Although the Honeybee Rescue Resolution was the only action item on the agenda, the vast bulk of the 01/12/2022 Board of Health meeting was taken up by the Covid-19 update. [I would say the TL:DR is that they discussed the marked increases in cases, how those case numbers would affect the local healthcare systems, and the availability of testing. They also discussed vaccination rates and what sort of communication efforts they could take to improve vaccination rates.]
Appleton’s Interim Health Officer Sonja Jensen reviewed the standard pack of slides that have become a regular part of the updates.
She noted that in the previous week, Appleton had a record number of 1,666 new cases, that was more than double the 730 of the week before, which in turn was almost double the 380 from the week before that. So, the numbers have been doubling or almost doubling for the last several weeks.
The city, as well as most of the state, continues to be in the critically high category for disease burden. Critically high is defined as greater than 1,000 per 100,000 people, and Appleton’s current rate was over 3 times that at 3,194.7.
She noted that the city uses the CDC’s transmission rate as the metric for determining when masking is required in indoor, city-owned facilities. Whenever the transmission rate is “substantial” or above, masking is required for both vaccinated and unvaccinated people. A substantial rate would be 50 per 100,000 people, and over the last week Appleton had been in the “high” category with a transmission rate of 2,221.3 per 100,000 people.
She had the basic vaccination numbers that have been routinely reported. She did not have information regarding boosters, but said that would be available for the next Board of Health meeting. She also reminded the board that Covid vaccination has only been available to 5–11-year-olds since November. She also wanted the board to keep in mind that “to be considered fully vaccinated it’s not just the primary series finished, but they also look at being at least 2 weeks out from the completion of that.”
She said the city had been providing vaccinations and Covid testing at the former Best Buy site on Kensington Ave. Testing had been Monday-Wednesday.
They held their last vaccination clinic on December 30. It had been well attended and they felt that they got a good number of people in during that last month, especially in the 5–11-year age group.
They have now switched to performing testing 5 days a week, Monday through Friday from 8AM to 4:30PM, instead of providing vaccinations because they felt that that was what the community needed right now. ThedaCare had partnered with them at that site and was offering both rapid tests and PCR test. A contingent of the National Guard was also still at that location providing PCR testing.
One of the board members wanted to know if the testing was walk-in or by appointment.
Interim Health Officer Jensen answered that testing through ThedaCare was by appointment and information on how to register for that was posted on the city’s website. The National Guard was also taking several hundred a day walk-in patients, but they only performed PCR test. If someone wanted the rapid antigen test, that would be by appointment.
A board member asked how many people were utilizing the testing site.
Health Officer Jensen said that the site had the capacity to do almost 1,000 tests a day. She heard it was very busy, but she didn’t have any numbers available although she could provide those numbers later.
Alderperson Vered Melter (District 2) pointed out that the burden and transmission rates were magnitudes higher than the thresholds for the highest categories and wondered if there was going to be any sort of update to those categories. What did it mean to be “critically high” but to be 3 times higher than the threshold for “critically high”?
Interim Health Officer Jensen said that the metrics the city uses were developed by the CDC and the Wisconsin DHS. She had not heard of anything changing at this point. She said she thought the Omicron variant had turned things into a new game and, case count wise, they had not dealt with this before.
Board member Dr. Vogel said that they had outpaced things, however “I think it’s probably safe to say that recategorizing anything at this point is probably not particularly helpful. but I can’t speak for, you know, experts beyond me, but I think it may not be that helpful right now.”
She thought the focus was on redoubling their efforts at vaccination and testing, but the concern was that demand would outpace their ability to test, which they saw with appointments being fully booked. She said this was due to manufacturing shortages.
In response to this shortage, she said, “We are starting to basically triage people that call in.” People who were mildly ill without high risk factors could try to get at home tests, although they probably wouldn’t be able to find one, and soon they would not be able to schedule testing appointments. “So, if you’re mildly ill, and you don’t have risk factors for serious covid, and you’re vaccinated, then we’re advising people to stay home for 5 days and consider themselves as having Covid and do the responsible thing, and, you know masking and isolating themselves from their fam—from other members in the household—and then when they return to work or school that they’re effectively masked in a very capable mask.” She said that surgical masks were better than cloth masks.
In addition to serving on the Board of Health, Dr. Vogel is a health advisor to the Appleton Area School District, and, in what I took as an oblique response to the pushback by some parents on the extension of the masking mandate at AASD, she stated, “There’s a lot of negation out there about whether a mask is helpful or not because, as you know, this Omicron is extremely contagious and the reason it’s extremely contagious is that—one of the reasons is that it is, in addition to being spread by usual droplets, it’s spread by aerosols (very fine particles that stay in the air, very much like how measles or chickenpox can be spread in the air and hang around for a while) and so it’s pretty easy to transmit it. That being said, you know, we know that masks are effective, um, and even with aerosols there’s—people who are coughing are also still coughing droplets, so I wouldn’t—my likening is, you know, masking and vaccinations aren’t 100% protective, but neither is a seatbelt against serious injury, but it doesn’t stop you from using a seatbelt. So that’s kind of my pitch.” [It sounded like she was saying masks are only effective at stopping the spread of Covid particles that are on droplets but not the aerosolized particles. I would have appreciated a clearer explanation of why, in that situation, masking was effective at preventing spread from asymptomatic people who are not coughing Covid-carrying droplets but are rather breathing out aerosolized particles.]
