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WC CWF Health District Board Minutes - 01/08/2021 WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES January 8, 2021 Wichita Falls-Wichita County Public Health District 1700 Third Street—Zoom Video Conference Wichita Falls, Texas BOARD MEMBERS PRESENT: David Carlston, Ph.D., Chair Citizen At-Large-County Appointment Keith Williamson, M.D., Vice-Chair Physician -City Appointment Julie Gibson, D.V.M., Secretary Veterinarian -City Appointment Tonya Egloff, D.D.S. Dentist-County Appointment Lauren Jansen, Ph.D., R.N. Registered Nurse-City Appointment Melissa Plowman Restaurant Association -City Appointment Paris Ward, M.A., B.S. Citizen At-Large-City Appointment BOARD MEMBERS ABSENCE: None OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Director of Health Amy K. Fagan, M.P.A. Assistant Director of Health Robert McBroom, M.D., F.A.C.P. Health Authority Woodrow W. Gossom, Jr. County Judge I. CALL TO ORDER Keith Williamson, Vice-Chair called the meeting to order at 12:12 pm after a quorum of members was attained. II. MEMBER RE-APPOINTMENTS Re-appointment of Lauren Jansen to City appointed Registered Nurse, Keith Williamson to City appointed Practicing Physician and David Carlston to County appointed Citizen At-Large was commenced by Janice Flores, State of Texas Wichita County Notary Public. III. ELECTION OF OFFICERS Lauren Jansen introduced a motion to appoint Keith Williamson as Chair and Tonya Egloff seconded the motion. The motion passed unanimously. Tonya Egloff introduced a motion to appoint Lauren Jansen as Vice-Chair and Keith Williamson seconded the motion. The motion passed unanimously. Lauren Jansen introduced a motion to appoint Julie Gibson as Secretary and Tonya Egloff seconded the motion. The motion passed unanimously. IV. APPROVAL OF MINUTES AND ABSENCES Keith Williamson called for the review and approval of minutes from the November 13, 2020 meeting. David Carlston introduced a motion to approve the minutes as submitted and Julie Gibson seconded the motion. The motion passed unanimously. It was noted all Board members present. V. COVID-19 VACCINE Lou Kreidler stated the community is beginning to receive vaccine. The first round went to United Regional and the State Hospital to vaccinate employees and the second round to Kell West and Electra Memorial Hospital. Before the vaccine rollout the Health District meet regularly with United Regional, Clinics of North Texas, Electra Memorial Hospital and Community Healthcare Center to prioritize group 1A individuals with the first vaccinations. After United Regional vaccinated staff that wanted the vaccine, the vaccine was offered to all physicians with admitting privileges at the hospital. United Regional was great, now working to vaccinate individuals of Promise Hospital and the smaller hospitals their patients are sent to that still need care but not the level of care United Regional provides. The Health District focus for the 500 doses of vaccine received was on Medical First Responders, Fire that serve as EMS, EMS providers and before the vaccine ran out got to home health agencies and physician offices. A waiting list was started yesterday with over 2,500 names comprised of groups 1A and 1 B. Two to three days into 1A vaccinations came an announcement to vaccinate 1 B as well which caused contention, 1 B individuals felt they should get the vaccine prior to the 1A list. As a medical community it was important to the Health District to focus vaccinations on the medical community so nurses, doctors and healthcare workers would be able to care for individuals that get sick. Once through all 1A individuals to schedule appointments shifted to 1 B individuals those over the age of 65 and under 65 with a pre-existing health condition that could lead to a poor outcome if contracted COVID-19. At this point no additional vaccine has been received, last week vaccine allocations went to mainly pharmacies and a couple of small physician offices. Clinics of North Texas began vaccinations with their patients over 90 year olds then to 80 years with a systematic approach of their 1 B patients to vaccinate those felt to be the highest risk: United Regional is working to do the same with their population but not sure of their methodology. Community Healthcare got a second round of vaccine and utilized that as well. On the comments about providers hoarding vaccine that is not true, there is not a local provider with vaccine that does not want to use it because that is the way to the light at the end of this tunnel. The Health District works hard as vaccine comes in to get it out in a timely and safe manner for individuals. The State has a BAO system that would allow the Health District a jurisdictional view to see all providers in the community with COVID-19 vaccine, how many received and given. Once accessible the system will be helpful with more information to provide answers for the community