Board of Health - August 13, 2021 Minutes

Regular Meeting: August 13, 2021

Opening: Noon, Virtual Meeting, Chelsey Matter called the meeting to order
Present: Chelsey Matter, Arlette Preston, Duane Breitling (via phone), Kayla Nelson DNP, APRN, FNP-C, Lyn Telford, MSN, RN, CEN (via phone), Robin Nelson
Others Present: Desi Fleming, Larry Anenson, Tracie Newman, MD, MPH, FAAP, Brenton Nesemeier, Justin Bohrer, Grant Larson, Lori Sall, Jan Eliassen (via phone), Holly Scott
Absent: Amy LaValla, DNP, PMHNP-BC, Bernie Dardis,
Announcements:
Pearl Mell Ferguson is no longer our Cass County Alternate. Robin Nelson has been appointed as the representative for Fargo Public Schools. COVID-19 testing is still available Monday through Friday from 8 am to 5 pm at the storefront on 25th. COVID-29 walk in vaccine clinics every Tuesday from noon to 6:00 pm, people can call for an appointment for a COVID-19 vaccine.
Community Needs Assessment/Justin Bohrer:
Community Needs Assessment update-we have completed our health assessment, started in December. Lots of change with people in their positions so different than previous health assessments. Previous health survey were a little too long and may have been a disincentive to participate. Sampling was just under 2000 responses with community and stakeholders mixed together. Mental health, obesity and cost of healthcare/living were shown as issues. Finished in February and did a hybrid meeting with just over 60 people. People have moved to different positions so we had to find them but overall went very well as did the small group tables. We have a list of what people discussed, next part of process will be discussing goals. Finding one goal that everyone can work on together, make a real community effort instead of as individual agencies.
Approval of Minutes: May 27th Meeting Minutes were approved. Motion to approve by Arlette Preston, seconded by Lyn Telford and Kayla Nelson, unanimously approved.
Health Equity/Immunization Grant Update/Desi Fleming:
Two initiatives combined in one, health equity and immunization. Grant is federal funds but will be coming through ND Department of Health. Discusses access to immunization and COVID-19 vaccines, increase rates of immunization and health services. We will have a staff position for this. Internal process first then go external for hiring. Rapid assessment for COVID-19 vaccines. We were looking for what groups are lower in getting vaccine, why the hesitancy. Drafting a health equity strategic plan. Weave plan into our programming at the health department. Also the reach out to the city director of diversity, equity and inclusion to get more information. We don’t have a lot of extra staff due to pandemic response we will partner with other community partners. The grant will run two years. We have a tentative contract for outreach with family healthcare. Arlette Preston wanted to know if there was any kind of conclusions that were come to when you completed the rapid assessment. Justin Bohrer a lot with in demographic groups such as with younger demographics they don’t worry about the effect from natural infection, there is also hesitancy from religious groups and different ideological groups. Some people had a wait and see attitude. There is no one reason, very individual reasons. There are some who will absolutely refuse to get the shot. Some people have trouble finding access and some are cautious and a solution is meeting people where they are. Matter of working on solutions.
Chelsey Matter mentioned the call to action from the City of Fargo Monday night commission meeting and the Fargo Public School boards looking for Fargo Cass Public Health’s input. This topic is very polarizing and she wants to remind the board members that it is our responsibility to advocate for public health and it is not a popularity contest and we have to do right by the community.
COVID-19 Guidance Update/Dr. Newman:
Initially on August 3rd we put out some guidance echoing the CDC recommendation because we transitioned into the substantial risk category. CDC stresses vaccination, new masking guidelines and guidelines for returning to school. We are now at a high transmission rate.
Vaccinated and unvaccinated need to mask inside. We look at new cases, hospitalizations, positivity rates, deaths, rate of testing, and social vulnerability index. New delta variant is the variant of concern, much more transmissible. Those infected carry higher viral loads so it’s easier to transmit to others. Majority of death and hospitalizations are unvaccinated people. We highly recommend vaccination. There are breakthrough cases and spreading delta. Good news is the vaccine is working and these breakthrough cases are not resulting in severe illnesses and hospitalizations. Sent correspondence to the schools K-12 in Cass County regarding specific guidelines for schools. As of August 12, we are in the high risk designation. Delta is very contagious. Trying to be proactive not reactive and stay head of this. Pediatric cases are going up and some hospitals in the south are at capacity in pediatric wards. Kayla Nelson mentioned that we are have a RSV spike as well. Unusual spike in RSV in July in August which is giving the medical community pause as influenza season approaches. Robin Nelson inquired about guidance from Public Health regarding day care/child care sites. Tracie Newman responded that we are reiterating the CDC guidance and what they put out was for K-12 education, not daycares or colleges. We do not create the guidance. Desi Fleming we have provided guidance to the entire community should be masking when indoors in public spaces. We need people to do mitigation strategies and prevent it from getting worse. Delta moves much quicker we need strategies to slow it down.
