Knox County Board of Health Meeting 7.29.2020: Bars to Close

health Department

The fact that this would be a three hour and fifty minute meeting was portended when a motion was presented before the agenda could be approved and the motion was to drop the agenda and the meeting altogether. Mayor Jacobs started the meeting by stating:

This is a motion to postpone this meeting until next Wednesday.

This board has become a policy making body. It is also a very powerful body, making decisions that impact the lives of 470,000 Knox Countians. Currently, by the powers vested by the governor, this unelected board is more powerful than the Knox County Commission, the Knoxville City Council and any other body that governs our community.

Despite this power, this board offers no recourse to our taxpayers, no due process, and is virtually unaccountable for its actions. It is also the only body which does not currently allow for in-person public input at its meetings. Sending an email is not the same as actually being able to speak in person.

County Commission, City Council, and the Board of Education all allow citizens to have an opportunity to speak at their meetings for up to five minutes. In addition, we must recognize that some citizens of this county do not have access to broadband, and therefore cannot view this meeting. It is unacceptable.

It is vital that a body such as this operate with full transparency in a public setting, something that we’re not doing right now. If we expect the public to have confidence in the decisions being made by this body, this has to change. Therefore, in the spirit of democracy and transparency, I move that this meeting be postponed until next Wednesday at 5 pm in the large assembly room of the City County Building and a public forum in which citizens can voice their concerns be added to that agenda.

The first half hour consisted of discussing the idea and voting to amend the agenda and place the new item on that agenda. The item was ultimately added for discussion.

Board of Health Agenda 7.29.2020

Dr. Buchanan asked for clarification and said she had concerns about in person meetings and the difficulty socially distancing.  Mayor Jacobs replied County Commission does it, and she said they do not do it very well. It was clarified that the governor allows, but does not mandate virtual meetings.

Dr. O’Brien pointed out they have gotten hundreds of emails and that they are to be an evidence-based group. Mayor Jacobs now inserted that Knox County and the Board of Health have been sued. He announced he has called a meeting for August 3, 5 pm with an executive group, which includes the board.

Dr. Shamiyeh pointed out that a week delay is a long time in terms of COVID-19 and he felt it would be irresponsible to delay action for a week. He said it should be a separate question to decide to move forward in the altered fashion starting next week.

Dr. O’Brien said he is concerned by that, as well and isn’t sure that the kind of science-based decisions they make is best served by inviting a public forum. He said the zoom meetings are safer and he didn’t want to see this turned into a political football with protests from either side as they met. Dr. Shamiyeh said this could have been proposed a week ago. Dr. Hurt said they are following the sunshine law and they are not required to have a public forum.

Number of Days to Reach Each Subsequent Thousand Cases
Weekly Stats for Counties in the state 7.29
New Cases by Week and Month For Knox County and the District

Myles Morton said the board is open to the sunshine law. When pressed he said the board can decide whether there has to be a public forum. The group divided the motion into whether to have a meeting at this time that allows action and a second motion to alter the meeting format at later meetings. All present, including Jacobs agreed to proceed with this meeting, including action items.

Mayor Jacobs then moved that for the duration of the crisis that the meeting be in-person and that there be a public forum. It was seconded by Dr. Gotcher for purpose of discussion. Dr. Shamiyeh said for the Board of Health to conduct an in-person meeting in a manner that isn’t safe would send a mixed message. He asked how they would ensure that safety. He said he felt like that the group was following their directions. Mayor Jacobs replied that the board is making policy, potentially over-riding county law and have changed to a policy making body.

Dr. Hurt said they are already getting feedback. She asked if they would take temperatures and screen? She pointed out that large gatherings spread the virus and how could the number of people present be controlled. He said that could be handled.

Dr. Gotcher asked Dr. Buchanan for the current guidance on the size of public gatherings. Dr. Buchanan said the current number is 50. Dr. Gotcher said he felt 50 could probably be spaced in the large assembly room and Dr. Buchanan said the space is already marked off because the court is using it. Mayor Jacobs said people could sign up in advance. Dr. O’Brien said he didn’t think it made sense for this group to advocate for an in-person meeting. He also questioned the benefit of having people speak in person vs. the emails and mail they have gotten.

