On 12/09/2020 the Appleton Board of Health held its very first virtual board meeting. [They did not mention why this was and it seemed odd to me for them to do that now when cases seem to be decreasing vs. 6 weeks ago when cases were at their height. Additionally, their video placement choice was odd because if they had just turned the camera a bit to the left we would have been able to see the screen with all the Zoom participants on it. Instead, all we could see during the meeting was Cathy Spears, the one, lone, in-person participant.]
There was 1 action item and then the rest of the meeting was taken up with coronavirus related information items.
The action item was a request to approve a noise variance for Fox River House so that they can play live music next year. In previous years, a neighborhood group had complained of excessive noise. This year there was no opposition to the noise variance request. Apparently the owner of Fox River House has been working to address issues directly with neighbors. Health Officer Kurt Eggebrecht has heard from the neighbors and reported that they are pleased with how Fox River House handled things last year and how responsive they were to complaints.
The noise variance request was approved unanimously which was a change from previous years.
After that brief bit of business they moved on to the Covid-19 update.
Health Officer Eggebrecht reviewed that fact that now that coronavirus antigen tests are available in addition to the PCR tests that have been used throughout the pandemic, they have started adding antigen testing results into their daily reports.
Positive antigen tests are reported as “probable cases” whereas positive PCR tests continue to be reported as “confirmed cases”. Kurr felt it was a better reflection of the true rates in the community rather than just showing PCR test rates.
Testing and tracing and quarantining protocols are the same in response to positive results from either test.
As of the day/time of the meeting, Appleton had 5,583 positive tests (both antigen and PCR), 507 active cases, and 44 deaths, and cases have decreased to the point that Appleton has moved from the “critically high” category to the “very high” category. The weekly total of cases increased slightly over the previous weekly total [note: only if you include probable cases in with confirmed.] but it wasn’t a large increase so Health Officer Eggebrect was still pleased.
They calculated the burden at 732 [again a note: it would be 585 if it was calculated using only confirmed cases] as is the lowest it’s been for a while. Appleton’s trajectory is decreasing.
Health Officer Eggebrecht expressed that the health department is very encouraged by the decreasing cases but somewhat guarded at the same time. Over the last couple weeks there has been a reduction in the number of people seeking testing and he is concerned that that is playing a role in the lower case count. He and other health professionals do not have an explanation for the sudden decrease in demand for testing. He also mentioned that this lack of demand for testing is not unique to our area but is a statewide phenomenon.
He also said something that I didn’t fully understand. He stated that the positivity rate remains very high (close to 30%) and that the high positivity rate is an indication that we have insufficient testing in our area. [I was confused by this because, clearly, we don’t have insufficient testing in our area. It’s readily available. People seem to be simply choosing not to get tested, but that doesn’t mean there’s a lack of testing availability.]
He was pleased to see rates decline but was concerned that the decline would not continue given that Thanksgiving happened a couple weeks ago. Nonetheless, he stated that he wanted to report transparent and accurate information and that declining numbers are what we are currently seeing, and he is pleased it’s trending in that direction.
Mayor Woodford asked him to provide an update on local hospital capacity.
Per Health Officer Eggebrecht: right now their capacity is improving. They’ve been able to maintain all their services including their ICUs. However, they believe that this week is the week that they’re likely to see the impact of Thanksgiving. The hospitals and healthcare providers are all concerned about the decrease in people seeking testing, and they don’t have a good handle on what is driving that. They are guardedly optimistic [he used variations on the phrase “guardedly hopeful” multiple times throughout this meeting] that there are truly fewer cases vs sick people simply not seeking testing, but the high positivity rate they are seeing with processed tests suggests something is amiss. He thought they would know more by the end of the week. There are still 16 ventilated patients in regional ICUs [it was not clear to me if these were all in St E’s and the Appleton and Neenah Thedacare facilities, or if they were spread out throughout the entire Fox Valley HERC region.]
Kurt stated that there is still a lot of concern about this disease. And it has really impacted the healthcare system in terms of demands on staff and the workload it has created.
Cathy Spears mentioned that she had seen some PSAs on television from the Community Blood Center asking people to donate convalescent plasma. She wanted to know if they were having difficulty getting people to volunteer and if the local supply of convalescent plasma was low.
Health Officer Eggebrect mentioned that there has been some concern about people not donating blood like they have in the past. He had not had any communication with the Community Blood Center for the last few weeks and had not received any notifications like they normally send out when donations are low, but he could call them later that day.
Cathy reiterated that she was not talking about blood donations but rather about convalescent plasma that can be donated after someone has had and recovered from Covid. It’s not turning out to be as wonderful of a treatment as they once thought, but it’s still a tool and she wanted to make sure the supply was sufficient.