She stressed the benefit of vaccination and said there was a huge different between the number of vaccinated vs unvaccinated people who are hospitalized or experience serious illness. She said that the Delta variant causes 1/3rd fewer hospitalizations than the original virus, and the Omicron variant probably causes 1/3rd fewer hospitalizations than Delta. However, the sheer number of people that are ill will increase the absolute number of people that will be in the hospital. “So, our healthcare systems are overwhelmed and this is my public platform to tell people that, you know, if you’re not vaccinated you have 13 times the likelihood of being hospitalized and you still have a likelihood of death, and if you’re fully vaccinated and with your booster, it’s extremely unlikely that this virus will lead to death.”
She finished up by stated, “And for those who are claiming that because it’s so rampant and so mild that it’s like a common cold and we just need to learn to live with it, living with this kind of a virus that does result in greater deaths than influenza and thus far has resul—is the 3rd leading cause of death in the United States—living with it means getting vaccinated. So that’s my preaching. Thanks for listening.”
Alderperson Alex Schultz (District 9) was wondering if they could provide some kind of chart graphing over time the rate of vaccination so they could visually see that progression and get a sense of what the trajectory was. He was concerned that Calumet County only had 55% of residents vaccinated with even a single dose. “It is still mind boggling to me that we’re entering year 3 of this pandemic and there are numbers here that are in the fifty percentile for fully vaccinated, and I think, you know, the responsibility of this board and this city to communicate to its citizens the most important thing we can do right now is, as you just stated, is to get vaccinated. I think it would be helpful to get a better sense of progression here.”
Mayor Woodford suggested that the historical vaccination numbers were available in the publicly available meeting materials from past Board of Health meetings. He didn’t seem to think that putting together a graph of vaccination trends should be a priority of the Public Health Department given that they were processing so many new Covid cases which involved an immense amount of manual data entry.
In terms of vaccination rates as a measure of the performance of local public health efforts, he thought they had to take into consideration the totality of the country’s public health efforts. “I still think getting to a place of 70% of our population in the city of Appleton vaccinated is a significant accomplishment for us as a community, especially when we look at, again, the concerning numbers regionally. The fact that the city of Appleton is close to the national average says something, I think, positive about our local public health efforts. But I think we have to recognize that the vaccination effort has been hampered by misinformation/disinformation about vaccines, the effectiveness of vaccines, and how important they are.” He noted that the city had made Covid vaccine shots available to residents through the mass vaccination clinic they had held at the Expo Center as well as the clinic that had only recently closed at the former Best Buy location.
Dr. Vogel asked if the vaccination clinic typically had empty appointment slots that were not being filled.
Interim Health Director Jensen said that was true most of the time. That had been something that had factored into their assessment of the current needs of the community; right now, the need was for more testing and that was why they had stopped offering vaccinations and moved to 5 day a week testing. She noted that vaccinations were readily available at community clinics in the area.
Mayor Woodford said, “I just want to caution us about looking at these numbers in a vacuum, for city data alone. I think we have to take into account the totality of the environment that we’re working in when it comes to trying to get folks vaccinated, and I think, to just underscore Dr. Vogel’s point, it’s still the most powerful tool we have to keep people out of the hospital.” He had heard from leadership at both Ascension and ThedaCare that they were deeply concerned about their ability to continue to meet the needs of patients. He agreed that a small percentage of a very large number was still a big number.
Alderperson Schultz appreciated those comments and clarification and hoped he hadn’t sounded as if he had been mischaracterizing the city’s efforts.
Mayor Woodford did not think it had sounded that way. His point had been that he thought they should recognize and appreciate the efforts of the citizens, 70% of whom had gotten vaccinated. Getting vaccinated also meant those people were far less likely to experience serious negative health outcomes as a result of the virus.
Alderperson Schultz wondered if there was something more they could be doing on a communications front regarding how the city was doing with vaccinations and testing. He thought people had fallen into weariness and complicity “And we’ve just gotten into this kind of uncomfortable comfort with this virus.”
Board Chair Cathy Spears said he understanding was that vaccines were still available at more pharmacies and that most of them accepted walk-ins. If people decided because of listening to the Board of Health discussion that day that they wanted to get vaccinated, all of the pharmacies were still providing vaccines.
