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WC CWF Health District Board Minutes - 11/12/2021 socourirrpi, WICHITA FALLS-WICHITA COUNTY PUBLIC HEALTH BOARD MINUTES 4§' /0 November 12, 2021 Wichita Falls-Wichita County Public Health District 1700 Third Street- Parker Conference Room Public Health Wichita Falls, Texas BOARD MEMBERS PRESENT: Keith Williamson, M.D., Chair Physician -City Appointment Lauren Jansen, Ph.D., R.N., Vice-Chair Registered Nurse—City Appointment Julie Gibson, D.V.M., Secretary Veterinarian - City Appointment Melissa Plowman Restaurant Association - City Appointment David Carlston, Ph.D. Citizen At-Large- County Appointment BOARD MEMBERS EXCUSED ABSENCE: Tonya Egloff, D.D.S. Dentist- County Appointment BOARD MEMBERS UNEXCUSED ABSENCE: Paris Ward, M.A., B.S. Citizen At-Large- City Appointment OTHERS PRESENT: Amy K. Fagan, M.P.A. Assistant Director of Health Woodrow W. Gossom, Jr. County Judge Mark Beauchamp County Commissioner I. CALL TO ORDER Keith Williamson, Chair called the meeting to order at 12:03 pm after a quorum of members was attained. II. APPROVAL OF MINUTES AND ABSENCES Keith Williamson called for the review and approval of the September 10, 2021 minutes. Lauren Jansen introduced a motion to approve the minutes as presented and Julie Gibson seconded the motion. The motion passed unanimously. Tonya Egloff had an excused absence and Paris Ward unexcused absence. III. HEALTH EQUITY GRANT Denise Santos the Health Equity Program Manager said the new Health Equity grant came about because of COVID-19, the pandemic brought to light a lot of social and racial injustice. Health Equity means when all members of society enjoy a fair and just opportunity to be healthy. In the community, the African American and Hispanic communities identified as Health Inequity communities. Factors identified that increase risk of Health Inequity are: 1) Discrimination in healthcare, housing, education, criminal injustice, and finances. 2) Healthcare Access and Use for people of race and ethnic minority groups face multiple barriers due to lack of transportation, childcare and ability to take off work. 3) Occupations of the minorities are in settings that lead to more exposures such as CMA's in long-term healthcare facilities, factory workers, grocery stores, and public transportation. 4) Educational income and wealth gaps for people of some racial and ethnic minority groups have less access to high quality education. 5) Housing for racial and ethnic minority groups that live in crowded conditions cause a higher percentage of people to spread COVID. The African American and Hispanic communities have a lack of trust in government and education. First goal is gain trust, to get out into the community hold town hall meetings, lunches, focus groups with community leaders, identify the problems and offer help with the needs. The East Branch Y known as a trusted community building now is the All Hands Cultural Community Center will house the Health Equity program temporarily to bring clinics and education into the community. The Center will hold clinics for immunizations, educational classes on diabetes and chronic diseases, WIC, classes on cooking, finances, mental health, suicide prevention, bullying/anti-bullying and arts to relax, relieve social stress. Also, provide the facts on the COVID vaccine in an attempt to eliminate the misinformation to make sound decisions about their health to live longer. COVID-19 was a curse in that so many people lost their lives and a blessing in identifying those issues that need addressed, that is the Health Equity program. Now just trying to encourage and educate those communities that making better decisions have better outcomes. The program covers all Wichita County communities but the first focus is on downtown to develop a system to mimic. The Boards support would be appreciated it will take a lot of work and partnerships but with everyone working together it can be done. Lauren Jansen asked if the community uses the Community Health Center since it is centrally located. Denise Santos said some do but the point is to get them there many have a blockage that there is no need to go to the Doctor, essentially dealing with a cultural mentality. The intent is to break that cycle, get them to know their self-value, self-worth, to go get a check-up so the Doctor can establish a baseline, unfortunately something not taught. Keith Williamson asked if medical literacy was going to be a part of the goals to establish in this. Denise Santos replied absolutely, Health Equity to her is all-inclusive. It is everything not just physical health, it is the financial, social and mental stresses, she wants the communities to understand the identified factors. As many partners as possible are needed to come, teach and educate the populations to enable better decisions. Julie Gibson asked how is all that going to happen, through town meetings, door to door, what is the plan. Denise