Dr. Gotcher said he understood part of the point is to provide access to people who may not have broadband. Dr. O’Brien suggested there be a Zoom spot for the public. He said there is no need for them to be live and that a contentious back-and-forth is not helpful. Dr. Gotcher reminded everyone that the only reason they can do Zoom meetings is because the governor has given permission. It is temporary.

Age Distributions of Cases and Deaths 7.29


UT Hospital Deaths by Month with Characteristics

Dr. Shamiyeh pointed out that the governor did that for a reason. He said if 50 people gather in a room in Knoxville at this time, one person present very likely has asymptomatic infection. He said what Dr. O’Brien suggested would work. Mayor Jacobs said it is usually 3 to 5 minutes and they have to fill out a form and agreed to modify his motion to include a remote public forum as a part of next week’s meeting if technologically possible. It unanimously passed.

Next, they discussed the facemask mandate. David Brace and Ronnie Nease reported on city and health department enforcement. 311 complaints are split between the Health Department and the city, depending on where and what kind of business is the object of the complaint. They follow with education, signage and masks. As part of inspections, education is also being provided. 444 complaints have been received this month at 247 permitted facilities (restaurants, etc) and 197 other businesses. Most of the complaints are about masks and distancing and they have diminished through the course of the month.

Mr. Brace said compliance has been good and mask wearing improved when it became a mandate. He said about 10% of calls to 211 or 311 (of over 13,000) are about COVID-19. He said should there need to be a citation, it would be brought to the board. He said evening alcohol consumption in bars has produced problems. Mr. Morton from the law department said the board could not act as an enforcement body. Mr. Brace said he would leave that to the lawyers, including the city’s attorney, to sort out.

Dr. Shamiyeh said he thinks mask wearing is much better, but he’s concerned that they included an exception for in-doors if they can maintain distance. Mr. Nease said, no, the issue is people simply not wearing them. Mayor Jacobs noted that many large chains are now requiring masks.

Dr. Buchanan presented the current situation in the county, including the numbers I’ve already published and a discussion of the benchmarks. Mayor Jacobs asked about false positives and Charity Menefee spoke to that. She reiterated that the guidance is if two tests contradict, positive and negative, they treat it as if it is positive for safety sake, because they don’t know which is accurate and noted it isn’t very common.

Dr. Shamiyeh said the outreach is slow and then the results for any additional testing is slow. He said the successful countries have had quick turn around a good quarantine protocols. He said he is concerned about people coming out of quarantine when they should not. He also said he’s concerned that on-boarding people so quickly to help with tracing raises concerns about their training.

Number of People Hospitalized with COVID-19 in the District


Regional (11 County Area) Hospital census and Deaths by Date

Dr. Buchanan said physicians in the community are not explaining to people that they should quarantine until they get their results, and that is a problem. Charity said many of the results are coming back more quickly, so not all tracing is delayed. Dr. Shamiyeh said he is concerned with the currently high numbers, but with students returning and schools opening, he fears it is going to rapidly become much more complicated.

Lisa Wagoner, with the schools, said they are already working on how those contacts will be traced. She said quarantines will be imposed on anyone who is in contact with a positive case in the school. Charity added that you can’t test your way out of quarantine. She said UT will also have an epi team to help with contact tracing.

Dr. Shamiyeh gave a report from the hospitals. He used the example of setting cruise control at 100, but accelerator is not being pressed. He said we’ve slowed the rate of things getting worse, but the pace we’ve set is very fast. He gave current numbers, projections and continued to express concern about staffing if the numbers go to the projected levels. The charts contained here are his from the presentation.

The report from the visiting team of CDC and others was discussed. They are visiting places with higher rates. Dr. Buchanan said they did a lot of listening. She said they have provided assistance with translations for communities primarily utilizing other languages. They recommended that we establish a community recovery group, which has been convened, to make plans for supporting our community to recover after the pandemic. Dr. Shamiyeh added they are concerned about adequate supplies of Remdesivir.

The recent White House document regarding the 18 “red” or concern states was mentioned. Knox County is yellow by this report. The recommendations are mask wearing, 25 people are fewer in gatherings, close bars until % positive is under 3%, restrict indoor dining, limit gyms to 25% (currently they are only asked to maintain social distance). They also recommended pool testing, but she said our positivity rate is too high for this to be practical.

