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WC CWF Health District Board Minutes - 09/11/2020WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES September 11, 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 Lauren Jansen, Ph.D., R.N. Melissa Plowman Paris Ward, MA, BS BOARD MEMBERS ABSENCE: Tonya Egloff, D.D.S. - Unexcused OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Amy K. Fagan, M.P.A. Michael Smith Woodrow W. Gossom, Jr. Mark Beauchamp Citizen At -Large - County Appointment Physician - City Appointment Veterinarian - City Appointment Registered Nurse —City Appointment Restaurant Association - City Appointment Citizen At -Large - City Appointment Dentist - County Appointment Director of Health Assistant Director of Health City Council Liaison County Judge County Commissioner I. CALL TO ORDER David Carlston, Chair called the meeting to order at 12:22 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES David Carlston called for the approval of minutes. Lauren Jansen introduced a motion to approve the minutes, Keith Williamson seconded the motion. The motion passed unanimously. III. COVID-19 UPDATE Amy Fagan, Assistant Director commenced that Wichita Falls disease burden is higher than preferred but does remain low compared to other cities of comparable size. Based on CDC guidelines that changed on the 22"d came a massive change to discontinuous of isolation and quarantine -protocols that went into effect the 22nd or 31st. That helped the staff tremendously, it provided the safety desired for the community with the 14-days vs 10 day CDC standard. The Health District (HD) does intend to remain -at the 14 days a higher standard than CDC. The HD is not as strict with the two negative tests to return to work. Several local industries have a higher standard to quarantine more people than the HD would and keep people out on isolation pending at least one negative test, many do the one negative test including the City to return to work. She has always kept an eye on the daily analytic side called the positivity rate. It is not necessarily indicative of the number of people in a community that have the disease because there are people that have never tested even though symptomatic or asymptomatic, so those are uncaptured populations. Those who are captured which are those tested in and reside in the jurisdiction are those resulted. One of the requirements of Centers for Medicare and Medicaid Services (CMS) is any County with a positivity rate, above 10% in a 7-day period have to test at Nursing facilities the staff and patients twice a week. That is.a lot of testing, huge expense, big burden on testing and staff, so the positivity rate now has things tied to it. The periods of 10 to 15% and 15 to 20% is very important to CMS so that will now be published. The current positivity rate has gone up substantially in the last week which is concerning. The week ending today resulted in 912 test which is average; however of those resulted were 121 cases for the week alone. The last time that high of a week was July 17th that means the positivity rate for the last week 7-day period is 13.27% it is high but not as high as some places. Post and graphs are posted every Friday, as of today current cases by race are; 58% White, 29% Hispanic, 11 % Black, 1 % Asian, 1 % Other. The population compared to disease burden is skewed especially for the Hispanic population, seen disproportion ally effected by COVID it was over 30% at the last meeting. In terms of case status after the July 31st modification of discontinuation of isolation protocol there was a substantial number of recoveries, those now have leveled out. Probably 90% of cases resolve within the given time frame which is the 14 days for mild to moderate, 20-21 days based on hospitalization or severe immunocompromised, typically those who do not recover within the given time frame have lingering symptoms. Also, been concerns about people who may misrepresent symptoms to remain out of work for a longer period of time. Death percentage is at 1 %, -Hospitalized 1 %, Recovery 12%. The Public asked for Active cases (recovering at home and hospitalized) so that was added to the main board. The portion of population based on age category is studied now that all schools are back in session. The 0-5 and 6-10 years have not changed much typically averages between 1 and 2%. The 11-19 years between 9 and 10% the whole time, saw an increase in number of cases but not a change in percent of total cases at this time. Ages 20-29 remain the highest category at 22%`and 80+ about 3%. As,of close yesterday Community spread was 37% has gone up, Contact at 30% has gone up, Close Contact (household contact) at 21 % and Travel at 5%. Community spread going up is of concern, that is when there is not an index to link the case spread to, it is not known. Contact is seen most often and most often question is what is seen 'in terms of where people are getting COVID in cases where you know. Most often seen are at work, the prison, some medical facilities, some industries, restaurants and it has to be looked at as a percent of