Santos said she does go door to door, attends Wichita Falls Housing Authority resident meetings, met with community leaders and a brainstorm meeting with focus groups is set for tomorrow. Now just trying to get it started to identify and how to provide the specific needs. Lauren Jansen said the churches have been invaluable as far as to touch-base. Denise Santos said she had talked to the churches there are numerous churches on the eastside, the pastors and preachers are trusted in the community, it is going to be a group effort. Her joining in with the community builds relationships that gains trust, she wants them to understand it is to formulate long lasting relationships not just to tell them what to do and leave. Melissa Plowman asked if the program would be utilizing the area food bank programs, the cooking matters, that sort of thing. Denise Santos replied absolutely, even the Food Bank designated distribution locations to reach out get a conversation going on their needs, their thoughts. Lauren Jansen said she suggested to MSU Health Sciences to do more outreach, she is interested in childhood obesity that is across the board and needs addressed. She hopes to start by the fall of next semester a medical Spanish so the healthcare providers can converse with the Spanish population. Denise Santos said the All Hands Cultural Center has a commercial kitchen and the Health District's Dietician will teach some healthy living cooking classes. Judge Gossom said Heather Simpson with the County Extension Service is the Better Living for Texans (BLT) agent she does cooking, meals training, things like that, to use her services it does not cost anything. Lauren Jansen asked if Judge Arthur Bea community garden still exists because that would be a place to restart. Denise Santos said there is a community garden she aims to restart, a few people volunteered to get it started. Julie Gibson asked about going to schools because education starts with the kids getting it home to the parents, are there plans to educate the kids. Denise Santos replied definitely will be in the schools, the Assistant Superintendent will be at tomorrow's brainstorm meeting to consult on how to participate in all the schools to teach different topics. 2 Julie Gibson said if in need of volunteers or anything put her on the list, she will do what she can. Keith Williamson expressed that judging by the Board's enthusiasm all the Board would be delighted to help. Commissioner Beauchamp asked as they have new patients in need of service where are they to send them. Amy Fagan responded what prompted that as all probably have heard, about a month ago the Community Healthcare Center (CHCC) made an announcement of limiting new patient intakes between ages 18 and 64, unless pregnant, that put a burden on the community. CHCC is ran by a Board, the Health District as a governmental entity cannot lobby the Board only make requests and inform them of the burden. It is very challenging her suggestion is for people is to call, tell them what a burden it is on the community, reach out to Allen Patterson the CEO. There was no advance notification, communication, coordination, the Health District referral resources are severely limited. Commissioner Beauchamp said if there is Health Equity grant money that is an area in real need of providers that provide services to indigents and others of less economic status. Lauren Jansen said the problem is going to be transportation, if it is not located in an area to get to reasonably easy that is going to be difficult. Amy Fagan informed Commissioner Beauchamp that the Home Equity funds are only for Public Health preventative services, referral and resource services, not for primary care. CHCC is a Federal Qualified Health Center (FQHC) in that the money received is a very distinguished and different available resource in how CHCC chooses to use that money. Judge Gossom advised Rolling Plains Management Services might be a contact for helping with the transportation to get people to medical facilities. Keith Williamson thinks there is lots of room for the Board to contribute both in voice and time as Denise gets the program organized. IV. COVID-19 UPDATE Amy Fagan advised cases are down, this week 102 new cases, 5 deaths, and 19 hospitalizations with 1 a reinfection one of the original 500. Still questioned a lot is vaccine breakthrough, she does not have data on how many by type of vaccine in the community so it is not indicative whether Pfizer or Moderna performed better because more Pfizer may have been given, now most all vaccine breakthrough are symptomatic. The Delta variant has killed a lot of the vaccine breakthrough cases, the majority of deaths now reported. The average number of days from vaccine series completion to onset now is 165 days and that range is 11 to 270. People were comparing reinfections and vaccine breakthroughs it is not an apples to apples comparison, so she put together useful information on