I believe Doug Nelson [though I’m not positive because the screen of the Zoom conference was not recorded and I could not see who was talking] wanted to know if Kurt had any insight into why the coronavirus numbers are going down.
Kurt said there had been discussion about that the previous night during a meeting of health professionals within the Fox Valley HERC region. They had no explanations–only speculation. In his opinion, human behavior is interesting and has been throughout this pandemic. He speculated that nobody wants to be the guy who was told not to gather during Thanksgiving and now has symptoms and needs to get tested.
“I don’t know,” he stated. “I really don’t know.”
Lee Vogel also engaged in self-admitted pure speculation. She posited that we are entering a really dire time in terms of people’s financial situations. People don’t have a sense of improving security or a sense that the federal government is going to come through with another Covid relief check or an extension of Covid-specific unemployment benefits. She suggested that people don’t want to get tested and find out they’re positive and then not be able to go to work for two week, unlike healthcare workers who, due to a critical shortage of manpower, have emergency authorization to continue to mask up and work even if you’ve been exposed to a Covid positive family member. [I was unaware that healthcare workers of all people didn’t have to be rigorous in their quarantining protocols.] She thinks that if the choice is between eviction and not being able to put enough food on the table vs hiding a need to be quarantined and out of work for 2 weeks, that people would go with the option that allows them to pay their bills.
Denise Fenton asked what the status of the local testing sites was is.
Health Officer Eggebrecht reported that the North high school testing site has had its funding extended by the state and will be able to continue through January 6. AASD is planning a partial reopening starting January 19, so there will be conversations with AASD to see how long testing can continue at that location. Additionally, cold weather protection will be a challenge at all 70 National Guard sites across the state.
ThedaCare has mobile testing capabilities and is looking to put a mobile unit up at the Timber Rattlers stadium into 2021. ThedaCare also has a site at Christ the Rock. Kurt’s understanding was that they are not charging for tests because the kits came from the federal government and were paid for by taxpayers.
Lee Vogel confirmed that the tests at the ThedaCare mobile testing unit are free.
Kurt did not believe ThedaCare was using an antigen test. He thought they were using a PCR test that was different from the one the National Guard does–one that people can swab themselves.
Health Officer Eggebrecht then returned to the impact of Thanksgiving on hospitalizations. The anticipated timeframe for when Thanksgiving-caused coronavirus cases should start showing up in the hospital is 10 to 21 days after infection. Per Kurt: we’re still entering that phase.
Doug Nelson stated that Anthony Fauci says we’re entering the darkest days of the pandemic.
Kurt went over the new CDC guidelines for quarantine. He stated that at the federal level they have recognized that it’s difficult to get compliance with the current guidelines so they’ve come up with new guidelines. First he reviewed terms….
Quarantine is when someone who is well but has been exposed to someone who is Covid positive separates themselves from others during the time when they could become ill and potentially spread the illness.
Isolation is when someone is ill and has a lab test to confirm that they are Covid-positive.
There are two new options for quarantining.
(1)Stay home for 10 days then, if they are symptom free, a person can return to school/work while continuing to monitor themselves for symptom for the remaining 4 days of the 14 day period.
(2)Quarantine for 7 days and get a test on day 5. If it comes back negative a person is able to return to their normal activities while continuing to monitor their symptoms for the remainder of the 14 day period.
He stressed that the virus hasn’t changed and the science behind the 14 day timeframe hasn’t changed. These changes in protocol are just a matter of practicality to get more people to comply with the hope that that will reduce the overall community burden.
The state has estimated that if people choose that 10 day option about 10% of them will contract and spread coronavirus during the final 4 days period when they’re in the community but still monitoring for symptoms. If people follow the 7 day option, that number could rise to 12%. Per Kurt, there’s a recognition that these protocols are not best practice and people will transfer the virus; however, if you get more people to comply there is a net gain, and that’s really the strategy.
He then reviewed a powerpoint the State of Wisconsin had prepared about the coronavirus vaccines. It was a 30 minute presentation that he tried to boil down to 7 minutes.
There will be 2 vaccine products available–Pfizer and Moderna. Both companies applied for emergency use. Both require 2 doses. Both only conducted clinical trials for adults, so children won’t be eligible. The Pfizer product has extremely cold temperature requirements that make it difficult for most facilities to store it. The moderna vaccine does not require that deep cold. Regular freezers will be sufficient. Pfizer will come in doses of 975. Moderna will come in doses of 100.
Although full guidance on who should get the vaccine during early distribution has not been finalized, the most likely scenario is….
Phase 1a: healthcare providers, long term care staff, and long term care residents.
Phase 1b: essential workers.