the total workforce. The prison workforce is so large it is a percentage not concerning at this time bit it has its own issues or challenges that needs to be of concern. As an overall percentage like some of the major manufacturing plants it is not as. concerning because the plant employs so many people those issues or challenges are expected to happen. At this time work together with over 350 businesses to make determinations of who needs to quarantine. Improvements in use of face coverings required has been substantially helpful in keeping business spread down. In the last month seen a significant increase in contact with family and friends, a lot of bachelorette parties, hobby type parties, family gatherings, barbeques, friends visiting, neighbors visiting, that remains a challenge before you know it the whole family or whole gathering is sick. Travel remains low. A substantial internal change was to establish a school management team that consists of 1 staff and 2 contractors to come up with policies and protocols specific of how schools would be handled. It was important to ensure all schools no matter if public, private, MSU, preschool, would be handled the same. People ask a lot about the contact piece so the Teachers Education Agency (TEA) came out with some guidelines, suggestions, protocols, to detail how schools were to handle things, without a lot of Public Health and Local Health Authority engagement. A strength here is the local communities work well together and established relationships with all .the school districts. ,Each school whether public, private or grade, works directly with a point person, with each case a determination is made of close contact which is the 6 feet or less for 15 minutes or more. Everything imaginable has been heard, still have to go through to make that identification of close contact from there do a risk assessment of low, medium or high risk from there make the determination of who should be quarantined. There is a line list of 10 different schools, recoveries have not been removed the total follows. WFISD student isolation. is 16, student quarantine those identified as being enough of a, contact is 84, teacher isolation is 5, teacher quarantine is 2, support staff (janitorial, custodial, etc.) is 0, staff isolation and quarantine is 5. Cases have been at all schools in all school .districts whether it be a student, teacher or support staff but it has gone relatively well. Dr. Williamson said MSU have had their own challenge. MSU has set up in conjunction with Amy's advice and the Public Health contact tracer point of contact Denise Santos a tracing team made up of volunteer Nursing students. They are learning by doing which is to say do not necessarily get all the information needed initially has to refigure, but are coming together better every week. On activity have not had enough time under the belt to see if it is stable or not at Midwestern. As far as he can tell his thumbnail assessment is it is pretty stable at Midwestern, do have some activity as expected in that 20-29 age group but it does not seem to be accelerating. He thinks at some point may have to deal with that but hopes not. Amy Fagan said that is the thing in all of this, knew it was going to be like that for Midwestern because it was like that for the HD there is no manual for how to do this, there is no written protocol. .The State has kind of left Public Health to their own devices which is good and bad. Very grateful for those Nursing students since we did not know the difference in dorms, dining halls, parking and all, the design was to help with the investigation process. With schools she goes back to look at the data based on what the decisions were at the time based on what was known at the time. Nationally it has been to return to school or to not return to school. She feels much better about the risk assessment process used because school was in session 2 days before the first positive. Those identified as close contact did not have medium to high risk so were allowed to remain in school, none developed disease. Individuals identified with medium to high risk were quarantine, the first one that developed disease was a case off -a weight lifter that had lunch With the original case identified as high risk and 5 days later developed disease. Did received a lot of heat from parents upset because an entire cheer leading team had to be quarantine. The work done, the provisions put in place, how the assessments are done, the disease burden kept stable and hope that continues because school can still be in session, but the work needs to continue. Judge Gossom stated this morning on National news they acted like the Universities were not changing enough parental control of the students who possibly had COVID, in his old dean days they would not have called it loco parentis it was anti. Dr. Williamson just how much is expected of you, all that puts you in an interesting quandary there. Dr. Williamson said he can tell you that students have a wide variety of reactions to be put into isolation they are generally okay with that but quarantine they get a lot of push back. They try to break quarantine early then they complain about it. Ohce someone is identified as a positive case or clear close contact that is less than 6 feet and more than 15 minutes, they are pretty tight with their quarantine because this is one big powder keg with the residential housing on campus. They do not want to have to close down the classes and send everybody home again. 