The Board of Health met 02/09/2021. As per usual, the majority of the meeting was taken up with the coronavirus update, but there were also a couple on non-covid items.
We were introduced to Kathleen Fuch, the newest member of the Board of Health. She retired 7 years ago from Lawrence University. She worked as a psychologist for 3.5 decades, and worked on crisis preparedness work in the community a decade ago during the H1N1. Lawrence received a federal SAMHSA grant in the last few years that she was at Lawrence, and she did work with that. She is excited to get back in the loop and hopes that some mental health perspective would be helpful to their/our work.
The Board took this opportunity to introduce themselves, which was interesting.
Alderperson Denise Fenton is the alderperson for District 6 and is happy that Kathleen, who is her constituent, has joined the board. Alderperson Fenton had encouraged her to do so. She doesn’t have a public health background but she is learning a lot on this board.
Cathy Spears has been on the Board of Health since 2004 when she was an alderperson. She has a degree in medical technology and a double degree in microbiology and public health. She works in the lab at Mosaic Family Health. This has always been a passion for her and she’s now a citizen member. She’s in the district abutting Kathleen.
Doug Nelson is a retired dentist. He didn’t remember how long he has been on the Board of Health. When Tim Hanna became mayor he asked Doug to join. He has been retired for 3 years and is now basically a wildlife photographer and grandpa.
Lee Vogel has been on the board between 25 and 30 years. She’s on the faculty at the Fox Valley Family Residency whose clinical practice and home is at Mosaic family and health. She’s the executive director there and also a geriatrician. She thought that the Board would benefit from Kathleen’s mental health background.
Doug Nelson agreed that they hadn’t had that background represented on the Board before and thought it would be good.
With introductions made they moved onto the meeting business.
The first item was the contract with the Expo Center. It was necessary for them to approve it in order to keep using the facility which started out as a testing site and is now being used as a vaccination site. The money to pay for it is coming from Covid related grants that the city has received from the federal government.
Doug Nelson said he saw there was a walk-in cooler and wondered if that was where they were storing the vaccine or if the vaccine was being stored in a separate unit.
Per Health Officer Eggebrecht, that cooler is just intended for the volunteers to put their lunches. They have a separate facility on-site to store vaccines. The Expo Center worked to make sure they had backup generators for the vaccine storage unit.
Mayor Woodford mentioned that the city is very appreciative of the collaboration with the Paper Valley. They’re very pleased that they can use this facility which was built with the shared resources of all the surrounding communities to serve not just Appleton but the whole tri-county area.
The contract was approved unanimously
After that Health Officer Eggebrecht moved into the Covid-19 update.
Appleton’s first case appeared in early March of 2020. As of the date of the Board of Health meeting, we are now up to 7,734 lab confirmed cases. Kurt stated that that indicates the disease continues to be widespread in terms of transmission. 422 residents were still in active isolation. 60 residents have died.
Doug asked why the total positive cases differed from the total confirmed cases.
That is the difference between positive PCR and positive antigen tests. Health officer Eggebrecht said that early on there were just PCR tests, and the state defines a positive Covid test as a positive PCR test. However, antigen tests now exist. If someone who is symptomatic has a positive antigen test, Appleton lists them as probable and considers them as a positive case. They respond just as they do for a positive PCR test and perform the same contact tracing and the same quarantining.
Per Health Officer Eggebrecht, “probable also includes those that might be like a family member, where there’s a lab confirmed case of a family member and then other members of that household become ill consistent with Covid symptoms. Those also are classified as a probable case.”
He mentioned that the city saw a rapid rise in cases in the fall which peaked in the winter months, then came down before the holidays, then increased after the holidays, and now cases have come down and plateaued at a level the city hasn’t seen since August. He stated that we still have a ways to go.
The state has defined the levels of low, moderate, high, very high, and critically high, and our burden still places us in the very high category.
[This is interesting because, as he stated above, the state defines a positive case as one confirmed by a PCR test. He also indicated that the state also sets the guidelines for what community burden levels are considered low, moderate, high, very high, and extremely high. It’s not clear to me that, if the state sets guidelines around both what is a positive case and what burden levels are, that it’s appropriate for the city to be including either people with positive antigen tests or people with no tests at all when calculating the city’s burden level. Our most recent 2 week burden rate calculated with only confirmed cases is only 339 which drops us down to the High category, but it’s 417 with probable cases thrown in which keeps us in the Very High category.]
