Board Meetings: Board of Health Discusses Knox County and Regional Situation

health Department

Two meetings held at once. The Board of Health Meeting and the School Board Meeting would each have accumulated very little interest among most of us six months ago. That is so early 2020. Now they have become much awaited and of critical importance and great interest to the community. In this article, I intended to address both, but that wasn’t possible, due to length. Here’s the first of the two:

Health Department:

Dr. Buchanan started by giving updates on other health issues the department is dealing with. Of importance is that school vaccine requirements have not been reduced, so they are working on that. She reported the $7.1 million in assistance from the state, which will have to be approved by County Commission.

She said 70% of the Health Department is focused on the pandemic response, though other services continue. While there has been an increase in the number of WIC recipients during this time, they are thankful those families have gotten food. They hope, with the influx of funds, to more closely approach normal service levels.

Dr. Buchanan presented the Benchmark information that was covered in my previous article from the Knox County Health Department Briefing. In short, the traffic light is red for new cases because of the rate of increase. The traffic light related to the testing benchmarks is also red due to lab delays in getting test results. The benchmark related to public health capacity remains green as contacts have been able to be traced within 24 hours.

The hospital capacity benchmark is yellow, as there have been increases in hospitalizations, ICU usage and ventilator usage. There has been a significant increase, but hospitals are able to handle those at this time. Finally, the benchmark regarding deaths is red, due to the fact that there has been a 200% increase over the last two weeks, even though the real numbers – from 5 to 15 – are small.

Dr. Shamiya noted that quick return of results is critical in order to get people out of quarantine or to contact trace if they are positive. Dr. Buchanan said they have seen increased exposure from people who did not isolate after their test because the time between the test and the results was so long. One lab they were using was lost to Nashville. Dr. Buchanan said it was unfortunate that cities are competing with each other. She said some physicians and labs are saying they will only run tests on symptomatic people due to the backlog. She said she doesn’t see how it can get better and is out of the Health Department’s control.

Dr. Shamiyeh presented data that has been accumulated locally (some regional and some at UT where he works):

  • More patients in hospitals are female at UT Medical Center and overwhelmingly white. The breakdown of hospitalizations show “a significant number of younger people.”
  • Numbers of hospitalizations for people in their 40s 50s and 60s are almost identical.
  • Length of stay is longest for those in their 50s (12 days). Most are about 5 days. Average length of stay is just over 8 days. One outlier was pulled out who stayed 90 days.
  • Based on regional data, they are 99.2% confident that for every 1000 cases, there will be 52 new hospitalizations.
  • The first thousand took 81 days. It has been much shorter since. (These numbers are regional and I was not fast enough to get how long subsequent thousand s took.)
  • 848 cases so far in July has already far surpassed June.
  • Hospitalizations have shot up.
  • Hospitalizations lag case diagnosis by three to four weeks.
  • His projection puts us at near 400 patients by Labor Day. It is currently just around 100.

He also gave some demographic details about the patients who have died at UT, which answers some of the questions posted in the comments on this blog. Here’s the screen shot:

Description of Deaths from COVID-19 at UT Hospital

He noted, once again, that the surge plan was based on cancellations elective surgeries and stays. He said the concern is when there is a surge, it’s a staffing issue. With so many places having surges now, it gets harder to get help from elsewhere, as New York did. He feels we are well positioned through the summer and probably through the fall. The projections do no include the return of UT students. It is only based on what we’ve seen so far. It could also be better than these numbers if people religiously practiced the guidance, such as wearing masks, etc.

Dr. Buchanan asked if there are any themes she has seen that might impact the board’s actions. She said there are no clusters at a particular store or spot. The community spread is from many sources, including social gatherings, churches, and work places, though none of these were large.

Mayor Jacobs noted that the original push was to flatten the curve to help hospitals be overwhelmed. He asked Dr. Shamiyeh where this goes from here. Dr. Shamiyeh said he feels like he lives in two different worlds: the intensity of the preparation and treatment of the illness and the apparent lack of concern outside that arena.

The biggest challenge is the lag between case diagnosis and hospitalizations. That’s why data to predict what might happen next is critical. He said this will likely go on, and he is encouraged about the news of a coming vaccine, but people have to take it seriously until then. He said they have seen very little infection rate among staff.

He said it is a concern not only for health care, but for other businesses. The stress level at the hospital, he said, is becoming difficult. Dr. Buchanan reported the same fatigue. She said the end game is to mitigate the impact on both our economy and health. She noted that if you stay open, more workers get sick, which hurts business, also.

The face mask ordinance was discussed. Concern was expressed regarding the lack of enforcement. Dr. Buchanan said she is seeing more mask wearing. She noted that enforcement is hard and expressed concern (because she said she was asked to do so by someone) regarding requiring masks to enter polling places and wondered if there should be exceptions. Poll workers will be given masks.

Dr. Shamiyeh said a busy polling place would be exactly the kind of place where we could see wide spread. He also noted that some might be more fearful if masks are not required. He asked why requiring a mask would infringe on somebody’s ability to vote. Dr. O’Brien noted that anyone concerned with voting can do so by mail-in ballot.

Dr. Shamiyeh said that masks may be the most important of all the measures contained in the guidance. He said he felt that masks are important in the polling place.

Dr. O’Brien said he feels that since no clusters or particular issues are noted, there may not be more action needed at this time. He said he doesn’t want businesses to be penalized because they have refused to support the mask ordinance, but that could happen.

Dr. Buchanan said it could be a full 28 days before the masks impact case load (and that is dependent on the public wearing the masks).

Resolution Adopted by the Knox County Board of Health, July 2020

Dr. Shamiyeh introduced a draft resolution, reiterating that he is very concerned about the projected data. He pointed out the fact that isolating should only be with your cohort, not with extended family or friends. He pointed out that even a repair person in your house is a risk if you aren’t wearing masks and following guidelines.

He referenced the CDC visit as a point of concern as they have identified us as a hot spot. The resolution makes clear that closures could be required if the community does not follow guidance and get the spread under control.

Regarding the resolution, Mayor Jacobs asked Mr. Morton from the law department if he had problem with the resolution. He said no and said it contains “suggestions.” A vote was taken on the resolution and it was unanimously passed.

The meeting ended with Dr. Shamiyeh asking Dr. Buchanan to look for trends in data with the contact tracing. He asked if the meetings might not need to be scheduled closer together. The group decided they would meet weekly at the same time and alternating weeks would be shorter unless there was something exceptional to discuss.