The Board of Health met 05/11/2022 and received their first Covid-19 update since reviewing the new risk level methodology back in March.
Amongst other things, they reviewed vaccination numbers, discussed the transition to the “endemic” stage of Covid-19, and touched on the Health Department’s discussions with the Appleton Area School District.
Instead of the multiple slides that past Covid-19 Updates included, this one had only one visual showing various vaccinations rates. The percentage of Appleton’s population that was fully vaccinated was 72.3% which Health Officer Charles Sepers said had not moved much in the last 2 or 3 months. [In March it had been at 71.8% so experienced a half percent increase over the course of 2 months.] He said that they were seeing a national stalling of the vaccination rate, but Appleton was leading the way in terms of being vaccinated as compared to the surrounding counties. The vaccination rate in the 5–11-year-old group had increased slightly more so that in the other categories, but rates overall for the city had not moved much in the last 2 or 3 months. [I’ve included the vaccination rate slide from March for comparison.]
When the new CDC community level Covid-19 guidance came into effect, Appleton moved to system wherein if it would take on the highest of the community levels of any of the three counties it straddles. Winnebago County was currently at “Medium”, so Appleton had also moved into the “Medium” category. He noted that this increased level was based on case numbers, not hospitalizations, and they were not seeing clinically significant Covid-19 infections.
He reviewed the case numbers for the last several weeks. They had been quite low then increased to a little over 100 where they stalled. They had been seeing some infections due to spring break and vacation. He expected cases to stay around that level until the end of the school year and did not expect any radical changes.
He touched on Covid-19 deaths because that had changed since they last met. “We’re currently at one hundred and sixty covid nineteen deaths. This was a considerable increase from the number of deaths that we had reported back in March, and that is due to a process change. So, prior to March we were really relying on coroners, our hospital partners, and that physically calling us to record. we are now using the state WEDSS data to capture that.”
He noted that they were seeing very few deaths at this point, but occasionally the number would climb. This was largely due to the Department of Health Services (DHS) going back and cleaning up data. Overall deaths could increase, but the death added might be from June of last year.
Appleton was no longer running a community testing site. They had been in partnership with ThedaCare to run one, and the city had set some criteria for when that testing site would be closed. They were looking at the numbers very closely “and we do have a plan to execute a community testing site if we determine that that there’s need—so exactly what those criteria are. We’re still sort of working through that as we consider test positivity numbers, rate of transmission, some of these other things.”
The city had recently hired a Covid-19 fellow who was a great addition to the team. She was taking on tasks which freed up staff to go back to their regular duties.
DHS launched a new antigen testing program which allows local health departments to order large quantities of rapid at-home test kits with the aim of getting those kits into strategic sectors. They were hoping a meeting later that week to consider where those tests would be sent. He mentioned Pillars as a likely organization.
The Appleton Health Department was working closely with schools to consider what protocol changes might be in place for the 2022-23 school year. There were no changes at this time, but they were having conversations on what the guidance would look like.
That was the conclusion of his report, so things were opened for questions.
Board member Emma Kane said that when she went to the city’s Covid-19 website she didn’t see any clear indication as to how individual behaviors might change given the shift from a “Low” to “Medium” community level. Was any communication being made to make sure people understood that with the shift to “Medium” masks were not required but they were more recommended?
Health Officer Sepers said that they put something out on Monday letting people know that the CDC framework recommended that, in the medium level, those at risk wear a mask in a public setting.
Board member Kane said that information was not easily accessible on the website which states what the level is but gave no actions people could take in response to that level. Health Officer Sepers said they could look into it.
Board Chairperson Cathy Spears said that she was concerned about the lower vaccination rate in children and asked if they had talked about addressing that with the schools.
Health Officer Sepers said there had been conversations; however, “You know right now there’s not a whole lot of appetite for doing that, but doing, you know like, school site vaccine clinics those are part of the conversations that that we are having. What we are seeing is that there’s not a whole lot of appetite for that but again these are conversations on going.”
He did expect there to be a little bit of a jump when vaccines were made available to children under 5 which he hoped would be very soon. He said there was always a jump in all categories when a new age group became eligible for the vaccine. Additionally, they were meeting the new school leadership later this month and were going to have those conversations at that time.
Alderperson Denise Fenton (District 6) asked if there was a way to extrapolate how much cases were underreported given that the vast majority of testing taking place now was at-home antigen testing and those people were not reporting their cases.