The state also sets the standards around how trajectory is defined. Currently Appleton’s trajectory is not changing. Our burden rate of Very High and our trajectory of no change and we are right in the middle purple Very High box.
The Department of Health continues to do contact tracing. They are in close communication with all the schools in the city, both public and private, so when cases arrive in a school setting the school focuses on conducting contact tracing within the school and the Department of Health looks at contacts outside of the school building.
Health Office Eggebrecht then moved on to what they are seeing at the state level. There are 3 different virus variants that the state is tracking. They just learned the day before that the B117 variant has been identified in a couple Wisconsin communities. The state surveillance system works by taking a small sample of all the cases and performing a sequencing so that they can determine the strains that are circulating. This new strain appears to be more contagious so it could accelerate the number of cases in Wisconsin. It’s also probably more widespread in the state than just the two identified cases would indicate. Neither of the 2 people who had it have any history of travel, which would indicate it came through community spread. In the UK the B117 variant became the dominant strain, and it’s likely in the coming weeks that it will become the dominant strain here and in the US over time because it’s more contagious.
Health Officer Eggbrecht stressed that that is why it’s important that everyone understands that although case counts are coming down, there are challenges ahead, and everyone needs to keep following the mitigation strategies of face coverings, social distancing, and frequent handwashing. Mitigation practices are going to be important moving forward.
Appleton added a couple new contact tracers knowing that AASD was returning to limited in-person instruction. Those new contact tracers have taken the lead in contact tracing so that other Department of Health nurses can redeploy to vaccinations.
Mayor Woodford asked to return to the new Covid strain for a moment and asked if Kurt could tell people what to expect in terms of symptoms or effects of the new variant.
Health Officer Eggebrecht answered that the first incident of the B117 strain was detected on January 12, 2021. There is some evidence emerging that the new strain causes an increased risk of death.
Doctor Vogel said that the array of symptoms is the same as other strains but the potential for it being more severe is greater. She thought we would know more about that in the next month or so. People are worried if it’s still responsive to the vaccine, but, per Dr Vogel, the vaccines appear to be effective against it. She stated that because it’s much more contagious that means vaccination and mitigation efforts are much more important because we’re on the front end of the virus outpacing our vaccination efforts.
Alderperson Metzler asked about people starting to wear 2 masks instead of one.
Health Officer Eggebrecht said that the Department of Health hasn’t come out with a stance on that because they haven’t gotten guidance from the state yet. There is some evidence that a person can have greater protection both for transmitting or contracting the disease if they double mask. However, he said there is a greater benefit just by wearing a single mask in the proper way, instead of sloppily or under the nose. He also mentioned that double-masking can compromise a person’s ability to fully breathe as well–particularly if one of the masks is an n95 mask. He thought that intuitively it makes sense that the more you filter as you breathe the more mitigation there would be. He said that the state hasn’t taken a strong stance on double masking, and Appleton has remained pretty neutral in their messaging to the community. What they would like is to see everyone wearing a single mask properly. If people choose to wear two, that’s a personal choice.
A Board member raised the issue of low testing. Per the questioner, based on the state’s reported deaths and reported positivity rate it would seem that testing rates are disproportionately low.
Health Officer Eggebrecht agreed that was a concern. He talked with the new state health officer and said that they are all a little puzzled because there is more testing capacity than they’ve ever had and more opportunities than ever, but fewer people are seeking testing. One hypothesis is that starting in 2021 companies that used to pay an absentee benefit for people who were in isolation and quarantine are no longer following that practice. So many employees now have to choose between staying home and following isolation orders or simply not getting tested so they can go to work and be paid. He thought more research needed to go into that. The positivity rate is still very high–25% and 30% consistently. The consensus is that if there were truly a lack of disease transmission that positivity rate would be between 5% and 8%. [There was no mention of what the decrease in hospitalizations indicates about this.]
