Board of Health - February 12, 2021 Minutes
Regular Meeting: February 12, 2021
Present: Chelsey Matter, Evelyn Telford MSN, RN, CEN, Amy LaValla NDP, PMHNP-BC, APRN, PHN, Arlette Preston, Kayla Nelson DNP, APRN, FNP-C, Tracie Newman MD, MPH, Duane Breitling
Absent: Bernie Dardis
Others Present: Desi Fleming, Justin Bohrer, Holly Scott, Suzanne Schaefer, Melissa Perala, Larry Anenson, Grant Larson, Heidi Lako-Adamson, MD, Robyn Litke Sall, Kim Vance, Doug Murphy, Lori Sall
Approve minutes: December 18, 2020. Motion by Lyn Telford, seconded by Amy LaValla. Unanimously approved.
Announcements: Monday is a holiday.
Revenue and expense which include period 13. Down in lots of areas because COVID-19 is affecting all of our operations. We recouped the difference with the cares funding. Still working on revenue and most expenses are in for 2020. We did receive more cares funding-awarded another 600,000 for local public health unit and another 3 million for task force. We haven’t figured out how that will be spent but we are figuring things out. Cares funding comes from federal government then goes to the state and then down to us.
Drug Related Death Data for Cass County/Robyn Litke Sall:
Data from Cass County Coroner data to illustrate the increase in drug-related deaths, discuss trends in drug related deaths, show the increase in opioid overdoses using SSP reversal data, discuss Naloxone and provide CDC recommendations. 2020 data is not final yet. 2016 was the highest amount we had 31 opioid deaths. We have introduced naloxone and it cut the amount of deaths in half. Meth related deaths (42 deaths in 2020) have increased. Over twice as many Meth deaths. We provided a lot of education and information regarding opioid but this encouraged some users to switch from opioid to meth because they had a misperception that it was safer. It is not true because there is no meth antidote like for opioids. No medical assisted treatment for meth like for opioids to get into recovery. All drug related deaths (excluding alcohol) went up to 57 deaths the last highest number was 48 in 2016. Alcohol related deaths high point in 2016 was 63 so far in 2020 it was 72. Alcohol related death, is death from injury when they BAC was .08 or higher or had known alcohol abuse disorder and died (cirrhosis of the liver). The highest increase in death is a 75% increase in death due to Meth, 50% increase due to drug use (illicit drugs or prescription drugs misused), 31% increase due to alcohol and 27% increase due to opioids.
We were not alone there were increases though out the nation. 25 states had a 20% or more increase in fatal drug overdoses through a 12 month period (June 2019 to May 2020).
Participant reported saves reported, saves in 2019-2020. The number of saves increased dramatically in 2020. Narcan and naloxone is the same kind of treatment, Narcan is the nasal spray and naloxone is intermuscular – they reverse opioid overdose and are available at the SSP building. There is huge price difference. For one dose: injection is $7.60 and the spray is $37.50. We had peaks in June and then in December and just recently in January 2021. The need is out there in the community. Police, coroner and SSP data is all mirroring this need.
In March 2020 the visits to the SSP (Syringe Services Program) really shot up, up to 392 and then it remained in the higher numbers. This is a good sign that people are coming in and we can mitigate risk and eventually lead them to treatment and recovery. We did remain open during COVID. The participants at SSP place their trust in our ability to be here for them. For the SSP they had a 51.6% increase in the number of visits from 2019 to 2020. 42% increase in unique participants served. 39% increase in number of naloxone doses distributed and 155 self-reported opioid overdose reversals.
CDC has put out recommendations. Raise awareness about bystander possession and use of naloxone. Co-use of fentanyl and other drugs including meth. Emphasize harm reduction strategies. Making sure you know how to use naloxone. Check in on those who use drugs. Message community groups and the leaders in the community. Link those people at risk with care. Emphasize harm reduction strategies. Expand our peer coaching network. We are already doing all of these at Harm Reduction.
Alcohol causes more deaths than all other drugs combined.
