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WC CWF Health District Board Minutes - 05/14/2021 WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES ecOUNry May 14, 2021 4 t-,G) Y Wichita Falls-Wichita County Public Health District 1700 Third Street - Zoom Video Conference PublicHeahh Wichita Falls, Texas BOARD MEMBERS PRESENT: Julie Gibson, D.V.M., Secretary Veterinarian - City Appointment David Carlston, Ph.D. Citizen At-Large - County Appointment Melissa Plowman Restaurant Association - City Appointment Paris Ward, M.A., B.S Citizen At-Large - City Appointment BOARD MEMBERS EXCUSED ABSENCE: Lauren Jansen, Ph.D., R.N., Vice-Chair Registered Nurse—City Appointment Tonya Egloff, D.D.S. Dentist- County Appointment BOARD MEMBERS UNEXCUSED ABSENCE: Keith Williamson, M.D., Chair Physician - City Appointment OTHERS PRESENT: Lou Kreidler, R.N., B.S.N. Director of Health Amy K. Fagan, M P.A. Assistant Director of Health Michael Smith City Council Liaison I. CALL TO ORDER Julie Gibson, Secretary called the meeting to order at 12:10 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Julie Gibson called for the review and approval of the March 12, 2021 minutes. Melissa Plowman introduced a motion to approve the minutes as presented and David Carlston seconded the motion. The motion passed unanimously. The absence of Tanya Egloff and Lauren Jansen was noted as excused, Keith Williamson unexcused. III. ANIMAL ORDINANCE REVIEW Lou Kreidler informed the Board that some minor updates to the Animal Control Ordinance are needed and will be up for review in July. The Off-Leash Dog Park changes are to clarify if an individual brings out two dogs the dogs must be of the same size, so that the individual does not have one dog in the smaller area and the other in the larger area standing at the fence of one area trying to manage the dog in the other area. Citizen complaints are individuals that bring in a large and small dog may have the large dog in the small dog area which causes issues with other dogs in that area. Another complaint is individuals that smoke throw their cigarette butts on the ground of an area already ruled tobacco free, but want to contact Legal to designate the dog park as no smoking, no vaping, rather than the tobacco free language. Dogs in the off-lease area are required to be fully vaccinated so puppies are obviously too young to be in the area. The ordinance already states it is unlawful to bring an animal with a bite history in the off-leash dog park whether deemed aggressive or dangerous, but the language needs to be distinct it is prohibited. Addition of some legal language about responsibility that an individual enters at their own risk. Animal Control was added to enforce the ordinance along with common sense factors, for instance to ensure gates are fully closed before your dog is either off the leash before entrance or on the leash upon exit. The Animal Control Ordinance currently states to adopt, all the animals in the home have to be micro- chipped. People feel strongly in not wanting to micro-chip and refuse to adopt from the shelter for that reason. Animal Control staff want to take out the micro-chip requirement being that it is better to get an animal out of the shelter instead of force people to micro-chip their other animals when they do not want to. Julie Gibson asked why are they against to micro-chip. Lou Kreidler replied because that animal is theirs and should not be forced even though relatively inexpensive, the same reason to not want to spay or neuter their pets. People with an animal impounded the first time are required to pay for the spray or neuter of their animal once impounded but people are not following through. On the second and third impound people prepay but do not get it done, even when most veterinarians do not refund the money on no shows. Language will be added that probably on the third impoundment the animal will be held and taken to the vet appointment as done with the adoptive animals. The Animal Shelter Advisory Committee (ASAC) was presented these changes but asked for the Boards opinion on whether it should be the second or third impound. Julie Gibson agreed suggested the second impound, animals are out roaming for a reason generally to breed. Melissa Plowman agreed. Lou Kreidler said another issue after snowmageddon this year several calls came in about animals out in the cold, normally officers do not go out but did because of the extreme cold. In one incident the people did not have an appropriate dog house, the opening was too big per ordinance requirement, an officer did assist on how to cover the dog house to block some incoming wind. There was not an instance where there was not a dog house or the dog out in the elements without the appropriate shelter. An ASAC member requested to require all individuals bring their animals in the house if the temperature falls below 44 degrees, but with that route Lou thought it should be at freezing 32 degrees. In review of ordinances across the United States even up North in areas with cold harsh weather all the time, no ordinance was found to require people to bring their animals inside when freezing, there was requirements for appropriate bedding, shelter, those type of things. Julie Gibson was asked how she felt about that and Councilor Smith on how he thought that would be received by Council. Councilor.Smith thought there should be a given temperature below,what temperature below does the ordinance now state. He thought it reasonable with no appropriate shelter to give a warning, put the dog in the house, garage or buy a dog house. Lou Kreidler replied there is a temperature for leaving an animal in a car which is below 44 or above 85 degrees, but