Board of Health - August 19, 2022 Minutes
Regular Meeting: August 19, 2022
Opening: Noon, Friday, August 19, 2022; Chelsey Matter called the meeting to order
Present: Chelsey Matter, Charlene Nelson, Kayla Nelson DNP, APRN, FNP-C, Lyn Telford MSN, RN, CPHQ, Arlette Preston, Nyamal Dei, Duane Breitling
Absent: Bernie Dardis, Amy LaValla DNP, PMHNP-BC, APRN, PHN
Chair Chelsey Matter presiding
Others: Desi Fleming, Jan Eliassen, Brenton Nesemeier, Melissa Perala, Lisa La Fontaine, Lucas Ringuette, Ian McLean, Tracie Newman, MD, MPH, FAAP
Introduction of new member Nyamal Dei
Approve minutes: Meeting minutes from April 8, 2022: motion to approve by Ms. Matter, move to approve Ms. Preston, seconded by Ms. C. Nelson. All members present voted aye and the motion was declared carried.
Announcements:
* Desi Fleming, Monday night Cass County Commission did approve a 10% designation for the nursing staff at the Cass County Jail that is historically difficult to hire for. 100% covered by the County and they are going to do a market study to see what the salary should be for that position so it may change later.
* Strategic Planning update: Ms. Fleming reports this started in 2022 there has been a planning retreat, input from staff and leaders which has reaffirmed our vision and mission and helped to create guiding values for the agency. A draft copy has been received from the consultant and we will meet and continue the process of vetting and receiving more input.
* Duane Breitling pointed out that the change in the salaries for the corrections staff will take place on September 1 of this year.
Board of Health Bylaws:
A subgroup of Chelsey Matter, Lyn Telford and Arlette Preston met to work on updating the Bylaws. The mission statement is simplified to make it easier to digest and remember.
Membership changes came from other Board of Health they researched. Items such as being knowledgeable about the vision and mission of the Board of Health, as well as, attending community functions, and being aware of community changes/trends. This way the members can report back to Public Health the information/trends that they are being exposed to.
Previously had nine members and would like to reduce to seven members, stating that they would have three-year terms and they can’t exceed three consecutive terms. Introducing five at-large members. More opportunities to include other school boards as well by opening the five at large positions. Individuals would have to re-apply for their positions. Making sure there are healthcare professionals and public health experts represented on the Board of Health. Ms. C. Nelson inquired about how that will work at the expiration of your current term or at the year-end? Ms. Matter they would need to reapply and staff those terms so multiple members are leaving at one time. We could start in the first new quarter of the upcoming year so it could align with the changes in the BOH bylaws. Elections of the officers would be clarified of being at the first meeting of every year. Some changes will require the City Commission to make some ordinance changes. Ms. Preston commented a few other committees and commissions in the City are going through the process of trying to make them more efficient and effective.
Ms. Matter did note that the legal staff for the City of Fargo has reviewed and mentioned that an ordinance update would also have to occur. Meetings change was to include a public comment piece being required. Ms. C. Nelson inquired about who sets the agenda. Ms. Matter and Ms. Telford have planning meetings with Ms. Fleming to talk about what is pertinent to the board, but any member can email either Ms. Matter or Ms. Fleming to request a potential topic. The Chair approves the agenda item. Voting and compensation for the bylaws have not changed. Responsibilities of the board have been moved around and reordered. Ms. C. Nelson made a motion that the board members get to study these changes and get some feedback before a vote would occur. Ms. Dei agreed and seconded. Mr. Breitling requested the ordinance changes that the City of Fargo will have to make. The city attorney Ian McLean stated that since the Board of Health is an advisory committee, that may make a recommendation to the City Commission to make these changes in the City Ordinance, the City Commission does not approve the Board of Health By-laws.
Monkey Pox Presentation by Brenton Nesemeier:
Monkey Pox is a rare, sometimes life-threatening infection, endemic in the west and central Africa. We have the Western Clade variety which is less infectious. It can be spread from infected animals to people or people to person from respiratory secretions, skin-to-skin contact with infected body fluids, shared towels, and contaminated bedding. Countries that don’t usually have monkeypox began to see cases in the spring of 2022. Most cases are among the MSM population. It doesn’t spread easily between people without close contact, so the threat to the US population remains low. In the US first cases were reported in May, a Massachusetts resident who traveled to Canada. Co-infection with STIs have occurred. The hospitalization rate is low and there have been zero deaths in the US.
Symptoms can include fever, headache, muscle aches and backache, swollen lymph nodes, chills, exhaustion, and rash usually lasts 2-4 weeks. Worldwide cases 40,399, 40,012 in locations that have not historically reported monkeypox. We have had three cases in North Dakota. Continuing to work with providers on administering PEP and PEP++ as needed. People who were tested and showed up negative for monkeypox instead received diagnoses of folliculitis, shingles, syphilis, hand, foot, and mouth disease. Prevention includes avoiding skin-to-skin contact with anyone with the monkeypox rash, do not handle the clothes, bedding, or towels of a sick person. Wash your hands or use hand sanitizer, especially after contact with a sick person, vaccination with Jynneos. The treatment of Tecovirimat (TPOXX) is also available. FCPH has given many doses, which includes events like the Pride at the Park event. North Dakota is working on getting more vaccine. In the beginning, we received 20 doses and we had to hold back 10 doses so we could finish the series. CDC and ND Department of Health, recommend two-dose series 28 days apart. Ms. Dei asked about the appropriate age for receiving the monkeypox vaccine. Intradermally you would need to be 18 or older, for emergency use they can administer subcutaneously for eight and under. Pregnant women may take as well, this vaccine has been around for about ten years for smallpox. It has been around for many clinical trials they do, however, ask that they wait a little bit if they have had the COVID vaccine. There are screening questions for allergies before getting an immunization. There are four health systems in Fargo that provide immunizations, Canopy Health, Sanford Health, Essentia, Fargo Cass Public Health. The vaccine is free but there may be an administration fee.