Phase 1c: individuals over 65 and those with underlying health conditions.
Likely there will be an overlap with each phase–meaning that when phase 1b is announced, people in phase 1a will still be eligible, likewise with members of phase 1a and 1b once phase 1c is announced.
The rollout of the vaccine started 12/10/2020 with the announcement of FDA emergency approval for use. They anticipate that the vaccine could arrive in Wisconsin by 12/15/2020. Guidelines will be published through the Morbidity and Mortality weekly and the CDC will send out Just In Time training related to the product and the specific vaccines.
The current assumption is that there will be very limited amounts of the vaccine available early on. Only about 49,725 total doses of the Pfizer vaccine in the state of WI. Hopefully, later the FDA will approve the Moderna vaccine as well and they anticipate getting 16,000 doses of that. Those doses represent the number of individuals who could be vaccinated. Health officials have been assured that the second dose will come in the future and that there will be a sufficient enough supply that each person who received a first dose will be able to receive a second dose in the required time frame.
Cathy Spears wanted to know if they are thinking about supplying the Moderna vaccine to rural areas where they don’t have the capability to meet the low storage temperatures required for the Pfizer vaccine.
Per Kurt, the working assumption is that no one will be able to pick and choose; what is made available is what will be made available. But he thought there would be great effort made to not waste or compromise the integrity of the vaccine.
Wisconsin has far more healthcare providers than vaccines doses that will be available. Health Officer Eggebrecht believed that will be something they’ll have to suitably warn the public about. Phase 1 is going to take a significant time period–perhaps longer than most people are hoping, probably several months.
CVS and Walgreens have the ability to store at suitably low temperatures and they will be providing the vaccine to long term care facilities. The state is working hard to make that program work.
The plan is to use a “hub and spoke” proces. Because of the cold temperatures required for the Pfizer vaccine there needs to be a location or hub within a region that can store the vaccine and then the spokes will be the clinics that actually provide it to their employees. The Moderna product, on the other hand, will likely go right to the vaccination locations because it doesn’t have that cold temperature requirement.
Doug Nelson wanted to know how many facilities in Appleton have the ability to properly store the vaccine.
Kurt replied that that information was something that the state is holding pretty close and that it would probably be better to not disclose locations or options. [Frankly, I found that to be a bizarre answer. (1) Doug didn’t ask him to name and map out the Appleton facilities that can store vaccines; he just asked “how many” facilities in Appleton had that capability. How hard is it to give a number? (2) Kurt literally just finished telling everyone that CVS and Walgreens are going to be storing and dispensing the vaccine to LTC facilities. (3) Is the state legitimately concerned that these storage facilities are going to be robbed? (Film idea: “Oceans Covid-19”.)]
One of the meeting participants [who I think was Dr. Vogel but I could not clearly identify because everything happened on a zoom call off screen] said that there’s been a lot of inquiries from health care workers about whether or not the vaccine will be mandatory. This is an emergency authorized vaccine and the rollout has been faster than other vaccines (although she believed the FDA had provided good oversight while its safety was determined). She acknowledged that there’s always potential things that can be discovered after rollout, so at this point they were being very cautious about making it mandatory and were really just going to encourage it at this point.
The discussion then moved away from vaccines. Health Officer Eggebrecht stated that all of the temporary employees they hired to assist with contact tracing have agreed to stay on past their initial end date in December since the health department received more funding to continue paying for them. The Health Department is also looking at possibly hiring additional contact tracers later this month.
Lee Vogel wanted to recognize the polarization that can exist between public health agencies and the economic sector. [Honestly, I find it a little concerning that She would speak as if public health is somehow disconnected from economics.] She acknowledged that people in public health know and are mindful that things are very difficult for businesses. She thought the best way to be able to reopen schools and businesses is to really “squelch the virus”. People may think things are moving too slow, but she believed that was how we’re going to get through this–to have temporary but thoughtful restrictions while looking toward the hope and promise of a vaccine.
Kurt Eggebrecht said they are working hand in hand to help businesses and schools be successful.
They then moved on to the 3rd quarter report. Health Officer Eggebrecht was struck by how quickly coronavirus cases increased since July. In July through September we were at 1,700 Covid cases and now we’re over 5,000.
He acknowledged that their nursing services particularly have been redeployed to handle coronavirus and he looks forward to the day that they can get back to providing services as normal. In the next quarter he thought they should have a discussion about childhood immunizations and the impact Covid has had on those. He thought it was important to make sure that we don’t fall behind on those childhood immunizations.
You can view full meeting details here: https://cityofappleton.legistar.com/MeetingDetail.aspx?ID=820114&GUID=02F400DD-93A8-48FD-B53A-2E0AB690CC9B&Options=info|&Search=
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