2 V Dr. Carlston asked in terms of counting he knows in the past a mention that cases are counted based on their place of residence. Are students counted in the County data or if a student test positive is that sent back to their home County. Amy Fagan said the American Association of Territorial and State Epidemiologist has a guideline the HD has always used, basically it is where someone resides for the majority of the year. In a typical year it would never be a question or debate because a typical college student would be at college for more than the year, so they would be counted in this jurisdiction. The challenge is school is out of session, school typically is in session 6 months out of the year so a registered student, non -online, here living in a dorm or apartment, would be counted in this jurisdiction. If someone is at Tarleton their med record would come here because that information is their home since their parent's insurance is home, so that information is sent to Tarleton's regional office to be counted in Erath County. Some MSU students tested positive at home in their jurisdiction over the summer, when retested here because of the NCAA requirements we got the positive, did not have it as a case so had to back track, but it was counted in their county of residence because of how the process works. Lauren Jansen said there seems to be some contraction on days of quarantine is it 14 or 10 days. Amy Fagan does not know where that contraction came from. It has been quite clear in the HD quarantine process that it is 14 days from date of last contact with a known or suspected case. It has never been 10 it should never be 10 because the exposure incubation period is 2 to 14 days from date of exposure. Paris Ward asked would school contact sports like 'volleyball, cheer leading, etc., if someone on the team test positive would that automatically be a medium to high risk case. What is the difference between contact and community spread? Amy Fagan replied more than likely it would be medium to high risk because -most of those contact sports do not wear any type of face protection. At preseason football practice they were smart and had the players practice in pods so instead of having to quarantine the whole football team it was only the pod of kids that practiced together in quarantine. Now getting into football season an active competitive sport season that will change a bit. Each assessment is different so there is never a blanket statement because every situation is so different. Assessment is done with the coaches, case, parents, to put all, the pieces of the puzzle together because often the reports are very different based on whom you speak with. Community spread is no idea where a case contracted it, no tie to any COVID positive individual within the timeframe who could have gotten them sick. Contact is a'case contracted at work, school or gathering. Dr. Gibson hears a lot of people say they tested positive are in quarantine but have not had any signs or symptoms, tested because of a cough, something like that or work with someone that came down with COVID. Is there any data on when people test positive how many actually come down with the disease? Amy Fagan does have a specific data point it is between 5 and 10% based on what is known from almost 1,500 cases today. However, as a personal opinion based on only Wichita County cases the virus is changing, use to be fever, cough, shortness of breath, those were the three hallmarks of COVID what it was thought to look like, now have seen fever in less than half the cases. Fever for cases have -been just an elevated temp not meeting that 104 which is why the recommendation has been at 99.6 that constitutes for an elevated temp as a symptom. In the last month have seen a lot that sounds like allergies, the runny nose, stuffy nose, fatigue. Case managers say the person went to work for a week thought it was allergies,.got tested and it was not allergies. The 5 and 10% asymptomatic is concerning because it is heard all the time that it is politics, why is this so important and flu kills more people. In the cases it is documented COVID transmission of disease is 2 days prior to symptom onset, that is highly concerning and why the HD work is so important it keeps that exposure down. The 2 days prior is scary to have no idea to possibly transmitting disease. The biggest challenge is that asymptomatic spread because of the documented cases of people who are asymptomatic are .cases spreading disease to other people. Lauren Jansen asked if there were any other viruses except for a cold, that would be picked up on testing. Amy Fagan said not to her knowledge but Dr. Williamson is more of an expert. Dr. Williamson