Board of Health - October 15, 2021 Minutes

Regular Meeting: October 15, 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, Charlene Nelson, Bernie Dardis (via phone), Amy LaValla, DNP, PMHNP-BC
Others Present: Desi Fleming, Tracie Newman, MD, MPH, FAAP, Justin Bohrer, Grant Larson, Lori Sall, Jan Eliassen, Robert Wilson, Holly Scott, LeDora Wohler, Suzanne Schaefer
Announcements: Welcome new member Charlene Nelson. Survey for members to choose the day of the week that works best for the meetings. It is flu shot season, also, please wear pink to show support for breast cancer awareness month.
Update to BOH responsibilities/Chelsey Matter:
Add the following to the rules and responsibilities for the Board of Health members:
Fargo Cass Public Health remains a politically neutral agency, focused on evidence-based practices that reflect our mission and vision. The objective of each Board of Health member is to uphold the mission and vision of Fargo Cass Public Health by remaining unbiased in analysis and guidance.
Roll Call Vote: Arlette motioned to amend, Lyn Telford seconded.
Amy LaValla approve, Charlene Nelson approve, Kayla Nelson approve, Arlette Preston aye, Chelsey Matter yes, Lyn Telford approve, Robin Nelson yes, Duane Breitling yes, Bernie Dardis yes. Unanimously passed.
Approval of Minutes: August 13, 2021 minutes to approve. Motion to approve Lyn Telford, Kayla second approved. Unanimously passed.
NFP Overview/LeDora Wohler:
1990s NFP (Nurse-Family Partnership) program started in Denver it is an evidence-based community health program. Helping first-time pregnant moms up until the child turns two years old. We enrolled our first client in May of 2000. Video played from the Denver office of NFP. NFP is an evidence-based community health program with over 40 years of evidence showing improvements in the child, mother and families lives. NFP vision is a multigenerational program, a strong mom, raises a strong child who then will become a strong parent. They are trying to help families thrive; communities prosper, keep children healthy and break the cycle of poverty. 300,000 families have been served since 1996 in 41 states plus U.S. Virgin Islands and some tribal communities. Every dollar spent in the NFP program saves $5.70 in future costs for the highest-risk families. Bismarck/Mandan has started an NFP site two years ago. There are also NFP programs that cover many counties in Minnesota (7 sites), South Dakota (2 sites), and Montana (1 site). Therefore, if they move we can transfer them to the NFP program in that county and continue to serve them. Key goals are to improve pregnancy outcomes, improve children’s health and development and improve economic self-sufficiency of the family. This happens by specially registered nurses providing an intensive connection from pregnancy through age 2 (first 1000 days). We enroll before the 28th week; we would like them as early as possible. Most home visits last about an hour. The first 1,000 days are extremely important: early experiences influence the developing brain, chronic stress has a toxic effect, adversity can lead to lifelong problems, early intervention can prevent consequences and we know that a stable, caring relationship is essential for development.