which has been a frustration for a lot of individuals. Judge Gossom asked of the 1 B what are the comorbidities for the 65 and older. Lou Kreidler said the 1 B group are the 65 and older,and if under 65 must have a comorbidity that puts an increased risk for severe illness from COVID-19, such as but not limited to: cancer, chronic kidney disease, COPD (chronic obstructive pulmonary disease), heart conditions such as heart failure, coronary artery disease or cardiomyopathies, solid organ transplantation, obesity and severe obesity (body mass index of 30 kg/m2 or higher), pregnancy, sickle cell disease, or type 2 diabetes mellitus. Tonya Egloff asked if there is a difference between the first dose and second dose 4 weeks later because some friends had no reaction to the first dose-then a significant side effect to the second. Keith Williamson thinks that is a very good thing; there is no difference in the doses of the RNA vaccines. What it is signifying is the body response to the first one and the side effects are not an illness so much as an immune response. Paris Ward asked if the reactions are tracked, if people have a reaction what is that related to, what is in the vaccine is it antibodies of the virus. Lou Kreidler replied the Health District requires notification of severe reactions that go into the Vaccine Administration system to the State of Texas. Minor side effects called adverse events, as headache, sore arm, are not reported but encourages vaccinated individuals to enter reactions into the VAERS system to provide CDC better information and these are not reported back to the Health District.The vaccine is a messenger RNA vaccine not a live virus, the vaccine sends a message to the cells,works at the cellular level to tell the body if infected with COVID how to respond and fight the virus. Dr. McBroom said look at it as an old fashion reel to reel tape machine and the messenger RNA is the tape and it goes through a dual head reader as it goes through the tape reader it codes for a specific amino acid that is generated and built at that site. The amino acid is then constructed into a protein, that protein happens to be the spike protein of the viral capsule and that protein is,released into the blood system where the immune cells recognize that it produces antibody to it. It produces that antigen that protein that is recognized in the immune system as foreign and builds antibodies to it, a simple concept. Keith Williamson said we live in an age of miracles that this could be produced so fast, mainly because of our technical expertise in genetics these days, it was not so much that it was rushed as we are now there in technology. Tonya Egloff asked if this spike protein unique to all coronavirus, she had read recently there is already some mutations happening with this vaccine. Do they feel like we are going to be immune to all coronavirus variants? Keith Williamson replied interesting question in that the spike protein is on all the coronaviruses but there are variants, the one that is effecting us in COVID-19 codes for the ACE2 protein on humans, it is like a key to a door with a specific lock, if the key changes to much it will not work anymore they cannot get in, so fortunately so far the vaccine continues to be effective even against those variants that have turned up. Julie Gibson asked if there is any group that should not be vaccinated, being rabies prophylactically vaccinated with a severe reaction it makes her nervous to get any kind of vaccine now. Veterinarian clinics are not in the necessity to receive the vaccine as human medical professions but are considered essential. Luckily the clinic 2 • has had no exposure or virus but great lengths are taken not to get it as well.The clinic has potential for exposures when people get COVID and goes to the hospital, the clinic gets their animals to take care of which has been a concern because it is not known if the person bringing in the animal has had exposure. Does veterinarian medicine have a place in any of the groups yet. Lou Kreidler did not know but will certainly ask at the next vaccine meeting. The CDC has their guidelines then the State of Texas has different guidelines which has caused some issues. CDC guidelines say school teachers can now be vaccinated but DSHS developed an expert vaccination panel of local health departments, medical physicians, legislators and other individuals, meeting weekly to determine what the priority groups will be for the State of Texas. Keith Williamson said his interpretation of the question to be medical contraindications. Currently the Pfizer vaccine can be given to anyone over 16 and the Moderna vaccine can be given to anyone over 18. The one contraindication is if one had a severe allergic reaction to any component of the vaccine and in particular polyethylene glycol which has been blamed for the 5 or 6 anaphylaxis reactions, polyethylene glycol is a very common generally benign