Knox County Board of Health Meeting 7.22.2020

health Department

The meeting began with Dr. Buchanan reviewing the benchmarks as had been done at the earlier meeting. There are current two indicators on red (cases, deaths), two on yellow (testing, hospital capacity), and one green (public health capacity). See the previous article for more detailed discussion of the current status of the benchmarks. She also stated that 26 contact tracers have been added since last week.

Dr. Shamiyeh noted that contact tracing, if positive results are received 8 to 10 days after the test, is not effective. He asked why we don’t know more about the full volume of testing and Dr. Buchanan said providers have never been asked to report negatives on other illnesses, so that number may not always be reported in a timely manner. The positive test reporting system is working better.

The Health Department results are running 11 days after the test. Dr. Buchanan said they are increasing their portfolio of labs. They are also pursuing other options to improve the turn-around time. She said the state lab is helping this week, but they can’t do that indefinitely.

Number of Days to each new thousand cases in our region

She said she is concerned about their capacity to continue contact tracing if numbers continue to rise. They will add others and she has realized as things have gotten worse that staff will have to continue working the tracing, rather returning to their normal jobs as planned. Charity Menefee added that tomorrow’s number will be significantly larger – probably around 200, if I understood correctly. She said it is going to be very difficult to continue contact tracing at the current level, though probably not in the immediate future.

Dr. Shamiyeh presented information showing that significant numbers of young people are being hospitalized, though not at the same rate as older persons. Relative to the larger region, Knox County hospitalizations seem to be slowing. It is the larger region that matters most, however, because people are hospitalized across county lines. The numbers regionally continue to be high and the projections for cases and hospital impact through September will be serious. He said he will continue to track the trends and hopes we might alter them. His presentation included the charts you see here, though the photographs of the participants obscured some of the charts.

Asked what impact schools opening and UT students returning might have on these projections. He said we don’t know, but the likelihood is that it will not help. The trends and projections are based on what has happened so far. He emphasized that if the five core actions can be followed in every situation, a worsening should be able to be avoided.

New Cases By Week for Knox County and the District

Dr. Gotcher noted a South Korean study that indicates children do spread the virus within their own homes and, perhaps, at a higher rate than adults.

Also noted, was public concern regarding people following the five core guidance and it was asserted there seems to be a significant level of misunderstanding. Dr. Souza said we are seeing more people wearing masks, but there is still some non-compliance. She asked for feedback from the County and Health Department about enforcement. Dr. Buchanan said complaints continue. Dr. Souza asked for a report someone who is involved in enforcement to see how that is going.

Mayor Jacobs said there are a lot of issues and talked about the divisiveness of the mask issue. He had a set of questions: From a media and historic aspect, a few months ago Dr. Fauci and others said we don’t need to wear masks and then they became imperative. What changed? Dr. Buchanan said we learned more about the disease, including asymptomatic spread.

Hospitalizations by Week for Knox County and Region

He asked about whether a cloth mask in an uncontrolled environment makes a difference and if there are studies that say it helps. Dr. Shamiyeh said the behavior of the virus is unusual and we know a great deal more now than we knew in March. He said the cloth masks make sense. While there has not been time for wide-spread studies to be published, they know more about the spread and cloth masks help.

Mayor Jacobs asked if touching the mask or putting it on a surface where someone else might touch is a a problem for spread? Dr. Buchanan said the mask comes off of you it can’t hurt you. He asked if the virus could transfer to a surface and then infect someone. Charity said that theoretically could happen, but it would be very unlikely.

Mayor Jacobs said he has observed that wearing the masks makes people feel they can get closer together. Dr. Buchanan said people tend to let their guard down in certain circumstances and that is when most exposures are happening. Mayor Jacobs said he is seeing people shaming others who are not wearing a mask. He told a story of a mother with an autistic child whose child is afraid when she wears a mask. Dr. Hurt countered that there are groups shaming those who do wear masks.

Dr. Gotcher pleaded with people to get information from reliable sites, saying it is easy and tempting to gravitate toward information that confirms our biases.

Regional Hospital Census

Dr. Shamiyeh said some of the emails were asking where cases are coming from and saying we need to shut everything down. He noted there has to be a balance. He said in Knox County we appear to not have clusters related to businesses and restaurants, meaning that portion of the opening is working. He said the problems are coming primarily from social gatherings like birthday parties, showers etc. He noted one social gathering with about 20 people that came to his attention, and pleaded with people not to do this sort of thing.

Charity added that this is exactly the kind of thing they are constantly running into. Dr. Buchanan reported they are seeing people who didn’t feel well, but went into work or to a social gathering and spread is resulting. Dr. Shamiyeh said that moment you let your guard down could transmit the virus to people you care about.

Dr. O’Brien said he is concerned about schools, even though this board does not control the schools’ decisions. He presented what could be a recommendation of how the schools might look at their decisions. He said it is similar to what Hamilton County is doing. It uses percentages of population infected to dictate next steps at all times.

Projected Number of Patients Based on Number of Hospitalizations of Patients to This Point and Rates of New Cases in Recent Weeks

Dr. Buchanan said she had reviewed the document and that positivity rate (included there), as a metric, is not available in reliable numbers for our area. She said she had talked to her counterparts in other counties who have these plans and said she’s learned that the Health Departments are not providing the information to them. She said she doesn’t think there is any way her staff can provide new kinds of data. Many of them are starting work at 5 am as it is.

She said she feels the Health Department’s benchmarks combined with the data schools typically watch (teacher/student/substitute health rates, for example), should be adequate in combination to determine if schools would need to revert to virtual. As schools start, the absentee rate among students, teachers and substitutes will give us more real-time data than other benchmarks. She said the schools are on-board to help with contact tracing. She said they have always worked with the schools and will continue to do so.

It was ultimately determined that they would continue to try to communicate to the community that they are coordinating with schools. The group agreed to meet next week to monitor progress.