Knox County Board of Health Meeting (9/16/2020)

health Department

The board was joined by Dr. Gregg and Dr. Plowman from UT and David Sanders from the Knox County Law Office. All members were present. Mayor Kincannon and KPD Chief Thomas also joined as the meeting proceeded.

Dr. Buchanan presented the current status of Knox County and reviewed the benchmarks as reported in the previous article. Benchmarks remain unchanged from last week. She said there have been seven days of red flags regarding case increases. She said there continues to be some concern regarding the number of people not being tested and a bit with turnaround times, though they think the latter is related to Labor Day. There were red flags regarding increases in ICU usage on more than one day. There have been eleven deaths in the last two weeks.

Pace of New Cases (Days to the next 1,000 cases)
New Cases by the Week and Month for the County and the District

Most case increases are school-age through college-age students. Most school cases are in high-school age students. Knox County has “by far” the highest doubling rate of any county in the state. We are set to double our cases every 39 days. The nearest county to that is at around 52 days doubling time.

Dr. Shamiyeh presented the hospital data. All charts are his except for the age chart, which is Dr. Buchanan’s. He said, Dr. Birx stated that the concern with college age students is as much that they will spread the illness in the community as with their own health. While he said the positivity rate may not be precise, the trend matters and it is up. He said Dr. Birx emphasized the volume of testing as critical. His central points: We’ve seen three weeks of case growth, including the worst week in the pandemic, and it is driven by people below 30. Children below 10 are barely registering in the totals and those over 30 are stable, but continue to be impacted. District hospital census has increased.

Dr. Buchanan said that the Knox County Health Department is working toward utilizing the positive test rate to watch the trend. She said they will be using state data (I wasn’t clear if they intend to publish it.) She reiterated that they are concerned with the reduced amount of testing and they want to increase it. Dr. Birx mentioned that she is concerned with the reduced volume of testing in the state. Dr. Buchanan said Dr. Birx pointed out that Tennessee’s testing volume has decreased by 50% recently. (Emphasis because we’ve talked about it so much on this website.)

Age Bracket Distribution
New Cases Among Different Age Rangers Over Recent Weeks

Dr. Plowman and Dr. Gregg spoke regarding the UTK situation. Dr. Plowman clarified that Dr. Birx reached out and that she’s visited many flagship universities and has visited six in the SEC. Dr. Plowman said she is happy about the current curve at UT (it has started heading downward) and hopes it can be sustained. She said they do know that cases will increase as they ramp up the testing. No cases have been traced to a classroom or an office.

As they emptied Massey Hall they tested everyone. They found a 7% to 10% positivity rate among those who were asymptomatic and did not know they had the illness. They will next determine if that is representative of the campus population. They are next planning to test a dorm that is similar to Massey. They have also selected a newer dorm that is less communal (no communal bathrooms) and more apartment style to see if that makes a difference.

Dr. Plowman said masks have made a huge difference and she was grateful to see so many students wearing them. She said Dr. Birx said that in addition to increasing mask usage, the second most impactful intervention she has witnessed, is cutting of alcohol sales at an earlier time. Both she and Dr. Buchanan said that quarantines are the hardest part and students have, on average, 20 contacts where other members of the community have four to six, which drives those numbers up. There have been at least two UT students who have been hospitalized.

Cases by Age Group

Ms. Wagoner gave a report on the Knox County schools which mirrored the information given on this website this morning. She noted that the numbers are improving. Teacher absences are similar to last year. The Knox County School System has had one teacher hospitalized, but that was in July.

Mayor Kincannon expressed appreciation for the mask mandate, as well as for the work the board has done. She expressed gratitude for the work being done in the schools as her daughter attends a county school. She said the city is happy to help with enforcement of any regulations the board presents. Chief Thomas concurred. She is a parent of a UTK student and she expressed appreciation for the work done there.

Dr. O’Brien asked if the board can expect support in enforcement. Chief Thomas said yes. Dr. O’Brien asked for comments on that or on Dr. Birx visit from Mayor Jacobs. Mayor Jacobs responded that there are things Dr. Birx would like to see – more testing and bar/alcohol limits. He said he was pleased with her praise of UT’s procedures.

Mayor Jacobs asked Chief Thomas about her department’s enforcement. She said they have done education and that the definition of a bar has been an issue. They have reported some bars to the Beer Board.