stated the Molecular test is virtually 100% specific and will not make mistakes, the Protein Antigen test maybe not quite so specific but is in access of 99% specific. Sensitivities vary with the Molecular being extremely sensitive and the Antigen test being somewhere between 80 and 90%. One thing he would comment about is the relative change in the symptom quality, seeing a shift from the victor to a different host, the host is tending to be younger there seems to be some evidence that the amount of infected dose the patient starts with correlates with severity of symptoms later on. 3 Paris Ward asked which test is used or is all used in Wichita Falls. Dr. Williamson said all are out there, the one that most of us our hearing when it is reported on the news is the Molecular test. We have the Hospital Lab, the Pathologist Associates Lab, there are a number of Reference Labs that use different versions of it but it all is a polymerase chain reaction, it is very sensitive, very specific. In office if you get point of care testing in less than 30 minutes that is the Antigen test it is not quite as reliable. Lauren Jansen is there any difference between the nasal swab and the oral swab as far as results. Dr. Williamson said the optimal seems to be the nasopharyngeal swab,. you have to have a good collection technique and a cooperative patient who will cough heavily before an oral swab or blow the nose before a nasopharyngeal swab. There some inter -operator sampling technique variability. He has seen a lot of people who are not placing a swab exactly in the right place to get the nasal fairings. instead they are sampling the olfactory mucosa at the top of the nose called the cribriform plates.it is a little different tissue with less likely yield. Done correctly it is a very good test. Councilor Smith. asked as far as direction and advise from whomever above where does it stand at setting up a plan to distribute vaccine. _ Some polls indicate less than a majority will take the vaccine, some going to wait, some do not know, then the group of 25% will never take it. Who" is going to provide the vaccine, will it be free to all those that want it and how is that going to be prioritized. Will the drug stores be giving the vaccine? Lou Kreidler answered not much is known from above but each year plans are in place through the preparedness program for some type of flu clinic, a drive thru in the parking lot or AG Barn or MPEC, certainly will look at which plan will be used based on social distancing. Education will be done to provide lots of information with the hope to get as many individuals vaccinated as possible, but there is always going to be individuals that do not vaccinate. There are individuals who will not get a flu vaccine, will not vaccinate their children because they do not feel it, is safe, even when the H1N1 vaccine came out individuals would not take it because it was new. The State provided the HD with the H1 N1 vaccine, it usually comes through either the vaccines for the Children's program or the Adult's safety net program, usually at no charge. The. State allows the HD to chargea handling fee then sometimes does not allow to charge but provides funds through grants to cover. the cost of the employees and administration cost, if available or covered the HD can bill individual's insurance, all methods will be reviewed. As far as priority that will come from DSHS which probably will come from CDC, but imagine it.would be individual's and young immune compromised and elderly. She does not know but heard the vaccine will come out through the pharmacies as well, in H1 N1 the pharmacies and Doctor offices had the vaccine before the HD did. She read the other day that there is an emergency use authorization that would allow drug stores to give the vaccines to individuals 3 years and above. Paris Ward asked of those people that have had it are they immune to it after or can they catch it a second time. Lou Kreidler said there has been one individual somewhere else that some gene sequencing was done, the individual had been infected, recovered, now re -infected. -What is believed that having the disease and, the amount of immunity depends on the severity of disease, the more severe the disease the more immunity is provided, the less severe the less immunity. Judge Gossom said it has been said that mask because of the size the COVID-19 virus mask really are inconsequential to have any effect. Amy Fagan works with a lot of businesses, staff work with lots of cases now schools, the people quarantine or identified in review on whether to wear face coverings or not that does seem to be tied in with how much disease is transmitted. Family gatherings, barbeques, parties, where people do not wear face coverings people get sick more often. The majority of what she has seen, read and known from feedback from staff is face coverings whether cloth, double layered, shields, whatever, works better than nothing to keep disease from spreading. Until the evidence shows otherwise she will continue to. tell people what is the worst case scenario wear it and it does not protect