Health Officer Sepers answered that there wasn’t a hard and fast way to do that at this point. There had been undercounting with the PCR, rapid PCR, and lab-collected antigen testing, and that undercounting was going to increase even further. “We don’t have a good read on what that is. I think that, you know, a couple years from now we’ll have some really good data and some really good science to understand exactly how far that undercounting is, but we don’t have that at the at this point. I think it would be dangerous to sort of get into the weeds in terms of predicting what that might look like.”
Chairperson Spears asked if there was a telephone number that people could call and report that they were positive.
Health Officer Sepers responded, “The difficulty with that is, other than providing the Covid-19 education, there’s not a whole lot of activity to be done around that.” Currently, people who tested positive with an at-home antigen test were considered to be a “suspected” case of Covid-19 as compared to a “probable” or “confirmed” case. The state and CDC were not collecting data on “suspected” cases right now. A family who had tested positive had actually called the Appleton Health Department recently to report it, but the Health Department hadn’t been able to do anything with those numbers.
Mayor Woodford asked if Health Officer Sepers could speak on the philosophical shift in public health and what public health was looking at now in terms of causes for concern and what was triggering response actions at all levels.
Health Officer Sepers explained that part of the new CDC masking guidance was aimed at moving into the endemic stage of Covid-19 in which there was a low-level constant virus that was always present in the population. “The federal framework is designed to remove public health to some degree out of that constant state.” There had been a lot of conversations around testing to treat and expanding the federal retail pharmacy program that allowed someone to get tested for Covid-19 and received a Covid-19 antiviral at the same time. “A lot of the actions around that that federal framework and a lot of the actions that DHS are taking are designed to think about how do we transition public health out of the Covid 19 pandemic response and into, you know, testing [and] vaccinations which are traditionally healthcare elements. […] Obviously vaccinations will always be a function of public health to some degree, but not into that mass vaccination piece.”
Mayor Woodford asked what public health was monitoring at the local level such as hospitalizations and deaths in terms of critical indicators.
Health Officer Sepers essentially seemed to say that as they moved from the pandemic state to the endemic state, the overall number of cases was not as important as the number of cases of clinical significance. “The new Omicron variant that is set to be the national dominant variant this week is even more infectious and less clinically significant right? So, we’re gonna see more variants like this, where more people are developing Covid-19 but are not seeing that sort of clinical significance.”
Harkening back to the question about the undercounting of cases, he said that the actual number of people with Covid-19 was becoming less important than the hospital capacity and the number of fatalities “which we see is rapidly moving downward.”
Board member Dr. Lee Vogel jumped in and stressed that vaccination was still important even as they moved from a “prevent all cases” mindset to a “prevent death and hospitalizations” mindset. She said that a recent study showed that 42% of people hospitalized with Covid-19 were vaccinated. [I’m wondering if she was referencing the analysis by the Washington Post that found 42% of Covid-19 deaths in January and February were among the vaccinated.]
She was worried that people would look at that number and conclude vaccination didn’t make a difference, but she stressed that the rate of hospitalizations among unvaccinated was still higher than among the vaccinated.
Additionally, people were still trying to figure out the “new normal” and were developing their own personal codes for how they wanted to protect themselves, their loved ones, their neighbors, and strangers. Paying attention to Covid community levels was like checking the weather forecast. “We have bad weather and then we have storms like thunderstorms that need to be alerted, and we have code grays and code blacks or watches and warnings depending upon your language. How we respond is quite different. And when public health and CDC trips a trigger for a bigger alert it’s going to be kind of like we live with some bad storms and we don’t always get alerted to those. And so, we’re all trying to figure that out no matter whether we’re individual citizens or we’re public health or doctors.
She also loved the civic duty demonstrated by residents calling public health and reporting their positive status. Although there was no benefit to the Public Health Department when residents did that, there was benefit to residents to call their doctors and report it so they could figure out if it needed to be treated or not. Treatments were available although they were limited to those who were sickest. “There’s kind of these algorithms, if you will, to prevent disease and not treat everybody, because the value of an oral antiviral is still dependent upon how sick you might get without it and how risky is the medication to you.”
View full meeting details and video here: https://cityofappleton.legistar.com/MeetingDetail.aspx?ID=959067&GUID=1D47D790-7EA7-4474-BA90-B60C90C9CF4C
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