Metro County Comparisons (Note: Each County has a Different Scale – Intended to show trends)

The board discussed the face mask mandate. As there is no expiration date for the mask mandate, Dr. Buchanan suggested the board might want to consider using benchmarks and, perhaps, the positivity rate to make a marker of when they might remove the mandate.

Mayor Jacobs asked how comfortable she would be with using positivity rate. She said it would be more the trendline and a list of other variables. She said setting a cut off of maximum numbers of cases per day might play a part. She also said when the mandate leaves, masks will still be helpful at least until most people have been immunized. Dr. Gotcher said he would like to see some metric or set of metrics.

Dr. Shamiyeh said there needs to be a sustained period below whatever threshold is identified and Dr. Buchanan agreed. He also said there may need to be metrics to determine if additional interventions are needed. He pointed out that Dr. Birx said visitors to the city should be informed of the mask mandate as so many will come to town for football games. Dr. Buchanan agreed and said locally the idea is to help people understand that following safe practices will allow them to do things they want to do – like attend football games.

Bar/restaurant restrictions were discussed next. A letter was received two minutes prior to the meeting from an attorney representing restaurants and asking that anything impacting them be tabled. Mr. Sanders said it was a “shot across the bow” kind of letter and he isn’t worried about the legality of anything the board is considering.

Knoxville District Percentage of State Cases

Dr. O’Brien acknowledged the concern regarding bars near campus. He said he “took a field trip around town” on Saturday night around midnight. He said there were large crowds on Cumberland, open bars in the Old City past curfew and more. He said the same was documented by a Knoxnews photographer (unconnected to him). He said he supports stopping alcohol sales at 10 and also limiting gatherings immediately outside establishments. It would sunset in four weeks unless extended and would close all restaurants and bars at the same time.

Mayor Jacobs noted that last week they were close to rescinding the regulations and now they are considering being more restrictive. Mayor Jacobs said he spoke to the owner and said the economic impact has already been so severe that this owner and others are in precarious situations.

He said a federal support program isn’t coming and any harm done by the board will compounded on the damage already done. He said that Dr. Birx is making statements somewhat based on conjecture and that family gatherings are more a problem. He said he worries about enforcement and that he worries that confrontations will be exacerbated by this. He mentioned that Governor Beshear in Kentucky just relaxed his states regulations.

Dr. Hurt agreed that the economic impact is there. She said, in contrast to the Mayor’s opinion, she feels they are basing this on science. She said she didn’t agree with what she saw as his indirect connection between riots in other cities and enforcement of local health regulations. She asked for Mayor Kincannan’s opinion.

Weekly and Monthly Hospitalizations for Knox County and for the District

Mayor Kincannon said she’s spoken to the President of the Cumberland Avenue Merchants Association who told her they depend heavily on UT being open to stay in business. His take was it is better to have some restrictions and stay open because the alternative is that the disease will spread and they will lose more business. She said it is in the city’s best interest to mitigate the impact. She also pointed out the concern about students spreading it as they shop around town and mingle with people who are more at risk.

Chief Thomas said their job is to enforce the law and they will do so if guidelines are passed and they are asked to do so. She said she has concerns on both sides of the issue, but law enforcement’s job is to enforce the law.

Mayor Jacobs agreed that alcohol reduces judgement, but he asked where the evidence is. Dr. Souza said a study this week showed a large portion of those who have been diagnosed have visited a restaurant or bar. Dr. Buchanan said that one of the differences between us and the metro areas which are doing better is that they have more restrictive regulations. Dr. Shamiyeh said other entire states, such as Ohio have done the same thing. He added that we are “living through this thing,” and data will be more available with the passage of time.

Dr. O’Brien said the proposed mandate as written does site evidence. He said he suspects we will take mild medicine now or stronger medicine later.  Dr. Hurt brought up, once again, the White House Task Force recommendation that alcohol be limited. She said there is a new White House Task Force recommendation that is more forceful. She said the task force doesn’t just “stop by,” and that we are now considered a red zone, whereas we were yellow before. She asked Mayor Kincannon to share some of the highlights from Dr. Birx visit.

District Hospital Census

Mayor Kincannon said this recommendation is coming from the White House. She said Dr. Birx told them that transmission rates are lower when bars are closed, but restrictions after 10 pm worked well. She said the proposal stops short of closing bars. She said it is a reasonable approach. Mayor Jacobs asked if Mayor Kincannon “as a guest on this board . . . should she be opining on this regulation?” Mr. Sanders said that is up to the board.