to her knowledge not an outside temperature below to bring animals inside. It is done now if people do not have an appropriate dog house to bring the animal inside. Julie Gibson was not sure someone can be made to bring their dog in the house because some dogs cannot be contained inside and does not know whether that would be an issue for people. A lot of people use common sense if it is that bad they are going to bring the dog inside.To snow like it did may be every so many years would there be an actual need for an ordinance for when it does. The areas heat is more of an issue than the occasional cold and dog houses are not always the answer for dogs to get out of the heat. Lou Kreidler said the ordinance states food, water, shelter, shade, because an animal has to have shade. She intends to email the proposed language for heat to get the Boards feedback. Councilor Smith asked if the northern cities like Minneapolis, Chicago, Detroit specific a below temperature to bring animals in. Lou Kreidler said Minneapolis was specifically looked at, their requirement is for the dog house to be elevated off the ground probably due to their amount of snow it would cover the front of the dog house. There was no requirement to bring in animals and no temperature by which to bring in animals. Animal Services Administrator Nicki Bacon did all that research, that information will be sent out, as well as changes are made, for the Board to review. The Animal Ordinance will not be a full overhaul as previously it is just to clean up some items put in that did not work, along with additions. IV. COVID-19 DATA UPDATE Amy Fagan said being cautious about everything, how it was done, incrementally done, not moving too fast, served well.When it declined to 30 cases in a week, data was moved to once a week. Positivity rate is important because it shows of those people tested for COVID-19 the percentage of people who are positive and negative. Under 5 is preferable not only because it signifies a low disease burden in the community but also long term healthcare facilities have to test staff and residents based upon the positivity rate. Anything under 5 the facility does not have to test, over 5 have to test, between 5 and 10 test once a week, over 10 have to test twice a week. Close of 4/30/21 was 41 cases at a 4.23% positivity rate, close of 5/7/21 was 48 cases at 7.4%, as of today 5/14/21 with 72 cases at 11.69%, the positively rate is up over 10% for the first time in 7 weeks. One thing that compounds it is less people are tested, only testing when in known contact with someone or symptomatic once concluded it is not allergies. COVID Cases by Race: Somewhat at the same place with the majority of the population White 65%, Hispanic remains 23%, increase last quarter in Asian population 2%, Other 1%. COVID Cases by Type: Continues with 2 the highest number 44%Community Spread, 35%Contact,20%Close Contact, 1%Travel remains down.Active COVID Cases by Day: Cases begin to go back up as in the previous summer, hopefully with vaccines will not see an increase. WICHITA COUNTY Vaccinations by Week indicates the number of Pfizer and Moderna vaccines administered (not fully vaccinated). From vaccination start-up it was a big peak up to 5/17/21 then started to taper off, simply got to the saturation point with adults now the struggle is to get people in to vaccinate. Some local health centers that receive federal dollars provide incentives as seen nationally. Total Vaccinations by Organization/Type provides doses administered by: Public Health Government 13,583, Health Centers (Community, Federally Qualified, Migrant, Rural) 13,741, Pharmacies 16,979, Hospitals 26,838. Vaccinated with One Dose:41,301 and Fully Vaccinated:35,168,the data is daily DSHS information from IMMTRAC it is reliant upon those administering doses enter that information into IMMTRAC. Single dose Johnson & Johnson is counted in both places so numbers are not askew because if in one dose it would appear people are not completing the series and if in fully vaccinated it would be out paced. Fully Vaccinated by Age: 16-49 years 11,057, 50-64 years 10,226, 65-79 years 10,256, 80+ years 3,626, unknown 3. Fully Vaccinated by Race/Ethnicity: Asian 2.32%, Black 4.36%, Hispanic 9.65%, Other 6.98%, Unknown 19.46%, White 57.23%. A lot of information was not maintained and entered so only have the data provided. Currently there are 82 active COVID cases, double from last Friday and the Friday before.Vaccine breakthrough cases are still reported, currently at 23 cases a significant increase of 5 from last week. The majority of the 23 cases are Pfizer not a lot of commonality two had the same lot number, one each of Moderna andJ&J, have been vaccinating with Pfizer longer since December or possibly less effective, do not know. Reinfections are currently at 60 up by 1. On the vaccine breakthrough Friday posts citizens asked to include whether or not symptomatic, all 5 of the last breakthrough cases this week were symptomatic. Symptoms have been relatively mild, none hospitalized. This week 1 death an individual in their 50's. There has been a significant increase in the number of gatherings, two this week have come across in cases, a couple cases tied to MSU graduation. Another was a MSU graduates private party at a small local restaurant of 75 to 100 individuals, shoulder to shoulder, no masks worn, got 24 sick with COVID an official outbreak status at 3. There was another 100 person Civic organization gathering where 2 individuals are believed to have contracted COVID, a real concern not to have an index case may be more people associated with the outbreak until that other individual is found. Melissa Plowman and her husband got their