalization list. Every Friday updates are posted on the website with the addition of active cases in each city all though at the last meeting it was said that would not be done. At the time it was uncomfortable to release in order to protect the privacy of those individuals in the smaller communities, when the 300 mark hit over the 4th of July holiday active cases by City were posted. Those active cases are currently managed by Case Managers to include those recovering at home and hospitalized. Individuals marked as recovered are not included in the case count, so it is not indicative of the total cases but active cases. New cases per day this week saw the highest number per day at 47 total, again active cases are total cases minus those marked as recovered a substantial increase in both total and active cases. As close of business yesterday had 567 positive individuals total of those 24 in the hospital, 429 recovering at home, 111 recovered or cleared and 3 COVID related deaths. People ask about underlining health conditions that is not addressed for those individuals and their families it is not found reverent to speak of the underlying conditions. People start to have dialogue about those conditions instead of how to protect themselves and their family from COVID. All the press releases indicated as COVID-19 related death just indicates the person previously tested positive. Last weekend was the third death the individual was in their 40's and quite a bit of social media has been around about that. For an age breakdown have seen an increase in the age of individuals 20-29 and 30-29, also an increase in the age of 0-5, the youngest now is 6 months old whom was at a day care and the day care room was closed as a result. Also seen a slight increase in the 6-10 category as more cases split out to 6-10 and 11-19. Based on that it is 2% for the 0-5 and 6-10 age group, 7% for 11-19, 25% of individuals now are 20-29 a significant increase in that age group, 18% for 30's, 15% for 40's, 14% for 50's, 10% for 60's, 5% for 70's, 2% for 80+, oldest is 92. The challenge with this virus is typically to be most concerned about the most vulnerable those with underlying health conditions, those over 70 and youth but subjectively find those hospitalized are of all age ranges. This week are 2 in the 20's, several in the 30's, many in the 40's, about 25% over the age of 60, however the oldest are in stable condition and those between the 30 and 40's tend to be in critical condition very different in how anticipated. Do have 1 in the 6-10 category at Cooks in critical condition. For the virus spread 4 categories are used to go through and determine how the virus is spreading in the community. The Health District is in the minority of Health Departments throughout Texas and the Nation still doing full contact tracing and surveillance to include control orders on cases, household contacts and those that had contact with individuals. The thought is that it still helps keep the case count rather low, hopefully it will control the spread to keep from expediential growth given Labor Day, Mother's Day, Father's Day and July 41h. All those holidays have continued to be a set back with the 41h of July already have seen ramifications of the gatherings and getting influxes as a result of those typical enjoyable events. Community spread is for those that a source cannot be identified it is not known where the individual contracted the virus. Case managers go back 10 days prior to symptom onset to figure out where the case had been to put together any commonalities, links or reason of suspicions, but with no common thread it truly is community spread. Contact means typically a contact, as example at a barbeque someone later says they are COVID positive. Contact at church has been up on the list of contact cases, a lot of work contact and friends or non -household gatherings. Close contact means a household contact lives in the same home regardless if married, sister, brother, etc. Travel has decreased substantially since the last meeting now it is at 9%. Citizens have asked through social media where the travel happened, where in Texas, that will not be revealed that does not protect the individuals. About 3 weeks ago it was decided to change it has been beneficial just to list States, travel within Texas, several to Missouri, some to Colorado, if travel out of the Country will list the Country. Case status currently as of yesterday; 76% are recovering at home, 4% hospitalized, 19% recovered, 1 % Death. Ethnicity and Race in cases has been studied from the beginning. Early on there was some indication by CDC there may be different health outcomes based on ethnicity, so far have not seen the health outcome portion locally. Some differences have been seen in the race of the local population compared to the race of those that have been diagnosis as COVID positive, local cases; 56% White, 9% Black, 3% Hispanic, 1 % Asian, 1 % Other. That really is not reflective of the population served, especially with the Hispanic population have seen an increase that has primarily happened in the last 4 weeks. Paris Ward asked when does somebody go to the hospital or how is that decision made. Amy Fagan replied there are several different ways hospitalizations happen. An individual does not feel well goes to the Emergency Room, a COVID-19 screening is conducted that comes back positive while in the hospital then can be admitted. An admission depends on any other admission it does not matter that the individual is COVID-19 positive, it is their health status that matters for that admission, it just so happens their also COVID-19 positive. The information is forwarded to the Health District to handle as a case, several times had to actually call the hospital room to start contact tracing, surveillance and the case management. Some have remained