Board of Health - February 18, 2022 Minutes
Regular Meeting: February 18, 2022
Present: Chelsey Matter, Chair, Amy LaValla, DNP, PMHNP-BC, APRN, PHN, Charlene Nelson, Kayla Nelson DNP, APRN, FNP-C, Lyn Telford MSN, RN, CEN, Arlette Preston, Robin Nelson, Duane Breitling, Bernie Dardis
Others Present: Larry Anenson, Desi Fleming, Justin Bohrer, Suzanne Schaefer, Tracie Newman MD, MPH, FAAP, Melissa Perala, Brenton Nesemeier
Approval of minutes: Approve minutes of December 17, 2021. Motion by Lyn Telford, seconded by Duane Breitling. Unanimously approved.
Chelsey appreciates the personal story of Desi’s being shared with the public in the interview with WDAY. The pandemic has put Public Health, which is usually in the background, center stage. There have been some tense interactions and unpopular decisions that have had to be made. This pandemic has brought to attention that we should look at how we structure our public health. Chelsey Matter would like to appoint a subcommittee to focus on the bylaws and to do some research, and comparisons and then make recommendations. Chelsey Matter appointed Lyn Telford and Arlette Preston to do some background work and then put together some recommendations; they could provide progress at our next meeting. She does not anticipate any major changes but would like have the structure reviewed. No objections.
Announcements: Entrance FCPH-Desi Fleming. There was a customer service training for staff by Matt Sanders from Fargo PD (he attended Disney institute). Encouraging staff to think about the touchpoints at our agency. These are points where you can positively or negatively affect a client. One of our challenges architecturally is that the public has difficulty finding where our front entrance door is. They are going to make it more welcoming, including ideas like new signage and colorful awnings. We have a staff door that is very visible which tends to confuse the public as well. Look at the logistics of our building.
Next month we will be back in person at City Hall Commission Chambers. Board will be up at the dais and the staff will be down below at the tables. Thanked the Board of Health for their patience with the virtual meetings and all of their support.
Budget: Melissa Perala - 2021 was all about COVID. Expenses for 2020: 11.5 million expenses and for 2021 expenses were 13.4 million, increase was COVID related. Testing and immunization were a big cost but Harm Reduction factors in as well. They went from 1.9 million to 2.5 million. Our costs went up in July, partly because the guard left and then our staff had to pick up all the slack or we had to hire on more staff. All of these covered by CARES or ARP funding. Highlight in revenues for 2021 in the third party insurance area, we budgeted for $430,000 but the revenue was 1.7 million and 1.5 million of that was vaccine reimbursement from insurance companies. Other programs were not quite as busy since staff was focusing on COVID operations. 2020 revenue was 114% over budget because we did not do budget adjustments to account for other areas, particularly the insurance reimbursements. For expenses for 2021, we were at 102% of the budget. Going into 2022, we will have to have some budget adjustments again due to COVID.
Desi Fleming: We will need to push the budget through again faster again this year. Kent Costin, the Finance Director is leaving on April 1. They would like to push through next year’s budget before he departs. Human resources is going to do a market study. There are less and less applicants and a very competitive job market. Certain jobs are more difficult to hire for, especially Harm Reduction. BOH budget meeting is in May but we may already have most of it laid out by then, however we will reach out if we need assistance before then. Arlette Preston: City department wide inquiries regarding wages, there will be a salary survey coming out in mid to third quarter of this year.
COVID Operations/demobilize/re-invent:
Dr. Newman: recent pediatric Pfizer vaccine, Feb 1, Pfizer requesting EUA for COVID vaccine for 6 month to five year olds. It is 1/10th the adult dose. This dose has 3 micrograms, which is a very low dose. They are looking at a two-dose regiment separated by three weeks then followed by a third dose two months later. Initial data did not show a strong enough response for older kids ages 2-4 but did for children 6 months to two years old. There were no safety concerns in either age range. US reported in January the highest amount of cases in kids since the start of the pandemic, 3.5 million new cases just in the month of January. We are seeing higher rates of pediatric hospitalization with Omicron. CDC released data showing that pediatric doses being administered in the 5-11 age range are very low. In US, age range 5-11, only 31% have started their doses and 24% are fully vaccinated. In ND rates for the 5-11 year olds receiving the first dose is 19%, second dose is 15%. In Cass County, 31% receiving their first dose and 26% their second dose.
Moderna COVID-19 vaccine has full approval. Novavax is applying for EUA. Their efficacy is 90.4% with two doses. It is protein based for adults 18 and up. They are waiting on late stage testing for 12-17 year olds. CDC meet two weeks ago and reviewed immunocompromised schedules, they are considering extending the interval between mRNA vaccines spreading it to 8 weeks. Data is showing higher antibody levels when they space the injections out and less chance of myocarditis. Eli Lilly’s bebtelovimab is another monoclonal antibody that is available that is showing to be effective again Omicron. FDA did approve it for emergency use although it is not a preferred product, use only when other treatments are not accessible. Supply of masks being handed out at 1240 25th St S have been exhausted. We will not be getting the federal masks as they are going to the federally qualified clinics (like Family HealthCare) and we will not be ordering more of the KN-95s unless we can get them from the state. We will continue to distribute COVID-19 home testing kits, free of charge with no residency requirements. These tests are available at the 1240 25th Street location (Monday through Friday from 7:45 to 4:30) as well as the COVID testing site located in the Family Fare strip mall on 25th St S. in Fargo (Monday through Friday from 8:00 to 5:00). CDC is going to update their guidelines, shifting metrics from case counts and infections to hospitalizations and severe disease regarding mask use.
Desi: We did get a small supply of KN-95 masks yesterday, so we will continue to distribute them. We have distributed 13,000 test kits and we encourage people to pick them up and if you need more, please come back in and get more.
Regarding demobilizing, want to clarify that it does not mean COVID is done, it is in regards to moving our staff back to their normal positions and routines. Numbers are decreasing. We are hoping at the end of March we can close up the testing site. Health system can help with testing and handing out test kits. We are still doing vaccinations for COVID in our clinic. We are trying to get back to our normal work we have to assess programs, check on the community needs and work on referral building. We do not know what the pandemic is going to do, so if something changes and we need to remobilize and pick up new duties because of the pandemic we will shift priorities again. We need to be flexible and adaptable but we are happy for the break to get back to our regular work.
Dr. Newman pointed out that if you have a child, two or under, they need to go to their provider to have a COVID test done. Lyn Telford wanted to thank the team at the test site. Fantastic resource for quick testing. The efficiency of that location has been a mainstay in the community. Charlene Nelson earlier this year invitation to appear on Chris Berg show and it was declined, she was disappointed in that decision. She also inquired about focusing on diabetes, obesity and exercise to have a long term, well-rounded approach to health. Desi pointed out that our Health Protection and Promotion division deals with obesity starting in childcare and talking about healthy activity. We are also working on a community health improvement plan, which will be developed this year, along with our other partners we will all work more on obesity but also mental and behavioral health. Desi also mentioned that if any board members have something they would like to see on the agenda for the Board of Health, they could send those items to Chelsey Matter. Brenton Nesemeier is scheduled to attend at the next meeting to talk about STI rates that are going up in our area. Immunization and STI rates were impacted because of all the focus on pandemic response. Brenton Nesemeier also mentioned that they would be able to present on other conditions that are reportable. State response is starting to scale down pandemic functions, including stopping case investigations. Chelsey Matter reviewed how items could be placed on the agenda for the Board of Health for Charlene Nelson.
Public Comment: There was no public comment.
Next Meeting: April 8th, 2022
Meeting Adjourned