The Board of Health met 06/08/2022 and received the Health Department’s January-March 2022 quarterly report. This was not a time sensitive item, so I didn’t recap it at the time, but now, during this quiet week, I have the opportunity to revisit it.
Appleton Health Officer Charles Sepers reported that the health department provided Covid-19 testing through the first quarter of 2022 first with the National Guard, which ended in January, and then continuing with a community testing site set up in partnership with ThedaCare.
They started reviewing Emergency Operating Plans (EOPs) in the first quarter, but that work continued beyond that. The Emergency Planning Team included the Emergency Management Coordinator, a battalion chief from the Fire Department, a lieutenant from the Police Department, and somebody involved in safety at the Department of Public Works. During the first quarter, they began to look over emergency plans and develop annual training. He did not go into detail but mentioned that they looked at what their table top exercises/scenarios might need to look like and what would be informed by their plans.
He then moved on to review the Quarter 1 report.
The Health Department administered 106 total vaccines in the 1st quarter, 52 of which were for Covid-19. By comparison, during the same period in 2021, they administered 17,394 Covid-19 vaccines back when they were holding the mass vaccination clinics. The numbers this year were showing what a baseline might look like during a normal year.
Moving on to the Communicable Disease Cases category, he noted that gastroenteric cases were 10 compared to 5 in 2021.
There were 6,379 cases of vaccine preventable illness during the first quarter of 2022. All but one of these were cases of Covid.
[Honestly, the idea that our health department is classifying Covid as a “vaccine preventable” illness doesn’t really foster a lot of trust in the judgement of the people who work there. We can see with our eyes that many vaccinated people are getting it, including high profile individuals such as Bill Gates, Anthony Fauci, Jen Psaki, and Justin Trudeau. Trudeau and Psaki actually got it twice within less than a year, and Fauci experienced an unpleasant rebound a few days after thinking he was over it. Whatever the benefits of the Covid vaccine may be, terming Covid a “vaccine preventable” illness does not seem consistent with reality.]
He jumped back up in the report to the “Other communicable Diseases” section and noted the increase in tuberculosis (TB) cases. He thought the increase was largely due to screening. Due to the focus on Covid-19 last year, if patients presented with Covid-19 symptom but tested negative, a lot of times there was not much follow-up due to “triage”. Now in 2022, there was a lot more of the screening and follow-up that had fallen by the wayside in 2021.
[Frankly, if people continued on for a number of months with active TB because doctors didn’t bother following up on their symptoms after determining they didn’t have Covid, then that seems like a huge failure on the part of medical providers.]
Mayor Woodford asked Health Officer Sepers to speak to community concern about tuberculosis and if there was anything that the public needed to be aware of.
Health Officer Sepers responded that TV itself was not as communicable as some other diseases, so it was not a general public concern. People who do have TB, even latent TB, needed to undergo treatment. When TB transmission occurred, it was generally in a household setting, so it was important that treatment take place particularly in multi-family homes.
Mayor Woodford asked if he could speak at a high level about the mitigation the Health Department did for TB.
Health Officer Sepers said that for both active and latent TB, the Health Department conducted Directly Observed Therapy (DOT). That meant that a public health nurse would physically watch a patient consume the TB medication. He said that was a standard best practice supported by state resources to ensure that the TB was treated.
He went on to say that TB was typically seen amongst populations that recently migrated to the state, particularly the active TB cases. A lot of language support is typically needed when dealing with those cases as well as case management. The home visits in which the DOT happened also included help on how to navigate city and community services.
Chairperson Cathy Spears asked how the Health Department was handling those visits in terms of staffing. Was there just one nurse who handled these cases or were they handled on a rotational basis. Were the visits impacting staffing hours and availability to do other things?
Health Officer Sepers responded that they currently had 8 active public health nurses. All but possibly one of them were providing DOT and case management. It was typical to have one or two active cases at any given point. The fact that there were currently six cases in just the first quarter was more challenging. [He said “six” but the report seems to indicate “nine”. I don’t know if he simply misspoke or if there were only six cases that they were currently dealing with.] The treatment was between three and nine months depending on the specifics of the case. Treatment was 7 days a week, so it required nurses to work on the weekends. There was some rotation and scheduling around family commitments to ensure that coverage and compliance were met.
He acknowledged that they were reaching a saturation point of being able to continue, and things would become pretty difficult to manage if they had 6 more cases on top of the ones they currently were dealing with.
Chairperson Spears asked if the cost of this was covered by the department’s current budget and were there any grant programs available to facilitate adding more staff if need be.
