Board of Health - April 8, 2022 Minutes
Regular Meeting: April 8, 2022
Opening: Noon, 225 4th St N, Chelsey Matter called the meeting to order
Present: Chelsey Matter- Chair, Amy LaValla DNP, PHMHNP-BS, APRN, PHN, Lyn Telford MSN, RN, CEN, Arlette Preston, Duane Breitling, Charlene Nelson, Robin Nelson, Kayla Nelson DNP, APRN, FNP-C
Absent: Bernie Dardis
Others Present: Grant Syverson, MD, Desi Fleming, Brenton Nesemeier, Suzanne Schaefer, Melissa Perala, Holly Scott, Justin Bohrer, Larry Anenson Jr., Jan Eliassen, Lucas Ringuette, Lori Sall
Approve Minutes: Approve minutes from February 18, 2022. Motion to approve by Robin Nelson, seconded by Lyn Telford. Unanimously approved.
Annoucements: Justin Bohrer update on accreditation. In January 2020 we received a not accredited status. Since then, we have made more changes and reviewed policies. We have done quality improvement but at this time no resources have been identified for having accredited status at the local public health level so we will not pursue it. We will continue to improve our practices continuously. Stutsman Public Health got accredited at the start of PHAB. The issue is as it has progressed the realization that there are significant differences in local public health units versus the state health department. Accreditation would not increase funds or grant funding. Grand Forks is currently trying for accreditation. The accreditation process is very costly. FCPH has benefited from the process and will continue to develop plans for improvement. North Dakota Department of Health is accredited. PHAB was going to work on doing a quality improvement focused plan, which would be like an accreditation “light”.
Desi Fleming speaking regarding strategic planning. An initial email went out to staff announcing the strategic planning process that is going to take place in June. On June 7th, the two Strategic Planning consultants will be coming in to assist us. This will involve management and staff, virtual and in person. Friday June 10th will involve large management group and an equal portion of staff. FCPH has not done a strategic plan for a long time and the plan is to put out the recommendations for staff and Board of Health for feedback and suggestions. We are looking at community needs and what we can offer, as well as improving team cohesion. There may be an opportunity for community partners to assist.
Desi Fleming speaking regarding the budget. We usually have a budget meeting in May, but it has not worked out this year due to staff issues. We had to turn in the budget template in by April 1st before Kent Costin retired. The PEC (Position Evaluation Committee) requests are due April 8th, so we can talk about any questions you have regarding the budget today.
Desi Fleming stated that FCPH can send out the organizational structure for the DHS/NDDoH merger.
Desi Fleming announced that there will be an addition to the agenda; Brenton Nesemeier is going to give an update regarding the rates of Sexually Transmitted Infections in the state.
Grant Syverson, MD is a pediatrician in Fargo presented information regarding misinformation challenges.
The difference between misinformation and disinformation. Surgeon General of the United States has been discussing how health misinformation is becoming a threat to public health. It undermines our role in society and confuses patients and caregivers. Poor information impacts our health decision making. This is not new, in 1808 when they were going to vaccinate people against small pox information spread that the vaccine would kill people. 1983 with the AIDS pandemic the misinformation put a negative spin what HIV/AIDS was and that impacted care and funding. In 1918 misinformation regarding masking existed and mirrors a lot of what we saw during COVID. The Office of the Surgeon General put out a community toolkit for addressing health misinformation.
Misinformation is false information shared by people who do not intend to mislead others most of the times they cannot recognize that the information is false, and they usually spread this information because they want to help others. Disinformation is spread intentionally to serve a malicious purpose, such as to trick people into believing something for financial gain or political advantage. The “disinformation dozen” 12 individuals who are behind most of the health disinformation that is on social media, who are doing it for financial gain. We live in a society that gets an overabundance of facts (some accurate, some not) and it makes it hard for people to find reliable guidance. People are hungry for information and they want to find a narrative that is what they want. People feel anxious, depressed, overwhelmed and emotionally drained. The Kaiser foundation did a study that showed that 8 in 10 people believe or are unsure about at least one common falsehood about COVID-19 of the vaccine, such as: government is exaggerating/hiding the number of deaths from COVID, Ivermectin is safe and effective treatment, the vaccines can cause infertility, pregnant women shouldn’t take, you can get COVID from them, it has microchip and it changes your DNA. How many false statements you believe has some correlation into what your news source is. The chart does not include social media. Demographics also play a part, political party, college graduate (didn’t impact as much), age, where you live (urban, suburban, rural). Why is it tempting to share misinformation? 1) We like to feel that we have new information that others don’t know. 2) We want to protect the people we care about. 3) We may be seeking explanations or wanting to share information that helps us make sense of events. 4) We want to feel connected to others. Especially with social media groups, the algorithms are set up to send you more of the similar information that suits you, so we start operating in information silos. The “disinformer” tends to be a creator of information and they do this deliberately. The “mischief-maker” they will create and share misinformation for fun to fool people. The “hoaxster” will share misinformation to fool people and to make money. The “enthusiast” posts information to support a person or cause. The “believer” is deeply connected to an online community that is pushing false, misleading claims. This individual believes this information to be true and wants to share it with others. They tend to be rigid in their beliefs and unwilling to listen to new information because this belief is a part of their identity. The “oversharer” shares information that they think is helpful or concerning without checking the source behind the statement. The “casual sharer” spends a lot of time online and can carelessly share items with no real intent. Disinformation tactics: using visual cues like wearing a white coat or stethoscope, creating professional slick looking website, included posts like, my family member works here and let me know about inside knowledge, or creating content that looks like first person experience stories. Sources of misinformation: social media algorithms, information silos, professional/official appearing websites, misused quotes, out of date data, misleading graphs and diagrams, cherry picked statistics. 90% of people are not going to look at where they get information. Podcasters like Joe Rogan has Aaron Rodgers on his show regarding vaccines. These individuals have the ability to influence others but they are not medically trained. People who are willing to misinform others for financial gain and not do things for the good of the community. Midwest Public Health Coalition website, lots of the links do not work, overlap of words, no one on the “coalition” has any public health experience yet they use the words Public Health in their name, they use the red cross icon to confuse people. Please note there is a contribute button on the website, the founder is not from North Dakota. He has done this in several other states and they are asking for money which is a red flag. Examples of their posters which attempt to get an emotional response. They misuse quotes and do not include source material. Health misinformation checklist to teach the general public to be more critical of what they see online: did you check with the CDC or LPHU to see whether there is any information about the claim being made, did you ask a credible health care professional such as your doctor/nurse if they have additional information, did you type the claim into a search engine to see if it has been verified by a credible source, did you look at the “About Us” page on the website to see if you can trust the source, if you are not sure, don’t share. Showed a PSA from Sesame Street, Big Bird had a COVID shot, but also, they did an immunization campaign back into 1976. Unfortunately, health misinformation is becoming political. Lyn Telford: no one is immune from political misinformation and true scientific research means that you seek out conflicting information, constant checking and vetting of health information. We need to check ourselves and be accountable for what we say. Grant stated that social media has gotten somewhat better. If you see information that is false you can flag that information. If that person who is posting continues to post false information, they can remove their ability to post. Arlette Preston: the issue comes from people were unsure, worried and they want an immediate answer however that answer is going to evolve over time, it is difficult to respond on a timely basis. Tracie Newman: another thing that is confusing is that science changes and evolves because they do not stop looking for answers, so it seems they are doing a 180 on their statements. Like now the scientific community wants infants to sleep on their backs and to start them eating peanuts at 6 months. Data continues to change and be analyzed which means recommendations change. Charlene Nelson: science is changing and what we call misinformation can become fact. People who have been vaccinated can carry a viral load. She feels that CDC mistrust comes from there is no public debate and conversation when CDC makes a statement. Maybe there should be more debate as opposed to flagging, reporting and shutting people down. Grant Syverson responds that vaccination is inherently for all of us, it helps the individual, but you do it for your community because at a certain threshold you no longer have a vaccine preventable illness. Tracie Newman explains the very public and rigorous process of the CDC for vaccinations. The VRBPAC (Vaccines and Related Biological Products Advisory Committee) is a subset of the FDA, and they meet and heavily debate the information). They present this to the FDA, FDA makes a decision, then advises the CDC and then the CDC decides after analyzation. Grant states it is not perfect and the science evolves, we do not expect it to stay the same.
