Board of Health Meeting 9/23/2020 – The Board Confronts Mayor Jacobs

health Department

All members were present. David Sanders joined the meeting on behalf of the Knox County Law Department. The meeting was intended to begin with a phoned-in statement from County Commissioner Larsen Jay. He had to cancel, but expressed his support of the work done by the board.

Dr. Buchanan presented the current COVID-19 numbers for the county, including the benchmarks. The benchmark for new cases was shifted to yellow from last week’s red. The others remained unchanged: Yellow for testing, hospital capacity and deaths and green for public health capacity. She said the average for daily cases is 116, and is trending downward.

Knox County and District Cases by Week and Month
Weekly Knox County New Cases by Age

Nine people have died in the last two weeks. An average of 562 cases per day have been done over the last two weeks. Current positivity rate is 8.2%, down from about 12% last week. She expressed concern that people are avoiding testing in order to avoid quarantine.

Dr. Shamiyeh presented his hospital data. Most of the charts shown here are his. He said his calculations of positive test rates was over 10% and that they’ve seen a big drop in testing in the younger age group, not due to any barriers to testing. Dr. Buchanan and Charity Menefee said they are being told by parents that people are not getting their students tested in order to avoid quarantine or isolation.

Dr. Gregg from UT echoed the concern with the reduction in testing. They believe numbers of confirmed cases will increase as they begin systematic testing. He discussed the research being conducted jointly with the University of Kentucky (also covered in the previous article). Dr. Buchanan suggested that perhaps the Health Department could contribute patients to the study in order to include more age groups.

Comparison of Trends in the 4 Metro Areas (Scales are Different in Each – this is simply to compare trends)
Knox County and District Hospitalizations by Week and Month

Dr. Shamiyeh said that based on everything he understands about the disease, there is nothing to explain the sharp decline in cases reported by UT other than simply a sharp reduction in testing. Dr. Gregg agreed. He said tests given in the Student Health Center have declined from 50 – 60 per day to as low as 1 test per day. He said the required pooled testing will allow them to target specific groups who need to be tested further.

Ms. Wagoner presented the school data. The number of active cases reported this afternoon reflected an increase from 44 to 58. Isolation/Quarantine also increased by more than 100. Dr. Buchanan noted that with school in session, each case has more contacts than others, and so one case produces a much larger number of quarantines. It was pointed out that distance matters most, and if they are within six feet for fifteen minutes – even wearing a mask – they are considered a close contact.

Reasons to have Trigger Points Based on Metrics

Dr. Shamiyeh presented possible metrics, calling it a “first attempt.” He noted that West Virginia, a Republican led state, has used some of these metrics by county even down to using them to stop or allow high school sports and other activities. He said it was presented for further thought.  5 – 10 per 100,000 is considered community spread, 10 – 25 is wide spread. Consistently above 25 per 100,000 is a point to consider a lockdown.

High volumes of testing make the data more reliable. Low testing volume leaves the community susceptible to a severe surge. Below 1000 tests a day in Knox County is too low to truly know the amount of the disease present. Over 10% positivity rate is when the White House suggests lockdowns.

What should be considered involving new cases.
Knox County New Cases With Cutoffs

Dr. Souza noted that any beginning availability of a vaccine could also shift the conversation.

Dr. Gotcher asked for one of the doctors to explain herd community. Dr. Buchanan said herd immunity comes when enough a percentage of a population has been vaccinated or has had the illness and can’t pass it on. We don’t know the latter, so vaccines are how we will have to achieve herd immunity. Dr. Shamiyeh said 60% to 70% of a populations is the cut off. Dr. Hurt mentioned Sweden and said originally they were hoping for herd immunity, but only 7% got the illness. Dr. Souza said today the CDC said at most 10% of the U.S. population has had the illness.

Reasons to Include Testing Volume
Knox County Testing Volume Over Time With Recommended Levels

Regarding facemasks, Dr. Buchanan said complaints remain stable and no business or individual has been cited. Dr. Souza pointed out a survey conducted by UT across the state at intervals showing most people trust the CDC or the local health department for information on masks. 75% support mask mandates in their most recent survey.

Under new business (at 1:50, if you want to go directly to it and see the video in question made by Mayor Jacobs), Dr. Hurt spoke:

Last week at the end of our meeting, Mayor Jacobs signed off by telling us that he felt for the Board of Health members, that we didn’t ask to be put in the position we are in terms of the spotlight that we are. I genuinely and sincerely thanked him. Frankly, that’s why I was outraged to see the Freedom Forward video that he released, literally, the very next day. I believe it is inappropriate. It’s dangerous.

It only reinforces the emails, mail and phone calls that we on the Board of Health get every day, and I’m quoting “Our Science is a lie,” we’re “just trying to put deep fear into the community,” we “destroy people’s lives,” we’re responsible for “skyrocketing overdoses, suicides” and being told that the “battle is going to continue.”

. . . My grown children begged me to start using an alarm system. My neighbors, both Republicans and Democrats patrol my neighborhood to make sure people aren’t harassing us. I’ll let everyone else draw their own conclusions.