Health Officer Sepers answered that there was currently a TB program through the Wisconsin Department of Health Services which covered some of the staff costs and there were some other reimbursement options as well particularly for case management. Unfortunately, those funds were pretty narrow, only around $10,000 a year. The bigger issue they were dealing with was that they were pumping up against their Full Time Equivalent limits. Currently they were sitting at around 4.8 FTE for public health nursing and those hours got generated pretty easily with the daily work.
A board member said she understood there was quite a surge of Afghan refugees so the fact that the TB numbers weren’t higher was encouraging.
Health Officer Sepers agreed. He reiterated that screening had been a challenge and they didn’t know if 2022’s numbers were actually higher than 2021’s numbers because of the screening issues they had experienced. He stated that the Fox Cities was not seeing a surge of TB. 6 was higher than 0 which was a concern in terms of Health Department resources, but it was not a concern from an overall public health safety standpoint.
Dr. Ring an intern at Mosaic Health Clinic who was a visitor at the meeting mentioned that at the Mosaic Clinic, they take care of the initial health screenings for a number of refugees. He stressed that every single refugee was screened for tuberculosis on entrance to the US. It was a very comprehensive evaluation that was performed for every patient.
Moving on, Health Officer Sepers reported that there were 83 mother/child health home visits in the first quarter as compared to only 6 during the first quarter of 2021. His exact words were, “And in the maternal and child health space—so these are also home visits. So, 83 in the first quarter, and so you can kind of see some numbers rise and some numbers decrease as Covid looks a little bit different.” [I’ve transcribed his words exactly, so you can see what he said. I don’t see 83 mother/child health visits. I see 7 visits total. If you added up all of the admissions and revisits across not only the mother/child visits but also the other adult and elderly visits then you would get 83. But as far as I can tell, based on this report, there were not 83 MCHs.]
Moving down into the environmental health areas, he reported that they conducted 4 licensing plan reviews and 20 pre-inspections in 2022 as compared to 1 plan review and 15 pre-inspections during the first quarter in 2021.
Actual inspections were very similar—67 in 2022 as compared to 69 in 2021—but the establishments in which those inspections took place were very different. Pool inspections stood at 13 in 2022 as compared to only 3 in 2021, but typical restaurant inspections were down to only 32 in 2022 as compared to 52 in 2021. He noted that there had been some staff changes which contributed to that. Re-inspections were up at 14 as compared to only 5 last year.
Complaints and follow-ups were both lower in 2022 as compared to 2021. Consultations had nearly doubled.
There were no food- or water-born illnesses this year or last year, likewise there were no rabies specimens in 2022.
Environmental investigations were down to 46 in 2022 as compared to 63 in 2021.
He noted that there had been an increase in temporary rooming houses such as Airbnbs, saying, “Since January 1 there were 16 TRHs or temporary rooming houses, so thinking Airbnbs. New TRHs. So currently that brings our total rooming houses up to 49. So—and this is a backlog—there is a backlog of that. So that’s a total of 60 if you include those applications that are pending. That’s in comparison to, in 2021 we had 8—8 TRH licenses. So I mean that’s like a 7 fold increase in terms of what that number is.”
[He mentioned the number 16, but I don’t see that number in the report in regards to TRH’s. Rather, regarding TRH’s, I see 0 plan reviews, 4 pre-inspections, 3 inspections, 2 re-inspections, and 22 consultations which would add up to 31. I’m not seeing the number 8 in regards to 2021 TRHs anywhere in this report, so I don’t know if I’m just reading the report wrong, or the 8 was total for all of 2021 and there were none during the first quarter of 2021, or something else. I feel like I generally have a better time following reports, but in this case, I couldn’t line up the numbers I was reading with the numbers he was saying, which very well could be my mistake. At any rate, feel free to download the report yourself and figure it out.] Bottom line, it sounded like there was some sort of big increase in Airbnbs in the city of Appleton.
Alderperson Vered Meltzer (District 2) wondered if the increase in Airbnb numbers was due to the fact that last year, prompted by concerns voiced by community members, the city had tried to publicize the fact that licenses were needed to run an Airbnb.
Health Officer Sepers thought that certainly had helped.
Alderperson Meltzer asked if there were any challenges and did city staff feel that there were a lot of unlicensed temporary rooming houses with owners that still needed to be educated and informed about the licensing process.
Health Officer Sepers didn’t have a sense of that. He mentioned that the temporary rooming house license increase was a challenging issue from a staffing perspective. He thought that Covid had helped spur the TRH boom and noted that travelling healthcare personnel used TRHs.