substance. Lauran Jansen said animals do carry it right, like dogs and cats. Julie Gibson said there has been positives but are not as sick with it as the humans, have been some animals die but not been anywhere an animal has transferred it to a human. They are not as concerned about that as the people that bring in the animals, on whether getting exposure to someone that has it. Keith Williamson had found it very challenging as a small office to sign up to be an enrolled provider for the vaccine. It is very slow, tied to ImmTrac also requires very detailed information on your freezers, refrigerators and monitoring. Have other physicians found this to be a handicap? Lou Kreidler had not heard from a lot of physician offices even when the hospitals and Community Health tried to get signed up it was an issue. It took forever for the Health District to get approval even being a vaccine provider with the State on ImmTrac. The State is working through some of those issues and hopefully it will be better. Keith Williamson said it is his impression they have hired some additional people to work through that, he applied on October 8th and received no response until December 30th. It appears that North Texas State Hospital(NTXSH) and United Regional both got the Pfizer vaccine and the rest Moderna as far as he can tell. He was surprised NTXSH got more than any other single source in the County. Lou Kreidler responded yes, other than hospitals others received Moderna because of storage issues. Judge Gossom said NTXSH did get Moderna and had surplus but was directed to reallocate amongst other DSHS facilities such as some of the homes operated by the State. He approached them about their excess Pfizer, as of yesterday afternoon they cannot move the Pfizer from their facility it will have to be administered at the State Hospital. What may be needed is to mobilize additional medical personal to the State Hospital to help administer the shots. Lou Kreidler replied a form must be submitted to the State for approval to transfer that vaccine to other locations. If they could transfer the vaccine it has to go from hospital to hospital another entity. Maybe the State Hospital cannot move it because of the cold chain requirements, the fact it probably would have to be packed on dry ice with a data logger to ensure between the State Hospital and United Regional it never gets out of that negative 70 state. Many locations are partnering with Nursing students to come out and give vaccines. Lauren Jansen said MSU Nursing will have 45 graduating seniors and 9 in the excel, 54 students. Lou Kreidler said the Health District is working with the Vernon ADN program as well. Paris Ward asked if you become immune to the virus or like the flu shot where it might minimize the symptoms. Keith Williamson replied that is one of the fabulous things about this vaccine, the flu shot is about 70% effective this vaccine so far has been 95% effective, go to CDC Science Updates: December 22, the graph is impressive. It is incredibly effective it is great technology. 3 VI. COVID-19 UPDATE Amy Fagan said information continues to be submitted at the close of each Friday for consistency, with both holidays on a Friday the numbers were still tracked to have a weekly comparison. At the last meeting it was discussed by year end there would be about 1,200 cases should the trend continue and hospitalizations about 130. It came in on target at the end of last week had 1,185 cases and Monday close around 132 hospitalizations. The Weekly New Case Forecast graph presents an artificial dip in the numbers at the holidays that was not the holidays in terms of reporting but believed to be holidays testing, due to the holidays people delayed testing also had a delay with labs closed. Based on the information at the close of last Friday the end of February will be over 1,400 cases because of the statistical variance. Cases are expected to be a little above between the Forecast and Upper Confidence Bound because of Christmas and New Year's gatherings. It gives a good indication on how to plan, to staff, what hospitals might see and some strategic mapping on how to move forward. The Max Daily Hospitalizations by Week Forecast is the maximum number in any given week and based on that information suspects the Upper Confidence Bound be around 180 for the end of February. COVID Cases by Race have been in aggregate since the beginning of the pandemic from reading all the case reports the Hispanic numbers have gone down in the last several months. In terms of hospitalization and health outcome the Hispanic population seem to be more adversely affected by COVID with poor outcomes, that is from observation not data supported. General population spread for race is within the jurisdiction it does not align with the census bureau but it is more representative with less of that disproportionately affected. In terms of COVID Case Status there are 25% of the total