Lyn Telford wanted to thank Dr. Newman for her expertise and advocacy. Local hospitals have seen a double in over the past week in hospitalized COVID patients. Important for people to understand you could have delta and spread it, which is why we are asking vaccinated to mask.
How do we respond to people saying that in a school masks are a medical device.
Tracie Newman responds that it’s not our place to comment on, we are trying to not respond to the semantics and try to stay united in getting mitigation strategies out to the public. We are looking at guidelines for CDC and American Academy of Pediatrics. They are pushing the importance of in person learning, then vaccine then a layered approach to mitigation. However, masks has been singled out as a topic. We recommend bike helmets are they a medical device, we recommend child car seats and seat belts are they a medical device where do you draw the line?
Arlette Preston commented that it doesn’t help much to get into conversations that are hurtful. City hall is looking for some assistance regarding what policy level is appropriate for mitigation strategies. Some employees are expressing concern and are looking for guidance. National companies are again leading telling their employees to mask. Maybe there should be a recommendation to city commission, county commission, and park district as far as what an employer could do as a legitimate and timely approach to mitigating this risk inside the employment setting. Chelsey Matter responded that different businesses are leading that fight. Delta will be moving into our area. We can’t wait and see they want to mitigate the risk and make recommendations. When we have transmission levels fall then relax the guidance. We were using the 14 rolling day averages and consistently under 3% positivity and we are over that already. We need to push that layered option approach with recommendations for distancing, vaccinations and masking.
Lyn Telford makes a motion to write a letter of recommendations, Robin Nelson seconded. Chelsey Matter will draft a letter for City of Fargo, City of West Fargo, and Cass County Commission recommending that they follow CDC guidelines.
Roll call vote: Chelsey Matter: yes, Arlette Preston: yes, Robin Nelson: yes, Kayla Nelson: yes, Duane Breitling: yes, Lyn Telford: yes.
Harm Reduction Services/Jan Eliassen:
Considerable jump in the number of people they are servicing. WMU, shelter, MOP and syringe services. Shelter beds are still downtown temporarily hopefully moving back to shelter first week of September. That will change the number of people they can serve. Can only serve 15-17 in the down town location. Street outreach has seen increase in activity, mobile outreach teams are having nearly a 1000 contacts or more every month. This is to maintain relationships checking on individuals, this doesn’t include calls of transport from hospital and police that is about 230 calls a month. In July they provided 238 transports to destinations such as the WMU, hospitals, and other programs. Increase in activity in the syringe services program: about 80% increase in numbers of service provided, 85% amount increase in amount of naloxone distributed, 24% increase in people served in the first 6 months of the year. Overdose reversals are at 283 reported saves (from Naloxone or Narcan that FCPH distributed). A number of the staff has been trained to perform HIV and Hep C. They are getting more people tested and getting more referrals to treatment and for medical issues.
All services are broken down such as providing food, water, and medical supplies. Engagement center operates with the intention to have predictable hours for people to shower, do laundry, lock up belongings and get information for other services. They have staff their all the time because the shelter staff is there but they have not been able to take city wide referrals yet.
Hopefully soon they can be open from 8 am to 5 or 6 pm but in the long run maybe from 8 am to 8 pm. All shelters are getting together discussing the COVID issue and then the winter months coming trying to figure out quarantining and isolating. Difficult to find staff that can handle the position, then you add COVID and the demands on the work force it is difficult.
We have some informal campaigns and the staff are helping recruit. They have a video about a day in the life for a harm reduction advocate. Trying to find creative ways to attract applicants. Some of the emergency solution grant dollars so they can hire some more people to meet the need. Each shelter received some funding to increase their capacity and increase sheltering and to have the ability to isolate people. They do have beds and rooms for referrals who have COVID and need to be quarantined. The capacity is okay, some shelters are reporting a few cases but once those beds fill up then they will work together to come up with solutions for clients. Best practice is to keep people in the facility that they are at, a lot of the people FCPH sees are people who live outside, couch surfers or have no home.
Desi Fleming mentioned that the remodel process for the shelter is still occurring and when that is done it will help with the space issues.
Desi Fleming wanted to thank her staff, they have been overwhelmed for almost two years and the idea of going back into a full on response again is daunting. Watching for burn out and for the health systems to not be overrun again, it’s to keep people safe and do the prevention before it happens so we can be proactive instead of reactive. People are physically and mentally exhausted.
Public Comment: There were no participants at City Hall.
Next meeting: October 15, 2021
Meeting adjourned