He mentioned that the testing site had been moved out of the Expo Center to Reid Golf course. The same National Guard team is running it. The number of tests performed Since January are fewer than at the beginning of the outbreak. They have all scratched their head about that.
Regarding vaccinations, partnerships with pharmacies continue to grow. More vaccine will be coming this week to pharmacies which means that in this next month people will be able to go to their pharmacy to get it if they’re in an eligible group.
One of the Board members mentioned that clinics and vaccination centers have the capacity to vaccinate more people than pharmacies and wanted to know how the state is addressing that.
Per Health Officer Eggebrecht, there is some controversy around that because everyone would like to have more vaccine. Through the experience with H1N1 the state gained a recognition that the pharmacists play an important role in vaccinating the community and, as a result of that experience, the state advisory group decided to elevate pharmacists because people are sometimes more likely to get their vaccination from the place they already get their medications from and with whom they have an affinity.
The question was raised as to whether many pharmacies have the ability to store the Pfizer vaccine that has cold storage requirements.
Health Officer Eggebrecht answered that CVS and Walgreens have the capacity to do cold storage, maybe not at all facilities but within their system. Also, most of the Moderna vaccine, that doesn’t require that cold storage, was prioritized for the work that the pharmacists are doing in long term care and assisted living facilities.
He said Appleton is now targeting vaccinations to those 65 and older. They have collaborated with Partnership, Primary Care Associates, Kaukauna Clinic, Ascension, and Theda Care and are trying to share resources so that they aren’t duplicating the non medical components that go into operating a clinic and instead focusing on vaccinating people safely and in a comfortable environment in the hopes that they can vaccinate people quickly ahead of the new more virulent Covid strain the the state.
The Expo Center is focused on targeting those 65 and over because, per the health records released by area healthcare partners, those are the people disproportionately experiencing hospitalization and death.
The state has put a targeted date of March 1 to move into the next vaccination phase. Some communities have hit their 1A targets and other larger communities aren’t even halfway through their 1A residents. Not every community is going to be experiencing the same eligibility at the same time. It’s likely that in early March, another group of people will be eligible and you’ll see and hear that other communities are vaccinating public teachers but not all communities will be. In Milwaukee and Madison there’s going to be a longer time frame where they’re addressing the 65+ group before they get to the other people even if the other people are eligible under state guidelines. He thought that might be a confusing concept for many but felt it was important to share with the Board of Health so they had an understanding behind why that was happening.
The expo center has been working very nice even in the cold weather. The setup minimizes people’s exposure to the cold. The whole process from when they walk into the building and when they leave is about 40 minutes. That includes the 15-30 minute observation time.
Per Health Officer Eggebrecht, hey have a really good vibe going. The volunteers are really engaged and the people who are leaving are leaving with a renewed sense of optimism for the future.
Last week they did 1000. This week they hoped to do between 1,800 and 2,000. For the following weeks they have to base it on the vaccine supply they have. They should be able to increase their capacity promptly as vaccine becomes more available.
They’ve been running the clinics Tuesday, Wednesday, and Thursday from 9-11:30am and then again 1-3pm
Kathleen wanted to thank everyone who was working on it. She got vaccinated there last week and was blown away by the organization, cooperation, and the spirit that was there.
One Board member wanted to know where they stood on the backlog of 4,700 people who signed up for only 1,000 available vaccines. (https://allthingsappleton.com/2021/01/30/covid-vaccination-rollout-not-going-smoothly/)
Health Officer Eggebrecht said they have a waitlist that they’re trying to close as quickly as possible. About 1/3 of the people they have contacted have already obtained other vaccination options elsewhere. He believes they’ll be able to close that waitlist by next week. The limiting factor is the amount of vaccine available.
They are looking at people in the 1a and 65+ where if they have vaccine they can quickly bring in a group. Just last week they had a group of clergy members they’ve been working with throughout the pandemic. Those individuals were high risk because they were visiting patients in Covid units and performing last rites. They also know there is disparity in ethnic groups. Black and Hispanics populations have higher incidents of hospitalization and death so the city reached out to the African Heritage group and vaccinated individuals on a list the group provided.