Reasons to Include Positive Test Rate
Knox County Postive COVID-19 Test result Rates Over Time (Daily)

With that, she cued the video. Mayor Jacob’s voice narrated over images ranging from Joe Biden and Donald Trump, to burning cities and the Board of Health itself.

We hold these truths to be self evident that all men are created equal, that they are endowed by their creator with certain unalienable rights. That among these are life, liberty and the pursuit of happiness. These words are the fire (unclear audio) mankind. They inspired a revolution. They launched a nation, nourished by the blood of patriots and built on a foundation of self-governance, freedom of choice, with liberty and justice for all.

Today, this foundation is, once again, under attack, not from some ominous enemy from abroad, but sinister forces within: Unelected bureaucrats (cue a picture of the Board of Health Zoom meeting) which pass down edicts carrying the force of law, with no accountability and no recourse. So called “experts” (cue a picture of Dr. Fauci) ordained by the media who weave a web of spin, misinformation and deceit. Violent mobs who lust to erect a socialist utopia on the ashes of the republic. And worst of all, an atmosphere of division, hatred and fear, conspiring to rob us of our birthright of freedom.

Thus far, the chaos engulfing the rest of the country has impacted us only marginally here in east Tennessee. Some of us are secure in the belief that it can’t happen here. But it can happen here. It will happen here if we don’t act and act, now. Now is the time for a movement. A movement that champions our God-given rights. A movement based, not on partisan politics, but on kindness, respect and compassion. A movement worthy of the high ideals of our founding.

For too long, good people have sat on the sidelines, forgetting the thing that makes America different, special, the thing that makes America great. Our freedom is only a generation away from extinction. Will this be the generation that stands up? The generation that joins up? That stands up? That shows up?

Or will it be the generation that gives up? The choice is ours. For now.

Silence followed the video until Dr. O’Brien spoke. He said it disturbed and hurt him. He said as a military officer, he felt threatened. He said the division has to stop. If others want to leave science behind, they will “reap what they sow.” Dr. Drake said she agreed. Dr. Gotcher said there has been a large outpouring of support from the public since last week. He said he is concerned about the ability to keep the board together and that he has been urged to leave the board for his own safety.

District Hospital Census With Possible Cutoffs For Different Responses

Mayor Jacobs said the intention was not to put anyone in harms way or to threaten anyone, but to get people to talk, speak out and show up at meetings. He said perhaps it didn’t come across as he intended and that the video was not supposed to be public. He said this board is looking at public health and his picture is bigger than public health.

He continued, that the country is setting a dangerous precedent by accepting government overreach. He said the metrics looked at tonight could take months to attain and people can’t do that. He said he apologizes if anyone felt threatened, but that wasn’t his intention. He said he can’t apologize for his perspective.

He reiterated that people on the board are doing their best and apologized for the harm it may have caused. Dr. Buchanan said her staff felt concern for their safety after seeing the video. Dr. Drake asked why they would be better if they were elected. He said they would not necessarily be better, but they would be accountable. He blamed the decision to move control from Dr. Buchannan to the board as the point when the confusion grew.

Dr. Hurt responded that they are held accountable by their solemn oaths and can have their licenses revoked if they do not work in the public’s best interest. She said she’d asked the National Board of Health and they had been unable to point her to a single local Board of Health anywhere in the country that is elected. She said aligning them as a force against the “good people” implies that there is a division and they are not on the side of the people. He said he understood that.

Dr. Gotcher asked Mr. Sanders if, given the fact that state statute granted authority to the board, the county commission could, in fact, take that authority away. He said the county cannot do anything that conflicts directly with state law, but until they take an action, it would be impossible to know if that is the case. Dr. Buchanan asked if a board member might want to have a representative present at next week’s county commission meeting and said Commissioner Jay had indicated he is open to that.

Dr. Souza said that might be a good idea, but she didn’t feel safe enough to go based on the images she saw from last week, with a large crowd of angry, unmasked people in the balcony. Dr. O’Brien said he would be willing to do so as he’s faced ISIS and this group doesn’t scare him. Mayor Jacobs said he would stand with Dr. O’Brien. Dr. Gotcher thanked everyone for their open comments.

Key Points from Dr. Shamiyeh’s Presentation

Dr. Shamiyeh addressed Mayor Jacobs comments regarding metrics. He said they were brought at the request of the mayor and others who have said they want to know when this ends. As for them taking so long to reach, the cut offs are those recommended by the White House Task Force, the CDC and others. He said if they don’t use fundamental medical principles this pandemic will land in a place they do not want.

He said he thinks vaccines may start in January and so the current situation isn’t without end. He said often science gets criticized because it is imperfect, but it is evolving through this crisis and it is still the fundamental basis from which they must make decisions. He said he lies awake at night thinking about all of it – the medical part, the economy, etc. He said it is intimidating to make these decisions even with the expertise to do so.

He said we all hope this doesn’t get worse, while others seem certain it will not. He said he doesn’t have that certainty. The process to address this has to be prepared with the possibility in mind that we may enter a more difficult phase. The lack of belief in science, he said, will be more of a concern if we hit a hard situation in the future.

Dr. Gotcher inserted a statement encouraging people to use hospitals as needed, noting a study this week saying transmission within the hospital is simply not happening.

With that, the meeting ended. The entire meeting, including Mayor Jacobs video is posted below.