recovering,2%resulted in death and 1%currently hospitalized. COVID Cases by Age Group are in aggregate released each Friday, is the more relevant which is a week over week for the last 8-week period. The 20-29 age group had stayed stable as the lead category of COVID positive individuals in a week that changed dropping from the lead about 2 weeks before Christmas break. COVID Cases by Type of Spread the Travel has picked up a bit which includes outside Wichita County travel but overall it has decreased and continues to decrease. Individuals that traveled over Christmas are included in the most recent 1,000 cases. Community spread is still the biggest category but not by much, most is by Contact. Case numbers in the Nursing homes staff and residents has substantially decreased. Most Nursing homes have had an outbreak and subsequently recovered only a couple are in a second outbreak and many have received vaccines. Hospitalizations change over time once back from break had the highest number hospitalized. Facebook posts read the Health District is not keeping up needs to do a better job and hire more people. There are no chairs, no phones, no computers, some work from home, probably 10-20% of staff are still converted to work on COVID with an estimate of 22-25 Contact Tracers actively assisting. A Professor in Lincoln, Nebraska with ties to Wichita Falls studied the Wichita Falls COVID-19 Case Study that provided some very interesting information he could analysis for his article"Professor Conducts COVID- 19 Case Study". He said Wichita Falls was one of the only cities he found that offered the data and information specific to cases, death, age and condition of hospitalized patients. Paris Ward asked on the Chart by Race how does that compare with percentages of the community, notice White is really high and Black really low. Is that how the community is set up or is it proportioned differently. Amy Fagan said the Census has not released their information and will not for some time but they do an inter- media study in the break of the 10 years at 5 year intervals. Right now if compared to Census Bureau information the Hispanic population would be disproportioned to what is listed for the community, however the actual spread of population is a little different than what the Census Bureau reports. Still the Hispanic community has more than reported as a percentage of the population and the Black community has less than reported as a percentage of the population. Asian also is under what the percentage is, subjectively seen more Native Americans especially in the last month or two and not sure why that is. Keith Williamson thinks we are entering the final chapter of COVID but it is going to be a long chapter. Judge Gossom asked Keith if he thought this new coronavirus is going to create a second addition to what we have now starting a new book. Keith Williamson said the variant coronavirus have been imported out of Europe. The variants are actual multiple variants, this is the only one that has caught on and had any medical significance it is more infectious than the one that has been around. After one dose of the vaccine it is reported more than 50% authenticity, broke even with this new virus variant that is out there, it will spread faster which can provide challenges in terms of absorbing capacity in hospitals, ICUs and the health department. Hopefully it can be outpaced with vaccine. Dr. McBroom agreed to that. Judge Gossom said one of things he gets calls about is why have we not asked to activate the National Guard since they have a large medical unit. What people do not realize when that is done those are weekend warriors 4 that are pulled from the current resources hospitals, offices, etc. that are over utilized right now. Keith Williamson is certainly grateful for the people the community has the Community.Leadership and the Health Department. Hopefully by the next meeting will have better news, more vaccine and fewer cases and hospital staff getting vacations that would be great news. _ Lindsay Barker, Public Information Director of Communications and Marketing asked for the Boards help to direct the Community to the website for updates such as when the Health District gets another round of vaccine, the vaccine wait list sign up, important information on those platforms.The website is wichitafallstx.gov directly on the home page is the COVID-19 link also there will be a button to click on that goes directly to the wait list to sign up. Lou Kreidler said information will be put on the water bill on how to sign up on the waiting list as well. Keith Williamson stated consistent and well informed message is the best defense. VII. NEXT MEETING DATE Friday March 12,2021 was noted as the next meeting date. VIII. ADJOURN Keith Williamson adjourned the meeting at 1:13 pm. Sig atur, M `tak4075011 A7P Prin Name-Keith Williamson, MD, Chair, Lauren Jansen,PhD, RN, Vice-Chair,Julie Gibson, DVM, Secretary 5