Tracie Newman question: increase rate of drug related death do you have an age breakdown? Robyn: coroner does have everyone’s age. I can tell you that we are not seeing adolescent increase in deaths, guestimate is 25-45 is the biggest age group.
Arlette Preston-meeting next week with mental health providers in town and it might be helpful to get some feedback from the Board of Health group to help follow through on the CDC recommendations for our community. Sharehouse is organizing the meeting. We don’t know how far out he (Ty) is reaching.
Board of Health becomes part of that part of that conversation regarding the city to role to play in provider community. Kayla Nelson mentioned in the chat that she treats many substance abuse patients in her practice and she prescribes suboxone, she only stated that she sees quite a few Sharehouse patients and will join the meeting if needed. They are also expanding their suboxone services to the Valley City area via telehealth.
Amy LaValla said she does a lot of mental health work but not as many with drug issues. Arlette will ask him to include public health staff and Chelsey Matter in the invite.
We are calling to help register those who can’t register themselves. We are working in congregate settings, jail, treatment centers, homeless shelters etc. We are trying to get the vaccine out to citizens as efficiently as possible. We are encouraging people to fill that online form and we continue to get more submissions. We are getting a lot of phone calls and we assist them in getting registered. We have 4,000 doses administered last week and next week we will see 10,000 total doses delivered next week. When people are entering information we ask that they watch their emails so they can get registered and to not share that link to others.
We are reluctant to give a time line until it gets closer, we are waiting for our allocations and to finish the other group then move on to K-12 group and daycare providers.
Smaller counties are getting through priority groups faster but public health is getting doses out faster than providers. We have a federal allocation coming to thrifty white and to family health care. They will get direct from feds. That is above and beyond the state allocations. We have people who ride with a friend or family we are also making referrals to senior ride to get rides available to help individuals get into the clinic.
We are still doing other activities. Contact tracing has been downsized a little bit and some of the folks are helping with community list and calling people to get registered and vaccinated. We are still doing testing at the church at the static site. Logistics for testing, vaccine and contact tracing. We still provide support and give guidance to schools and businesses. General messaging regarding COVID is keeping Holly Scott busy. We still have the Q and I center that Harm reduction is running. We are talking about the mask mandate and we are far from done with safety measures and we still want all those strategies to continue: masking, social distancing, and hand washing. When the mandate goes away it has to be a strong recommendation to continue with masking and asking local businesses to continue to mask.
We did survey with bars and restaurants: any licensed place: coffee shops etc. 300 recipients and got 102 responses. Holly Scott: just under 75% for continuing the mask requirement.
Arlette Preston mentioned that the Mayor will not bring the mask mandate to commission it will expire between the next meeting and he will just let it drop. We aren’t far into herd immunity. Businesses in large numbers are in support of continuing mask mandate. Staff are starting to have to deal with the rules.
It will lapse on the 18th. Tracie Newman, if we see the rates go up after the masks mandate drops it would be troubling, we want kids to go to school and keep wearing masks. Lyn Telford believes we should keep it until the end of school, we expect this of our kids so why can’t adults. Arlette mentioned sending a letter to mayor and commissioners to extend the mask mandate. Business and schools rely on the City of Fargo to keep them safe. Lyn Telford makes a motion for a letter, Tracie Newman seconded. Proceed with roll call vote:
Tracie Newman: yes Evelyn Telford: yes Arlette Preston: yes
Chelsey Matter: yes. Amy LaValla: yes Kayla Nelson: yes
Duane Breitling: yes Bernie Dardis absent
Graph from our dashboard shows that the date of the mask mandate and the decline of the cases correlate.
Legislative Update/Justin Bohrer:
A lot of anti-public health bills for some reason. We are perplexed and many have been shot down. Total of eleven that we support six are still in. One of the more concerning one is 1152, a cigar bill is still going more traction than we expected. It came out of community with no recommendation but it was a tie for the first time for pass/do not pass vote. Increase tax on cigarettes was defeated.
Desi the core group has continuous work with COVID. Now that we are getting vaccine we are more optimistic because we feel like there is some progress. The community is giving us positive feedback and that is very encouraging.
Next Meeting: April 16, 2021