Gold standard of research by having trials to look at effects of NFP program.
Trial outcomes observed among participants: 48% reductions in child abuse and neglect, 56% reduction in ER visits for accidents and poisonings, 50% reduction in language delays of child age 21 months, 67% fewer behavioral/intellectual problems at age 6, 79% reduction in preterm delivery for women who smoke, 32% fewer subsequent pregnancies, 82% increase in months employed. Our funding sources in Cass County have been through Medicaid reimbursement and grant funds. United Way has also provided funding for the past 9 years. Fargo Cass NFP Families: 91.7% of babies are born at a healthy weight, 90.9% born full term, 83.3% of mothers initiated breastfeeding, 33.5% continue at six months, 19.7% continue at 12 months, 92.4% of babies received all their immunizations by 24 months, whereas in Cass County the general rate is 73.3%. We also see a 24% drop in cigarette smoking among NFP moms, 74% remain employed when the child reaches 24 months, 47% see a reduction in experience of reported violence. Fargo Cass NFP from May 2000 until August 2022 we have served 1,637 families, 1,206 infants/toddlers and have had 40,514 total home visits.
The NFP team consists of one administrator (Desi Fleming), one supervisor (LeDora Wohler), seven nurse home visitors, and one office associate.
We find our clients through WIC, school nurses, counselors or clients, 3 health systems but anyone can refer. If they are on WIC they automatically qualify, we use the 200% poverty level. If you are above a certain income level we would not enroll, our best impact is with people who are at a certain level of poverty. We have a Maternal Child Health (MCH) program for an individual that is past the 28 weeks of pregnancy. MCH qualifications are if they have domestic abuse in their relationship, homelessness, mental health diagnosis, we rarely turn anyone away. They are usually available for one or the other. MCH has no income requirement, but those who come in usually are on WIC or MA. Essentia, Sanford or Family Healthcare provide many referrals. Student health centers and women’s clinic. We are working on getting a QRC code that will go directly to the Fargo office instead of the Denver office.
Fargo Youth Initiative: scheduling issues, we will reach out to them to reschedule.
Budget Review/Melissa Perala: Melissa is absent. Numbers are looking good, specific questions can go to Melissa directly.
Massage Ordinance/Grant Larson:
Proposed City of Fargo Massage Ordinance.
Fell to Environmental Department because it was similar to body art, which they regulate. They have had three industry input meetings. We want to assist their programs. Administrative code defines the requirements for Massage Therapy Establishments but the ND Board of Massage Therapy does not license individual Massage Therapy establishments. The intent is to implement requirements for Massage Therapy Establishments to ensure the health, safety, and welfare of the community. This process will also uncover and gives means to address illegal activity that uses massage therapy as a cover-up.
We would like to license and regulate massage therapy establishments NOT the individual massage therapist. The NDBMT takes care of individual massage therapists so this is not a duplication of government services. The City of Fargo does not have an ordinance and/or requirements for Massage Therapy Establishments. The environmental department would have annual inspections that are proactive. They could deal with establishments and unlicensed individuals attempting to fill the void that exists.
Feb 22, 2021, the City Commission approved directing the COF attorneys to work with Environmental Health on a proposed Massage Therapy Establishment Ordinance and associated requirements. There have been several internal meetings and many industry meetings. January 1, 2022, is the tentative date to implement the program, licensing and fee if approved by the COF Commission.
The following establishment or business models would be licensed if the program was approved and implemented: all brick and mortar establishments within the City of Fargo massage therapists who rent commercial space would be individually licensed, licensing would not apply to in-home massage businesses or massages conducted directly in patron’s home. The fee for licensing will be $100 annually.
The program contact information are City Administration: Michael Redlinger 701.467.4135, FCPH: Grant Larson 701.241.1388, PD: Captain Chris Helmick 701.476.4095, City Attorney: Alissa Farol 701.280.1901.
Second and third industry meetings went out to all massage therapists licensed in town about 200 in town. Chiropractic offices, professional hospital settings would be excluded.
COVID Update/Desi Fleming and Tracie Newman:
Desi: Testing still going on at storefront, we continue with COVID-19 vaccination clinics, Saturday booster clinics for Pfizer by invite. Using some contract staff for some of these because we have a lot of demand on our staff. We are continuing with press briefings and social media, as we need them. Still struggling with misinformation in the community. Social media also misrepresenting the facts. We are doing what is best for the community. We continue to meet with our physician advisory group. We still are seeing the effects of COVID-19’s Delta strain. Death rates are in the ’20s. We are hoping that we will peak soon so it will begin tapering off. The vaccination rate is low and below the national average. Our number one recommendation and will help if we get future surges. Little to no mask wearing in public and large gatherings increasing. We are also having issues with people not self-quarantining and isolating while sick. Still waiting for the 5-11 year olds to be approved for vaccination, hopefully sometime in November we will see that. Dr. Newman: Pediatric update, since July cases have risen 240%, even when we see total cases decline, there is a higher portion of children infected. More than 6 million kids have tested positive for COVID-19 since the beginning of the pandemic with 1.1 million new cases since September of this year. In ND, childhood cases are accounting for about 28% of the cases of COVID-19. We are asking for childhood cases to be reported on the NDDoH dashboard. FDA met about boosters and then the ACIP will meet October 20-21 to talk about Moderna and J&J boosters. They have also talked about mixing the boosters. Moderna has announced a booster that would have COVID and flu in the same shot; this would be for next year. Novovax is also looking at doing this. Pfizer has submitted trial data for 5-11 year olds and is requesting Emergency Use Authorization. It does seem to be effective and safe but it is not peer-reviewed or published, however is available to the public for review. Breaks down trials. The children got a 1/3 or less dose. The vaccine was well tolerated and side effects were slight. 28 million children in our country that could become eligible to get the vaccine. Storage and dilution is different for the pediatric doses so you cannot use the adult vials for children. There is a new oral antiviral pill for COVID-19 from Merck. Used to treat mild and moderate cases of COVID-19 and it is generally well-tolerated. This could stop the virus early before it replicates and becomes asymptomatic disease. It could be taken at home and would help decrease the stress on the hospitals. Could be a game-changer but vaccinations remain our number one defense.

We do not test for the Delta variant, individuals receive a positive or negative result and they go to the state lab where a certain percentage are randomly chosen to go to the CDC to be tested. Delta has been the only variant that has been found here recently. CDC designation for high or moderate transmission etc. is set by looking at our active cases, positivity rates, hospitalizations and death. There are eleven different elements on the CDC website; it is the same standardized risks they measure for every county in the United States. Mitigation efforts effectiveness is measured by the more layers of prevention the better we are at controlling spread. A lot of confounding factors because the kids are going to different test sites or not being tested at all. Some schools are doing contact tracing, some schools letting close contacts to come to school. It is difficult to tell where a case may have originated (school vs the community) which is why we like to have contact tracing in schools. We measure the success of the mitigation efforts in that we have not had to close a Fargo public school, cases in school have been low, and the schools and their extracurricular events have been able to continue.
Robin Nelson mentioned the kids are utilizing the double masking exemption at the Boys and Girls club. Keeps kids in school or in licensed childcare and keeps parents working. Most of these kids are getting their cases from siblings and family. Also a vaccination exemption, if they have two shots and they are exposed they can continue on as normal and just symptom watch and get a negative test 3-5 days after exposure.
Public Comment: There were no participants at City Hall.
Next meeting: December 17, 2021