Interim Health Director Jensen said she didn’t know about walk-ins. She said Vaccines.gov was the best site to go to. People could also call 211 for help finding a place to get the vaccine. She noted there were still some community sites, including one in the Fox River Mall run by Outagamie County.
Dr. Vogel noted that all primary care clinics in the community were offering vaccination as well, but they might not be able to do all age groups. She said the 5–11-year age group was a little difficult because the numbers are smaller and clinic staff had to constantly gauge how opened vials of vaccine would be used so that they did not waste vaccine.
She went on to say, “Our challenge is for communication in the midst of this Omicron is that people will start to think they don’t need to get vaccinated because they’ve had–because they’ve had omicron.” She said there was a lot they didn’t know about natural immunity, but one of the things they did know if that if a person had had Covid and was vaccinated they really had significant immunity and the immune system would respond to something coming down the road. However, she said she didn’t think they could count on natural immunity from Omicron protecting people from any new variant that might happen, so “the more people that are vaccinated the less we have room for a variant to kind of cook up and mutate somewhere.”
Chairperson Spears said “unfortunately I think that the only way that some people will have their minds changed is to actually experience—if they are unvaccinated—to experience the death of someone that they know who are close to them and then suddenly the lightbulb goes on. And that’s sad.” She said there had been a lot of public services announcements where people have talked about getting it and how serious it was, so she hoped those would be helpful.
Alderperson Meltzer, said “So, when we look at our vaccine numbers and we’re frustrated that they’re not increasing, I think there’s a section of the population out there that has already made up their mind they will never get vaccinated no matter what happens. So, is there anything else additional we can do with communication towards that segment of the community? Ways that they can be safer, things like avoiding going out in public, I don’t know. Is there any kind of a messaging like—here we are, we have this crisis right now with Omicron. What should people who will not get vaccinated for whatever reason—what can they do? What can we encourage them to do to be safer for themselves and help our community be safer? ‘Cause I think that for some of these people getting vaccinated is just never going to be on the table for them.”
Chairperson Spears answered “Unfortunately, I believe that it’s until you are totally experiencing it. Whether you’re having a medical condition or a family member’s having a medical condition, and they go to the ER expecting to be treated like they were pre-pandemic and they’re waiting in the ER for 10, 12, 14 hours because the ER is handling the cases of unvaccinated people because they’re critically ill. I…know of three people that have taken parents to the ER and have waited 8-10 hours in the ER. I know that there’s some ERs that have Covid patients that are sitting in the ER waiting for a bed somewhere within the state that can handle the Covid. This is critical, and what’s really sad about this is our medical community has been strained—has truly been strained. These people have been on the front lines working hard to save lives and I can’t imagine being either Dr. Vogel or our guest doctor today and feeling, like, the frustration level that they must feel having people not want to get vaccinated and to help them out. Because there’s going to be a burnout. There’s a mental health issue that will be happening to our medical field, so if—that’s my preach.”
A city staff member briefly reviewed the City of Appleton’s Covid-19 dashboard and information page and showed all of the information it provided to residents and resources that it directed them to.
Alderperson Meltzer was concerned that they had been hearing about people going to the emergency room to get treated for covid and that a lot of Covid cases were being acquired in the hospitals by people who had gone there for other reasons. “I just wanted to bring that up to see if we have some more insight or some more explanation of what’s going on there. Does the Covid crisis overwhelming our health system mean that now going to a healthcare facility risks exposure?”
Dr. Vogel that that was ” misunderstood information and misinformation.” She said that there were people, particularly children, admitted to the hospital for non-Covid related reasons who go on to test positive for Covid. But they were not acquiring Covid at the hospital. Rather, they came to the hospital asymptomatic and then became symptomatic, or they came in already with symptoms. “So, I think the procedures around masking—and we’re all using surgical masks for our patients as they come into the door now, rather than their home mask when they come into the facility—and I think that the procedures used for protective equipment by clinic personal, front facing, front line clinic personal and throughout our clinics and hospitals are actually protecting people. So, when people are turning—are becoming positive or are identified as having Covid infection in the hospital when they weren’t admitted for that reason, it really is that we’re testing everybody because we’re concerned, and we’re finding asymptomatic positives so that we can contain it.”
Mayor Woodford finished out the discussion by stressing that “if folks need emergency care they should still go to the hospital or they should still call 911 for emergency services. Those emergency services are still available. I mean, we continue as a city to provide those emergency services regardless of the pandemic at this point. And so, if people need help, they should still seek help.” He thought it was important that people not defer care, especially in emergent situations. At the same time, “the healthcare systems are also asking that folks not go to emergency rooms seeking Covid testing [but instead] that they look for covid testing through the sites we’ve been talking about this morning.” He again stressed that if people need emergency care of assistance that they should go to the emergency room or call 911.
View full meeting details and video here: https://cityofappleton.legistar.com/MeetingDetail.aspx?ID=921501&GUID=FF834A85-C1C3-41FE-AF45-8F7D97BEAF81
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