Mayor Jacobs asked if there would be board appetite for moving it to 11 pm, as Dr. Birx said “10 or 11” would help. Dr. Shamiyeh asked Chief Thomas what enforcement would look like. She said enforcement would look however the board would like. She said they’ve tried to educate and report to the beer board. She said if there was a specific time and it was all establishments serving alcohol, they could issue citations and enforce the mandate. She said she would want to educate first.

Dr. Gotcher asked Mayor Jacobs how late most restaurants stay open. Mayor Jacobs said that many close at 11 pm on the weekends. He said Dr. Birx has been to other places, so she wasn’t singling us out. He said 11 pm would be better than 10 pm. The board discussed 10 vs. 11. Dr. Shamiyeh asked Mayor Jacobs if 11 pm would be less toxic for those opposed. He said probably not, but it would help the restaurants which are open until 11 pm.

Dr. Drake asked if this regulation would include package stores and convenience stores. Mr. Sanders said it would not because they don’t sell for on premise consumption. Dr. O’Brien said what he saw last weekend is what shifted his thinking and that he is not opposed to citations. He said he has also had an acquaintance die of COVID in the last week.

Cases by Age Group

Dr. Hurt said this is a sound decision based on the data. She noted how much worse the situation has gotten with largely recommendations and education, and that encouragement and education has not been enough. She said the local numbers and the national recommendations both suggest action is needed.

Dr. Gotcher asked asked if Dr. O’Brien would accept a friendly amendment to change it to 11. He said no. Dr. Gotcher made a motion to amend it to 11. A vote was held regarding the amendment and it passed, with Dr. Drake, Dr. O’Brien and Ms. Wagoner opposing.

A discussion of “closed” vs “stop selling alcohol” was held and Chief Thomas said “closed” was much easier to enforce. Dr. O’Brien and Dr. Sousa agreed to a friendly amendment that it say “closed,” meaning restaurants and bars would close at 10. Dr. Shamiyeh noted that enforcement would be a separate issue than passage of the regulation. Mr. Sanders said enforcement would be up to law enforcement. Mayor Jacobs asked the potential penalties. Mr. Sanders said “up to 30 days in jail and a $50 fine.”

Dr. Hurt said she had two visiting doctoral students last week and they were both surprised that there was no enforcement and said there was accepted enforcement in Nashville. She said it doesn’t have to be all or nothing, but it could be citations as opposed to jail. The board made it clear they would intend for education to be the first stop, and a citation to be a next resort.

The new regulation to mandate closure of bars and restaurants at 11 pm passed 8 -1, with Mayor Jacobs voting no, but thanking the board for moving to 11 pm rather than 10.

Key Points from Dr. Shamiyeh’s Presentation

A regulation regarding limiting group sizes was discussed. It prohibits public gatherings of more than 25 people inside an area of 900 square feet and outside businesses. It does not apply to private homes, churches, weddings or funerals. It will be reviewed every 14 days. The regulation passed 8 -1, with Mayor Jacobs voting no.

Executive order 38 from the governor was discussed. Dr. Shamiyeh said he was wondering what was already in place. That part of the Tennessee pledge, paragraph 11 says bars nightclubs, etc. “may only” serve customers only at tables which are appropriately spaced. He asked Mr. Sanders if this wasn’t an enforceable mandate. Mr. Sanders said the regulation does not address enforcement. Dr. Buchanan said most bars are following this and she would not want to put her workers in a worse position by enforcing that. She said they are already taking a great deal of abuse.

Dr. Gotcher ended the meeting by addressing the public regarding emails and asked that all emails be addressed to the .gov email addresses because they could be missed if they go to personal email accounts.

He also noted that these are tough times and that people have become more angry to the point that he worries about violence. He said he wants the public to know these decisions are being made with good intentions and that sometimes the board feels they are “on an island.” Mayor Jacobs said the same is true of the Health Department employees. And he said the board has been put in this situation by legislation that people should take up with the legislator’s and the “system” not the board. He says even when he disagrees with the board, he knows their decisions are made from good motives.

The meeting ended after 3 hours and 15 minutes, all of which is provided below for your viewing pleasure.