Tracie Newman, Health Officer Update:
COVID variant BA.2 is new sub lineage of Omicron and there are others but right now BA.2 is playing out differently in other parts of the world and we are unclear of how it will the US. The W.H.O. reported that BA.2 if responsible for 86% of COVID samples being sequenced worldwide, in the U.S. it is 72%. This is significant because last week it was at 57% so it is rapidly becoming the prominent variant. Seems to be causing less complications perhaps because people have omicron immunity. W.H.O. is also tracking another subvariant called XE which appears to be a recombinant variant. UK had it identified in January and now it has about 637 cases. We need to watch this as it may be up to 10% more transmissible. Cases here in Cass County remain in the new CDC low risk range. Stay up to date with COVID vaccines and get tested if not feeling well. As of March 9th, masks are required at Fargo Cass Public Health in the WIC and Clinic areas only. ND vaccine rates are fairly stagnant, 58% for one dose, 54% for both doses and 53% for receiving a booster. In Cass County it is 67% for one dose, 62% for both doses, and 55% boosted. The 5-11 age range is still the lowest rate for vaccination. COVID vaccine is still available at Fargo Cass Public Health by appointment (701.241.1383, Monday and Wednesday from 8 am to 6 pm and Thursday from 8 am to 4 pm) The 25th Street location near Family Fare for testing has been taken over by North Department of Health as of March. PCR and Binax test are available Monday through Friday from 8 am to 5 pm. Fargo Cass is also giving out home kits. The FDA on March 19 is recommending a second booster for those 50 years old and older and for immunocompromised people. Excellent example of scientific debate, some experts think this will help people who are at risk until the fall when will most likely need another vaccine for protection. Moderna is going to submit pediatric trial data for 2 dose vaccine for 2–5-year-olds. Right now, it is only being used for 18 and older. They have already submitted paperwork for the 12–17-year-old range, but regulators wanted more information. Childhood vaccine rates have been falling so we need to do some work there. It is too early to say that if you have Omicron immunity that you will be immune to the subvariants.
Brenton Nesemeier, NDDoH Director of Field Data, presenting an update on STI rates in North Dakota and Cass County.
Data for 2020 should be interpreted with caution due to the impact of COVID-19 pandemic on access to testing, care-related services, and case surveillance activities. Data for 2021 is preliminary and subject to change. Chlamydia cases have remained stable, the dip in 2020 was due to lake of testing and care related services in North Dakota. In Cass County the case count went from 893 in 2020 to 1,136 in 2021. Gonorrhea case count in North Dakota has been on a steady increase from 1,005 cases in 2016 to 1,723 cases in 2021. The treatment for Gonorrhea has changed to a one-time injection vs Azithromycin and an injection. Cass County count has gone from 363 in 2020 to 466 in 2021. Syphilis in North Dakota went from 63 in 2016 to 105 in 2021. Prior to 2010 many providers had not even seen it and now providers are seeing it much more frequently. We need to increase education and testing. Sometimes those presenting symptoms are referred to dermatology instead of being treated. We would like providers to take a blood draw to test for syphilis as well as the urine screen to attempt to diagnose these immediately. We can do a rapid HIV test in 15 minutes but there is nothing like that for Syphilis. North Dakota does sit above the national average for syphilis. South Dakota has seen a sharp increase as well (in 2021 over 1,000 cases). In Cass County in 2020 we had 21 cases in 2021 26 cases. We are also now seeing congenital syphilis cases in North Dakota, since 2016 no cases then in 2020 3 cases and in 2021 2 cases. We don’t have a law that requires screening during any point during pregnancy. In 202 there were 9 known pregnancies where there was congenital syphilis and they were prevented. There were 3 pregnancies in 2020 where 1 received no prenatal care and the other 2 screened negative at first prenatal visit and tested positive after delivery due to symptoms. Congenital syphilis can lead to death, developmental delays, and birth defects. In 2021 there were 8 known pregnancies, one received late prenatal care and was no able to be adequately treated before birth and one received no prenatal care.