initial Moderna vaccination in Wichita Falls, the second in Lubbock and asked if they are reflected fully vaccinated in Wichita County since it is their place of residence. Amy Fagan answered at the place of vaccination some basic information should be taken your name, date of birth, address and County of record that goes into IMMTRAC, the probability is your counted in Wichita County. Paris Ward asked when individuals receive the vaccine is that reported on their actual vaccine record. Is there any health risk if an individual does not know they have COVID and gets vaccinated? Should individuals get a COVID test before receiving the vaccine? Amy Fagan replied yes, the vaccine is entered into IMMTRAC and will be on their IMMTRAC record. Back in December with the start of vaccinations noticed people whom had been vaccinated about 3 to 5 days later get sick, got tested was COVID positive. Since studied some now the thought is getting the vaccine could push that process in the body more than likely to get sick within 3 to 5 days and it is still seen. The challenge.to recommend testing is that window you could have the virus, be tested and test negative believed to be in the clear and not. Never seen a test recommendation prior to immunizations it might be something to consider for someone who is immunocompromised or has significant issues where their body might react more strongly. Also seen people get vaccinated while symptomatic, have two now one had a headache and one had sinus issues. People should remember not to get vaccinated while having any symptom consistent with COVID, the Health District recommendation is to test. The other day one positive case individual was also a vaccine break through case, had attended a large gathering was symptomatic for 3 days so had no thought it was anything other than allergies since vaccinated. That is something to be cognizant of, although not as common still needs to be considered. Paris Ward asked if the large gatherings include outdoor gatherings such as baseball games, should people wear masks outdoors. Amy Fagan said the CDC has come out with official positions, outside is not as bad as inside, inside is shared air, close spaces, and the probability to share items. Large gatherings typically result in an outbreak, before the vaccine saw about 20% of individuals get sick, this gathering being higher do not know but possibly had some other behaviors as shared smoking devices. People say all the time they wore a mask but no one else did so that is how they got sick. It is all about virus and how it can be transmitted to someone it is basically in your spit. 3 V. COUNTY HEALTH RANKINGS Amy Fagan presented the 2021 County Health Rankings& Roadmaps an annual release in partnership with the University of Wisconsin and the Robert Wood Johnson Foundation. It is a community based model on how policies and programs effect health factors that effects health outcomes. Rankings for Wichita County are typically in the lower one-third of Texas and Texas is in the lower one-third of the United States. The percent weight was changed this year; Social and Economic Factors are 40%of the comprised ratings, Health Behaviors 30%, Clinic Care 20%, Physical Environment 10%.Wichita County Social and Economic Factors have done very well within education, employment, income, family & social support and community safety. Health Behaviors not so well in tobacco use, diet & exercise, alcohol & drug use and sexual activity includes STI's. Wichita County is not necessarily the healthiest in overall Health Factors to look at it year over year it appears as one of the healthiest counties in the State of Texas. Health Factors are controllable it feeds into Health Outcomes comprised of Length of Life ranked 183 and Quality of Life ranked 160 out of the 242 ranked counties in Texas. Quality of Life has improved significantly it conveys how people self-assess; poor or fair health, poor physical health days, now number of poor mental health days and low birthweight babies remains high. The Behavioral Risk Factor Surveillance System (BRFSS) calls people, ask the questions and reports the data. The data has a two-year lag period that does not include any COVID information so in the corning years will see the change in one's perception of their over health and mental health. Length of Life is of concern it is based on premature death, takes the average age of men and women should live to and how far away from the average as a county. Wichita County is losing life in both men and women typically associated with heart disease,stroke,cancer, primarily lung cancer, colon cancer.Wichita County Health Factors scored well, Health Behaviors are ranked up 172 from 235 the prior year. Smoking remains the same 20%, Obesity in adults not to include overweight went from 33-34% to 36%, Physical Inactivity in a 7-day period is 30%, and Excessive Drinking is 16%. Clinical Care does well ranked 19 the prior year 21, partly because there are a lot of Healthcare providers for the Trauma Service Area. Archer, Baylor and Clay county residents come into Wichita County for medical care since there are more physicians, dentists and healthcare providers.The clinical care number is based on a ratio of residents to that, so it is a little skewed. Just reported this year, 47% of the population had the flu vaccination. Social and Economic Factors ranked 75 the prior year 96, these factors truly effect one's health. High school completion is currently 87%, although it is high for the State of Texas it had always been over 90%, some College at 56% and Unemployment 3.2%. Children in poverty at 17% has gone down, some years it has been as high as 25%with the average about 20% and Children