The Pfizer vaccine has a really short shelf life. Once it’s brought out it needs to be used. If there are any remaining doses the system throughout the state is there is a regional distribution coordinator and then it goes back to that regional coordinator and he will redeploy it to pharmacists or healthcare systems that can use that vaccine before it stops being effective so there’s no waste to the vaccine. Every vaccinator is required to enter every vaccination given into the Wisconsin Immunization Registry within 24 hours. That’s how the state is able to draw a picture of vaccination rates within Wisconsin. He thought it made the news the day before that Wisconsin is leading the country in terms of the vaccine we have received actually being administered to people.
One Board member wanted to know how they were handling registering elderly people who lacked the technological ability to schedule online.
Health Officer Eggebrecht said that after they clear the wait list, they have the ability to withhold online applications for a percentage of available vaccines and make those available to people who may not have access to a computer. What’s difficult to know is who are those people and how do you reach them? They’re finding that many of those people have a child, sibling, or neighbor who is able to help them. They’re exploring the best and most equitable way to make the system work for people who don’t have access to a computer, but they don’t want to encourage by default a phone based registration system because that’s not as efficient as an online registration process.
Doug Nelson wanted to know how long after having received the second vaccine dose would people be able to not necessarily go without a mask but feel more comfortable resuming their normal life.
Per Health Officer Eggebrecht, normal is in the eye of the beholder. People develop immunity 2 weeks after the second dose. But they are still supposed to wear masks and social distance; just because they’re vaccinated doesn’t mean they couldn’t’ contract and shed the virus–they just wouldn’t get sick.
Right now Appleton is in the Very High. He said that when we get down to the Low category that would be the time to have a discussion about when and how we go about getting back to what we once thought of as normal. He also pointed out that all the vaccines currently available to adults are not available to children; the FDA has not approved their use in children. That likely won’t happen until the fall. So, there is still a sizeable part of our population that remains vulnerable and capable of contracting and spreading the virus.
A Board member wanted to know what outreach was being done for people with a language barrier.
Health Officer Eggebrecht said that’s something they want to be mindful of as they gain more vaccine and the clinic expands to more people. Their experience is that people with a language barrier are coming with an assistant to help with translation. They’ve only had two instances where they needed to use the language line. They have a contract with several different firms they can dial up through an 800 number to get a translator on the phone immediately. They do have an eye to the future of having a Hmong and Spanish speaking interpreters, but they learned from the testing site that when they brought those people on site, they weren’t used.
The questioner mentioned that all the information was being distributed in English and wanted to know how the city was getting the word out to non English speakers in the community.
Health Officer Eggebrecht said they could do better at that. Alderperson Thao is Hmong and has been very instrumental in getting info to Hmong leadership. They were able to vaccinate the local Hmong spiritual leaders 3 weeks ago for their first dose, and they’ll be coming back again next week for their second dose. Those spiritual leaders have then worked with the Hmong community.
Similarly, before her departure, Karen Nelson established a group of people of color and people with language barriers whom the city has been able to work with throughout the pandemic. This was passed off to the communications director in the mayor’s office after Karen left.
Some more concerns about the decreased demand for testing were brought up. And Doug Nelson mentioned that he hadn’t known the site had moved to Reid.
Health Officer Eggebrecht mentioned that in addition to the testing site, they’ve been able to bring antigen testing into AASS as well as Pillars.
Someone expressed a hope that the federal government would give employers more CARES Act money so that they could keep paying their employees to stay home if sick.
Someone wanted to know what happens if someone is already infected but they’re asymptomatic and they go to get vaccinated. Does the vaccine still work?
Per Health Officer Eggebrecht, when someone gets covid and recovers, they will develop antibodies. That immunity is strong for 90 days and probably lasts for some time beyond that but wanes. The recommendation from the CDC and the state of Wisconsin is to get vaccinated whether or not you’ve had Covid because the vaccine will give you a longer and stronger immunity.
With that, they ended the Covid update and moved to the survey results. They sent out a survey to 1/3 of the businesses they inspected last year to find out how they are viewed by the establishments. For the most part, results were positive and the Department of Health was happy with the results.
View full meeting details here: https://cityofappleton.legistar.com/MeetingDetail.aspx?ID=837509&GUID=0D6AEDB2-B2E7-480D-8071-7555E30E98FF&Options=info|&Search=
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