Incident HIV rates (these are new cases) went from 50 in 2016 to 37 in 2021 in North Dakota. In Cass County went from 12 in 2020 to 18 in 2021. North Dakota did report a congenital HIV case in 2021. Negative screen at first prenatal visit, tested positive after delivery. Hepatitis C cases went did drop but they did have a change in case definition in between 2020 and 2021. Cass County does make up about 24% of the cases, this could be because we test more and do treatments. Hep B cases have dropped from 113 in 2016 to 62 in 2021. We have about 2/3 of the cases in Cass County but that may be because of cases from people who now live in North Dakota, however we have seen a drop in the number of people immigrating to North Dakota. In 2020 Cass County had 48 cases and in the 2021 42 cases. More information on data is available at North Dakota Department of Health Disease Dashboard and 2020 HIV.STI.TB. Viral Hepatitis Epidemiologic Profile. For education we need to focus on the populations of: persons of color, Native, and MSM. We are trying to increase the ability to test people where they are at instead of having them come to us.
Tracie Newman added that this is not unique to North Dakota that it is nationwide. The rates of STI’s have been increasing for the last 5 to 6 years. Part of this has prompted on how we treat include screening younger people and updating our treatment guidelines.
Larry Anenson Jr., Director of Health Protection and Promotion: presents on the Family Planning Site Review Visit. FCPH has been providing Title X reproductive health services since 1972. The objective of a site visit is to assure that we are meeting our Title X goals of cancer control, wellness exams, birth control, testing and treatment of STIs. Because of COVID most of our visit was virtual but we did have an onsite inspection of policies, forms and witnessing our care of patients. A great deal of time goes into preparing for a site review. They focus on the financial, administration and the client services in a review. We received positive feedback regarding the friendly staff, eagerness to do things the right way, charting and documentation, warm, flexible, compassionate, client centered care. For improvement they pointed out the busy clinic lobby area could be configured differently to ensure privacy for those checking in. They want us to review some of our billing processes and how we collect our fees. Also make sure our data entry into the Ahlers software is consistent and accurate so we avoid double entries. Very proud of the staff and want to acknowledge the Board of Health for their support.
Melissa Perala presented the budget information.
Budget was doing earlier than normal. Reviewing the revenue sheets: Grants is our Federal funding that comes from either Health and Human Services or Department of Commerce and flows through the State. The two changes Ryan White has increased due to the numbers we see and MCH decreased because it went from competitive to all requests across the state being funded. The last four items are related to COVID, Cares funding ended last year, Emergency Solutions grant ends this year. ARP funding will end in 2023. State grants: tobacco, mobile outreach, and opioid outreach remain stable for another year. Local funding from the United Way for NFP is done this year. Fargo Public Schools are now on a three contract. We are getting more money into the shelter from Giving Hearts Day. Cass County budget has increase due to salary and benefits because of all the turnover. Correctional health is more this year due to increase in supplies and travel. Overall, the budget increasing for more staff education.
The operational expenses increased; at Ryan White we received an increase in the funding so we can provide more help for those clients. We are experiencing increases in cleaning costs across the board for our buildings, we requested more education for staff. We moved our building repair budget to buildings and grounds. We paid off the lease of an SUV.
FCPH still has a budget submission to the County coming up. We will adjust FCPH budget depending on the outcome of the County budget. Cass County pays for rural health services, close to a million dollars for 2023. In addition, they pay for the health care individuals who work at the jail. Desi Fleming states we do have a new nursing supervisor at the jail, we have only one LPN position open, we should be fully staffed soon. That cost is approaching $700,000 a year. Difficulty with COVID at the jail because of short staffing and having to single cell COVID positive inmates. FCPH may be at capacity for what we can do with staffing if we need to go to 24x7 staffing they may need to look elsewhere. Once you cross over to 24x7 coverage that is going outside of what public health provides. We can discuss this. The contract with the county renews each year unless there is something that needs to be addressed.
For NFP we are now looking for some state funding for preventative care going to NFP. We are not decreasing services.
MCH had significant changes at the state level going from competitive to $15,000 for all local public health units, which is not equitable for us because of our county size. FCPH did some streamlining, and we had a retirement. It is not going to impact current services; it is just shifting funding.
No public comment
Meeting Adjourned
Next meeting: August 19th, 2022