someone vs the 90% chance wear it and protect someone. Dr. Williamson agreed completely with Amy in that science is very reductionist, studies can be found that indicate the porosity of the mask is not adequate to prevent transmission of the virus. Most important would be to stay away from other people, after that would be stay as far away from other- people as possible, after that comes the wearing of a mask, one person -wears a mask decreases his ability to project the virus into the environment, if you wear a mask and a face shield their both non -projecting the virus and preventing eye contact with flying virus then after that comes washing your hands diligently. If you use them all you optimize your chances, if you use any part of them your chances are better but if you do not use any of them you are at risk. Councilor Smith said early on there was a Doctor that provided charts and graphs with future projections of Wichita 4 County. I there anything out there like that at this point ,forthe future in.particular: ' What is going to happen when half the population says, no thanks, when a vaccine is: available: Amy; Fagan. replied that was Dr. Von Gray he had -come up with that based on some National modeling based on what they thought they knew from studies in other countries as it came into the United States. The projective remodeling was discontinued here because it did -not lineup, there was:so much push.back; in -sighted fear and panic. The virus has: changed it is hard to do; projective modeling that would 'be effective but it may be revisited as there . is more substantial data Nationally for our Country vs other Countries. States and cities. have handled it so'differently, how, it is handled here vs the urban or rural. areas make_it verychallenging to come up with enough data to do projections that are meaningful. Do not know what that looks like with vaccine.:because:do not -know. the.effectiveness of.vaccine or number of people who will take the vaccine, we are .kind of .stuck in .a. place doing.;more defensive analysis vs projections. lV. HEALTH AUTHORITY APPOINTMENT' Lou Kreidler, Director explained -State law mandates that a Medical Physicianbe appointed as the Health Authority for Wichita County, the. Board of Health in -the. County is responsible to make the appointment. Historically contracted with the Residency program for both the Health Authority'and Medical Director, but when that entity was dissolved there was a short period of time for the transition. Dr. Szczerba knew the. Health District-operations'and was contracted.,. Dr. Szczerba.has done a good, job_ for the Health District, but with the pandemic came a realization-of'the need -to have an Infectious Disease expert as the Health Authority and Dr.'McBroom agreed to contract in the position.: Dr. Szczerba wasgiven notice his contract would not be renewed. Today need from the Board if the members agree a motion to appoint.Dr-.McBroom as the Health Authority. Melissa Plowman introduced a motion to appoint Dr. McBroom as the Health Authority for. the Health. District and Keith Williamson seconded the motion. The motion passed. unanimously, V. HIKE AND BIKE TRAIL Karel Davis, Program Coordinator took the indoor/outdoor concept of"the Texas Healthy Community Grant to use bicyclingas the trail system -in an app'since.Wichita Falls is designated as a bike friendly -city. In discussion -with her. supervisor contacted Crane West Advertising Agency to do the technical side and insert the;work to put it all together. Karel was to find.the latitude and longitude, of various spots of interest, .key attractions, parks and take pictures of various things that'would go.into,the app. .In June.of this year Crane West finished the mock, up design that was approved by the Health District Leadership and Apple approved the app August 18e1, 2.020. The app isuser friendly; open thePlay Store go to "Wichita Falls Trails". the. landing page shows the design and various parks. Icons. indicate restrooms- pavilions, bicycle repair stations, gazebos, picnic tables, and basketball courts. -Lucy Park is.a gigantic.park with a swimming pool, log cabin and duck pond great for families. Williams Park on.the eastside is.really nice too, with beautiful trees for photography -even for an engagement shot it is a great place. Lou Kreidlersaidthe app-goes back to the Transforming Texas. grant but was never approved in any of the stores. So: to continue the app into different grant funding with. an approval it really is a great tool for the community,and able to do amidst COVID. With everything else going on wanted to share something that was not COVID and;positive for.the . community. Dr. Carlston stated it was great to get some good news and have something positive to think about other than just the quarantine and COVD pandemic. Thank you for all the work on that VI:: NEXT -:MEETING DATE Friday November 13, 2020 was'noted-as the next meeting date. VII.. ADJOURN Dr.: David Carlston adjourned the meeting -at 1:25 pm.. . Srgnaturd. not Name David Carlson PhD Ctisir, Keith Williamson. MD Vice -Chair. Julie Gibson, DVM. Secretary