in single-parent households 25%. One of the last scoring methods Physical Environment ranked 55 the prior year 49; Severe housing problems 16% and Long commute - Driving alone 8%. The next phase is the County Health Assessment compiled of this and other data, once completed it will be reported out to the Board. Councilor Smith asked how the COVID situation effected the data just presented, is it there or does it remain to be factored in. Amy Fagan said one thing talked about into the pandemic was people not doing medical care not wanting to go into an environment where they could contract COVID and URPG shut down all regular appointments. There is a delayed care aspect, mental health aspect, physical health aspect, right now there is not any substantiating data and it will not be known for a couple of years that overall impact. In speaking to the citizens, cases and environment observation COVID has effected people whether COVID was contracted or not. Public Health is going to have even more work related to the effects of COVID than during COVID. Councilor Smith said with cases going up, what will be done about making that known to the public. Amy Fagan said the numbers will be released today the plan is to reach out to the media and discuss large gatherings. People are tired of COVID their thought is if they get it they are not going to die. COVID is still here it is going to take people to be more careful and not go to the 100 person gatherings, but that may not happen. Councilor Smith heard another phrase critical mass to state as it gets closer to half the population being fully vaccinated that critical mass will have some effect to reduce the spread of COVID, what has been heard. The intent is to get to herd immunity but with 35-40% of people with no intentions to get vaccinated it is a problem. Amy Fagan replied she had never heard of the term critical mass in a Public Health publication or used at the Health District, with enough people vaccinated way less are in the hospital and dying, there will be that unvaccinated population. From data on the website in comparison to first vaccine and fully vaccinated the male population are not getting vaccinated at the percentage as women but they are not completing the series. If vaccinated you do not have to quarantine, that has gotten some people to get vaccinated not having to spend 10 days out. Only 47% of the population get the flu vaccine so probably will not see 70-75% of the population with the COVID vaccine. 4 Julie Gibson asked if the people not getting vaccinated had any correlation with people not knowing the vaccine is available and free. Amy Fagan said there is the population that do not get routine health screenings even though they have health insurance they do not engage in their own health. Also there are people that do not trust the vaccine, Public Health, or the science, it is concerning. Locally have done everything to be as consistent and transparent with the same faces in interviews because it is a trust issue. Another part is in certain populations especially Hispanic and Black, if the family culture does not believe in one vaccine or two in the COVID vaccine they are not going to get vaccinated that leads to group mindset. Public Health's job is to provide education and engage those specific known communities under vaccinated since those communities get sicker than other communities. Two supplemental grants have been received to hire additional staff to engage and educate, to go into unusual places to find the people that either have not heard or do not believe. Public Health never gives up, going to continue and hopefully get more people vaccinated. Melissa Plowman said some individuals are vaccinated in their restaurants,they would like to put together a clinic bring someone in to get more individuals vaccinated. In the case she gets 100% fully vaccinated in the kitchen, do not wear masks and someone becomes a COVID breakthrough, what is the protocol for that situation. Amy Fagan replied if everyone in the kitchen working together is vaccinated, no masks worn, if one of those individuals becomes symptomatic or gets COVID, any of those individuals do not have to quarantine, have them self-monitor look out for signs or symptoms. Lou Kreidler responded to Melissa that the Health District would be happy to do the clinic just let them know, and the same goes for the others that have people that want to get vaccinated. The only vaccine on hand is the two dose Moderna so would need to come out twice. Julie Gibson asked if the plan was to get vaccinated yearly. Amy Fagan said still waiting to see. Best guess right now is yes there will be boosters but not sure of the intervals since there is no set recommendation, still studying people to see how long immunity lasts. Lou Kreidler said she believes will get a COVID vaccine in the same manner as a flu vaccine. Paris Ward commented she knows vaccines in the African American population are low, that a lot of times in the African American communities there is the distrust in the government, in vaccines, it is new and do not trust it, so that might be something to take into consideration as well. Lou Kreidler told Paris with that in mind, she is trusted in her community so may reach out on the education campaigns and videos, as well as to some of the others. The next Board meeting may be in person depending on how things are going and where the cases are at, but will let you know. VI. NEXT MEETING DATE Friday July 9, 2021 was noted as the next meeting date. VII. ADJOURN Julie Gibson adjourned the meeting at 1:15 pm. Sature-4% , r A.,/;// fu don Print Name-Keith Williamson, MD, Chair, Laurennsen, PhD, RN, Vice-Chair, Julie Gibson, DVM, Secretary 5