He stated that there are businesses that do nothing but TRH property management. That was a new industry niche that was growing. Currently the city works very closely with those businesses because most of the Airbnbs in the city were actually managed by one or two large TRH operators. The city worked with those companies to perform annual inspections in between guests when the Airbnbs were empty, but that was becoming more challenging as more TRHs were being opened. The Health Department had one open position that they expected to fill soon, so he thought having another employee would be helpful.
He moved on in the report and noted that lead elevations were down from last year, saying, “Lead elevations are down from last year, so 3 in comparison to 2021. So, this is important to think about though too; that lead level actually decreased. It was 5. The blood lead level was 5; now it’s 3.5—3.5 to 4.9, right. Er, it’s 3.5. So, if you look at the 3.5 to 4.9 there, there’s only like two in there, so these are true 3.5 and lower. So, but that was a point change.”
[I transcribed his words verbatim because honestly, nothing he said made sense to me. When I look at the chart in the report, I see 1 case of elevated lead levels and 2 instances of “education”—not 3 cases of elevated lead levels. It wasn’t clear to me if he was counting the “education” as “lead elevations”. As far as the important point he was trying to convey regarding the blood lead levels, your guess is as good as mine. Feel free to leave a comment explaining the point he was making and where on the report it shows a blood lead level of 5 μg/dL dropping down to 3.5 μg/dL. Like I said above, I had a hard time following this report and making the numbers on the page match up with what he told the Board of Health.]
He noted that the city had a contract with Planned Parenthood to provide STD testing and treatment. 5 people were served in 2022, undergoing a combined total of 12 tests with two individuals going on to receive treatment. Those numbers were all about half of what they had been at this point last year.
Regarding consumer protections, they had received 8 complaints in 2022 as compared to 6 in 2021. Out of the 8 complaints, they only found 2 violations which was up from 0 last year.
At the end of the 1st quarter of 2022, the Health Department had conducted only 121 onsite inspections as compared to 167 at the end of the 1st quarter in 2021; however, they had some staff changes in Weights and Measure and an employee who had been with the city for 14 years had “cycled out of that role”. [I’m interpreting that to mean he retired.]
Price scanning inspections, however, were fairly comparable year over year.
He finished up the report by mentioning that one of the big things that stood out in the first quarter of 2022 was that Appleton took over the City of Neenah’s Weights and Measures program. They had been able to establish a streamlined process to bring Neenah on without adding any extra staff. The end result was a positive impact on revenue.
He opened things up for questions.
Chairperson Spears asked if there had been any monkeypox cases in the city and if the Health Department was concerned about monkeypox. She also mentioned that she had read an article which stated that people born after 1972 had not received the smallpox vaccine.
Health Officer Sepers answered that there were no cases of monkeypox in Appleton yet, but they were seeing pockets of outbreaks and cases were probably being undercounted. They were not, however, expecting a national epidemic, and the pockets of cases that were popping up were one-offs.
In answer to a question from Mayor Woodford, he confirmed again that there were no cases within Appleton, and he didn’t believe there was even a case within the entire state of Wisconsin. [There has, since this meeting, been one reported case in Dane County.]
Chairperson Spears responded, “Right I didn’t think so either, but I—you know I find it ironic and glad I’m old as I am because I had the smallpox vaccine so.” [Frankly, it’s a little difficult to take the Board of Health seriously when the chairperson makes nonsensical comments like this. This meeting happened June 8th. By the end of May, prior to this meeting, it was already established that the current monkeypox outbreak was tied to sexual activity at a couple raves in Europe. While it’s not a sexually transmitted disease per se, the chairperson of the Board of Health suggesting that her smallpox vaccination was the main thing protecting her from getting monkeypox vs simply not having sustained close contact with a person who has monkeypox rashes does the community of Appleton a disservice by presenting a deeply incomplete and wholly inadequate picture of the relative risk of getting monkeypox and the best way to prevent infection. It’s also worth noting that the CDC, hardly a vaccine-hesitant organization, is not recommending the pre-exposure prophylactic use of vaccination to prevent the spread of monkeypox outside of some very limited cases.]
Health Officer Sepers responded with a noncommittal, “Yep,” then changed the conversation by saying that, while they were on the topic of current events, the FDA had approved a fourth Covid shot.
He also said that not covered in the first quarter report were the first quarter Key Performance Indicators for the Health Department.
He did not go into them in detail and said that there wasn’t really anything that stood out, but he mentioned that they had submitted their 2021 Annual Report on May 16th. You can download those below:
View full meeting details and video here: https://cityofappleton.legistar.com/MeetingDetail.aspx?ID=959063&GUID=126642DD-65A5-4C75-A1F5-3F4735D4DE38
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