reinfections vs. vaccine breakthroughs to allow people to make a better comparison. Vaccine breakthroughs are those individuals fully vaccinated, as of the close of last Friday had over 54,000 fully vaccinated with 974 that have contracted COVID-19 that is 1.8%. There are 16,000 people potentially re-infected of those 201 are validated as reinfection so that is 1.24%. Now have individuals considered as a third case their second reinfection, there are 30 individuals in both reinfection and vaccine breakthrough categories. Vaccine demand has been steady, pediatric Pfizer became available last Thursday given 83 pediatric doses, and seen a steady demand for both Pfizer and Moderna booster shots. An informative graphic on eligibility for the booster is on the health social media page, now most quality because of their job, age or health status. Individuals moderately to highly immunocompromised are eligible for a third dose not a big difference unless had the Moderna a full dose vs. booster a half dose. So disconcerting with so many deaths in the younger 20s and 30s, the loss of parents with young children. In observation of some of the deaths looked for ethnicity and underlying health conditions. There is no data or fact to publish but from review of all the case reports Diabetes through last February was not an outcome of COVID, saw it more often with Delta that people with diabetes not fare as well. BMI tends to be a better indicator of outcome, in some of the individuals that passed away there were no underlying health conditions other than obese or morbidly obese. Typically, what she looks for is obese with a chronic condition certainly seen that, but more often than expected with no diagnosed underlying health condition and obesity or morbidly obesity. Melissa Plowman asked on the vaccine breakthrough deaths is there data not just Wichita Falls but across the country. Is there indications that the vaccine breakthroughs are happening after a period of time that they are 3 giving less immunity from the vaccine. Are the ages typically of the deaths older where immunity maybe more of an issue than it would be for a 20 year old, for example. Amy Fagan replied she looks for National and State data but not seen the data in other places, she cannot speak on other things that are happening other than what she has seen. Yes primarily in vaccine breakthrough deaths most are 60 and older, actually 70 and older is the highest, with at least one health condition disclosed on their case report. Keith Williamson stated he knows United Regional has periodically released some figures and graphics that suggest it is people predominately over 70 who are vaccine breakthrough cases who actually end up in ICU or die and often they have multiple comorbidities. What he sees in regards to the efficacy waning of the vaccine without getting into an immunology lecture you got two components to immunity. The cellular component a long-term memory component then antibodies the vaccine seems to induce circulating antibodies that effectively neutralize the COVID virus for about four to six months then fades out. You still have that cellular immunity what that means is that you will get exposed to COVID you may catch COVID and then your cellular immunity wakes up and starts producing antibodies that limits the severity. If you have gotten the vaccine, you do not end up in ICU or dead that is a substantial victory. He asked Amy what the test positivity rate was for this week. Amy Fagan said not since June it is 6.8% and long-term care facilities will not have to test twice a week. Julie Gibson asked if there is any information on the antiviral pill and availability in the area. Keith Williamson said there are two under review by the FDA one is a nucleoside analogue that basically, gives a funny looking Lego that does not fit with the rest of the Legos, so everything falls down. The other is a protease inhibitor by Pfizer when the virus releases its information into the cell it makes proteins, trimmed into their final form using viral protease inhibitors, the protease inhibitor blocks that. Very much like the approach taken with HIV, he suspects the drugs ultimately will be able to be used in combination. Although he does not think will be in our hands until several months but it will be a game changer when we do because right now his treatment is sorry, there is nothing to be done go home call me if you get worse. Keith Williamson said sadly, the Board is going to miss one long time member, Julie Gibson. Amy Fagan thanked Julie Gibson for her eight years on the Board that it is going to be strange without her, thank you from all of us. Julie Gibson replied thank you it has been a pleasure to be on the Board. V. NEXT MEETING DATE Friday, January 14, 2022 VI. ADJOURN Keith Williamson adjourned the meeting at 12:46 pm. r Si. ature K- h Williamson, MD Print Name-Keith Williamson, MD, Chair, Lauren Jansen, PhD, RN, Vice-Chair, Julie Gibson, DVM, Secretary 4