in the hospital for their entire 14-day period to include getting their 2 negatives, so it just kind of depends on the outcomes. More typically what has been seen is the individual will go to a testing location, goes home and when it comes back positive a case manager makes contact checking in with them daily. Often times when the individual is called the case manager will say you do not sound like you feel well you cannot breathe, the individual will say it is fine but the case manager will tell them if they have difficulty breathing they need to go to the hospital. When that happens it is a little disconcerting the case managers are very in tune with these people because some could of had really negative health outcomes, some live home alone. The case managers help them several times had to call Police Dispatch to get a call in to get individuals to the hospital because they could not breathe or had substantial health concerns. There are more incidences where individuals have a hard time breathing, the primary complaint is shortness of breath and chest tightness that ends them in the ER then admitted. In one day went from no hospitalizations to 3 then to 9 then like in 2 days at 23, the highest day was 24 or 27 believe it was Wednesday May 9th, it has decreased since which is great. A daunting day was when it was lower at 12 or 15 hospitalizations but the majority was listed in critical condition, some of those have since improved and 1 passed away. To speak more about the case management surveillance part Lindsay Barker is going to put together a video to explain how the surveillance part is attained. Fourteen contact tracing contractors have been hired, not to include the translators. Recruited staff nurses, health educators, laboratorians, preparedness coordinator to staff the coronavirus hot line and as case managers. That staff was expanded due to unable to keep up with the workload/volume so hired 14 contractors to do contact tracing and surveillance then 2 additional that can translate a big challenge. A significant number of people speak English as their primary language, 2 individuals live with a hearing impairment and 1 blind those have been some additional challenges. Once a case finds out they are positive a case manager makes contact to inform them they cannot go anywhere, household contacts cannot go anywhere, for at least 14 days so often times does not have groceries with no plan. On a Friday night one family had 10 people in the home 4 adults and 6 children with just enough food to last to 8 am the next morning, the Food Bank was called and took out enough food and things for the 14 days. Throughout it all the Food Bank has been amazing, if food is in need the case manager can pick up the food and the Food Bank has delivered in turn we have helped them with a variety of things. The case managers 2 also have been amazing in all this. People need their medicines things like that, the case managers make sure all those needs are taken care of during the quarantine period to improve their odds/outcome, also to make sure being compliant. Keith Williams asked, are you intending to continue to increase the number of contract workers to keep up with the volume or will there be a point in which you cannot keep up with the individual contact tracing. Amy Fagan responded as an old school laboratorian that is called our saturation point, she has been asked that many times and not sure she knows what the answer is. In talking with Lou Kreidler about it some not sure they have a collective answer, right now it is manageable. Part of the challenge with hiring contractors is the Health District's big standards, basic concern, compassion, non -judgmental, the job is hard it is hard finding the right people. Lou has been great in finding 14 people who can get the job done but to train, to make sure those same standards are used and implemented across the board has been a big challenge. She is not sure what that saturation point is, she thought when it reached 500 but that was passed Tuesday, it is still manageable. One of the things that has not been addressed at all is the business component. Melissa Plowman has been through this piece it is a big part of the puzzle. The case management piece is always talked about and cases in the household contacts but there is a whole other side to this which is the control of that community spread. Also is the job in working with these businesses, this morning had a day care call where a person worked was symptomatic, the day care owner asked at what point are schools going to be back open. What has to be done is what is known today that is the best way to control the spread of disease. Engage in that old school public health, do the contact tracing figure out where that person works, where that person has been, isolate those people that have been around them directly and control the spread from there. Not sure what point community spread becomes so pervasive that it is not advantageous to do that anymore, right now have 189 businesses that are either linked to cases directly or indirectly. Spoken to about 75% of those businesses, a risk assessment is done and talk about how to either safely operate, isolate, reopen, clean or all those things. Part of that risk assessment piece done makes sure to control the spread of communicable disease that remains the goal. To your question not sure where that tipping point is but it will be known when seen then reevaluate like it is done every day. David Carlston speaking for everybody said thank you for everything the department is doing, it has not been easy for anybody especially you all but the Board appreciates the expertise and work being done. The Board certainly wants to be helpful in any way they can. Lou Kreidler thanked the Board and their support. 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 3