Dr. Tracie Newman provided the Health Officer report:
Vaccination rates have dipped, it is a nationwide issue. COVID-19 caused disruption in immunizations. In North Dakota, the immunization rates dropped as we sit around 93% vaccination for MMR, Polio, DTap, and Chickenpox. (The goal is at least 95% for each vaccine). Right now, on the North Dakota Health dashboard they are reporting the coverage rates for vaccines (2021-2022) is DTap: 92.01%, MMR 92.23%, Polio 92.38%, Hep B 94.17%, Chickenpox 91.88%.
These types of numbers put us at risk for an outbreak. The exemption rate in North Dakota is about 2.2%, with the reason for the exemption breaking down as follows: personal beliefs (3.34%), Medical exemption, (.19%), and religious exemption (1.27%). Rates for babies are also falling which is worrying. Cass county is ahead of the rest of the state for immunization rates.
The goal for us is 95% herd immunity. Nationwide we are seeing adolescent wellness visits decrease which means less immunizations. Fargo Cass Public Health has had walk-in clinics for school-age children for immunization as well as social media and radio campaigns. We make it too easy to not vaccinate by offering the exemption form so readily. There is usually an October 1st deadline to get your child vaccinated. The schools are pretty good about enforcing but with new students cycling in that can be difficult to get them the level of vaccination required. Mr. Nesemeier mentioned that on the dashboard individual schools are listed as to their rate of vaccination. Many states allow exemptions for religious and medical reasons, but there are only 15 that allow for philosophical reasons.
Downtown Engagement Center (DEC) Update by Jan Eliassen:
Fargo Cass Public Health Downtown Engagement Center is in the downtown former police department building. They have other services on site like the Homeless Healthcare clinic five days a week from 8 am to noon and they have Presentation Partners in Housing navigators for housing who provide assistance in moving people to housing and support when people are housed and Native Inc. out of Bismarck providing care coordination which is an evidence-based approach to helping people move to their goals of finding sustained housing and sustained recovery. Numbers at the shelter were a little low in July, some of the contributing factors would be Fargo Police carrying out some old warrants which removed guests to the jail. They are working with the jail to set up discharge planning so when people are released, they can assist them. Downtown Engagement Center operates from 8:00 am to 8:00 pm. Morning hours are for inviting people in, share coffee and educate them with the services available. They have access to internet, phone, and health services. By the afternoon as more staff come on, they can offer their guests services like, taking a shower, doing laundry, and having access to a locker where they can lock up personal items.
Harm Reduction has hired an RN (Lisa La Fontaine) to help with screening for health issues. She spends time at the DEC, shelter, and syringe services building so she can focus on identifying a primary care relationship for their clients in the community for better health outcomes and addressing inequities that they have been seeing. She promotes vaccination to address the spread of disease and the guests hold her in high regard as a member of the medical community. During June and July, we were experiencing more complex mental/behavioral health issues in the downtown area. We as a society are facing some difficult circumstances and they have met with business owners in the downtown area. For Harm Reduction, they have a goal to get people housed as fast as possible because of the crisis of being homeless perpetuates other issues. We saw an increase in homelessness after COVID. We need to get people back to providers to begin working on mental health issues. Harm Reduction’s goal is to respond and try to avert a more costly, legal response to these issues. There is not enough mental health staff here to respond to all the mental health issues in town. There has been discussion about increasing mobile outreach. This will save the community money and have better outcomes than having the police involved or doing nothing.
For legislation, they seem to be looking at acute psychiatric care for areas that are rural, and we need more of a rapid response facility for when people are in crisis. There seems to be a large gap of understanding between what the legislators know and what is happening on the ground level on daily basis. The legislators are interested in hearing more information about what is happening. Ms. Matter feels that we should present this information to the legislators to increase their awareness. Issues are arising in the urban area as well as the rural. We need to focus on solutions like prevention and support early on to prevent acute issues. Gladys Ray has about an average of 21 beds per day filled (have 30 beds available), but many of them sleep at a friend’s/family member’s house. We believe that are about 1,000 people in the FM area that are unhoused every given night. As a community, we need to focus on housing programs and affordable housing. The engagement center is very important to help these individuals start connecting to the services that can improve their lives. Downtown Engagement Center opened as quarantine and isolation for COVID, and the shelter was located there for a short time while the shelter was being updated.
Every day they try to increase the opportunities for services there like recovery groups and cultural activities. They do have volunteer opportunities, they received supplies and they need help to keep it organized and accessible. Gladys Ray does have a Facebook page, but they are working with Holly Scott (PIO) to get on more social media platforms. Each of the Harm Reduction programs provides unique services.
The Safe Syringes building has been downtown for about five years, it is primarily for people who are injection users to help them take control of their health and make sure they can access treatment and other services. There is a lot of education and overdose prevention and Robyn Litke Sall works on the Narcan/Naloxone education and distribution. The state and federal grants help support and fund their work at the Syringe Services program.
Mr. Breitling brought attention to the settlement of the Opioids lawsuits and that Fargo Cass Public Health should be at the forefront of those discussions about how those funds should be spent.
No Public Comment
Meeting Adjourned
Next Meeting: October 14, 2022