Local bars were up for discussion, next. Dr. Hurt shared a possible resolution based on the White House task force and Dr. Birx remarks in Tennessee. It proposed that local bars be closed until the numbers get better. Mayor Jacobs asked if the law department had had a chance to review it. Mr. Morton said said his advice stands to not go beyond what the governor has put in place.

They discussed the difference between bars and restaurants. Mr. Morton said paragraph 8 is illegal and inappropriate.

Dr. O’Brien expressed concern for the businesses trying to do what they are supposed to do. He said he is most concerned with what is coming when UT students return. He pointed out Craft Breweries would be shut down and he questioned whether they are part of the problem. Dr. Buchanan noted that Arizona, Nashville and Shelby county closed bars and numbers seemed to go down.

Dr. Gotcher referenced an article he had sent to the board. Face masks, eye protection and distancing were the main interventions by evidence. Dr. Shamiyeh said masking doesn’t seem to be doing enough quickly enough and we know we are about to have UT students and that wearing masks and distancing doesn’t happen very well in bars. As to the economic impact, he said that will also be severe if the illness continues to spread. Dr. Hurt pointed out that sales for off-site consumption would be allowed.

Mayor Jacobs pointed out that governments shutting things down only creates black and grey markets. He said UT students will simply find other places to gather in groups and drink. Dr. Hurt said it may be true, but the data shows there is a reduction in cases when bars are closed. He asked if you could isolate the evidence as to what works and what doesn’t.

Dr. Shamiyeh said if multiple interventions make sense and you do four of them and the virus is impacted, it really doesn’t matter which one worked best and the science takes longer than real time to determine what is most effective. He pointed out this has been going on for several weeks and the choice is action or inaction. The idea is to “get ahead of this,” and then once it is more controlled, we can decide what can be taken out.

Dr. Gotcher pointed out that in a bar social distancing, talking loudly and mask wearing are all jeopardized. Mr. Nease said it is an issue, but many are working very hard. Dr. O’Brien questioned whether social gatherings should be looked at, instead, since that is where so much spread is happening. The current number is 50, could it be 25? Dr. Hurt pointed out that 25 people drinking would produce the same issues.

Dr. Buchanan suggested that businesses being given a longer timeline before closing in order to become prepared. Dr. O’Brien and others said defining “bars” is critical to make this work. Dr. Buchanan said she the definitions at the state level are clear. Dr. Shamiyeh said delay is a concern given the imminent return of UT students. Mr. Nease said restaurants are generally doing a good job, but bars less so.

Mr. Morton said the resolution would allow 30 days in jail and only the Sheriff can do that and the Board of Health cannot enforce the law. He said he isn’t sure the board can do it at all. Dr. O’Brien countered that the state Attorney General had affirmed that they do have the power. Dr. Hurt asked how this would be different from the face mask ordinance. Mr. Morton said he can’t “comment on pending litigation.”

Trendlines Presented each Week With Updated Data

Dr. Hurt said the courts can sort it out, but she thinks they have the power and to do nothing is unconscionable. Dr. Shamiyeh said not to loose sight of the fact that the White House via Dr. Birx suggested this measure and the governor said they have the authority to take the action.

Dr. Gotcher asked if we need to be as restrictive as Nashville, as they are “red” and we are “yellow.” Dr. Buchanan said they have been behind on their actions and acting quickly is better. Dr. O’Brien spoke for craft brewers. Dr. Shamiyeh expressed concern that it would leave a gap in the enforcement that would be difficult. Dr. Buchanan said she thinks making a distinction between craft breweries and bars would be difficult to enforce and the behaviors are similar.

In the end, they agreed that something had to be done agreed the new restriction would begin August 2, in order to allow more time for businesses to shut down. A two-week sunset was added in order to give businesses a time-line. It could be renewed.

A vote was taken and everyone voted “yes,” with the exception of Mayor Jacobs voted “no,” saying he still feels it puts the county at risk for liability.

If you would like to enjoy the entire 3 hour 50 minute meeting, you may do so here: