Knox County Board of Health Meeting 9/2/2020

health Department

The meeting was joined last night by Dr. Gregg and Chancellor Plowman from UTK.

The meeting began, once more, with a public forum:

  • Charlotte Myer requested that computers at public libraries be made available, once more, as they are important for people who do not have internet connections. She suggested they be spaced for social distancing. She pointed out that Sevier County Libraries have made theirs available since June and Nashville plans to do so next week.
  • Bill Watts thanked Mayor Jacobs and said he wished the governor’s orders had been rescinded so the meeting could be in person. He questioned whether this virus was different from others in the past. He also questioned whether the tests are accurate in and whether causes of deaths were being accurately portrayed. He asked for the Health Department to provide an accounting of each death.
  • Zack Nabors advocated for removing mask requirements in every environment. He said the small numbers of cases, etc. related to the virus didn’t warrant the response and everyone should make their own decisions.
  • Kevin Hill suggested that tests are not an accurate diagnostic tool, quoting Kary Mullis. He noted Mullis’ claims were rejected by Reuters fact checking, but that Reuters is wrong. He reminded all that there is a financial incentive for over-diagnosis.
  • Brian Bonnyman, a local physician who has assisted with testing, said if we could see and hear what he sees and  hears, we’d support mask mandates and other interventions. He gave examples of people who have tested positive and have infected loved ones. He noted they had an outbreak at work which was stopped by wearing masks and distancing. He ended by asking where the public can access reliable, local positive test result rates.
New Cases by week and month for Knox County and the Region
  • Aija Purvis, who is homeschooling her child said she wanted him to join local physical education classes, but he was required to wear a mask. She asked for exceptions during physical exercise and for small children.
  • Elizabeth Murphy began by quoting Dr. Fauci, from February, saying that asymptomatic spread was not generally documented in any illness. She quoted studies that suggested wearing masks do more damage than good in operating rooms. She said the mask mandate does not help and implored people to take off their masks. Saying the board has no authority, she accused them of having an agenda with no legitimate reason for requiring masks.
  • Christy Stephens said she does not wear a mask and represents many who are harmed by wearing them or who have religious or other opinions regarding mask wearing. She quoted civil rights laws suggesting that the requirement tramples their rights and said public accommodations are required for everyone and civil liberties are being denied. She said it is illegal for employees of businesses to take temperatures. She asked to be told what the plan was for eliminating the mask mandate.
  • Michael Murphy thanked the board for allowing him to talk. He pointed out that masks were discouraged at the beginning and said the box on his masks said it would not prevent coronavirus. He said he has given up on media and learned from alternative sources that the death rate is much lower than mainstream media is saying. He said the response is not in line with the risk. He claimed that Dr. Redfield of the CDC has stated that hospitals are inflating the rate (Ed. Note: This is not what Dr. Redfield said.). He said Governor Cuomo chose to send patients back to nursing homes rather than an available ship and that he must have an agenda. He said we should follow Sweden’s example stating that they have a low death rate. (Ed. Note: Sweden’s death rate is currently the 8th worst in the world, just behind Brazil and just ahead of the U.S.)
  • Marci Ing (?) Citing a raid on her family’s milk farm regarding an E coli outbreak, she and said Dr. Buchanan did not provide evidence at that time and she was lied to to further the agenda of ending distribution of raw milk. She said we are capable of keeping ourselves safe, while questioning the drink curfew and other restrictions. She said being allowed to choose is “what America is about.” She said this is unnecessarily scaring people.
  • Mark Whitmire identified himself as a former medical industry worker and a small business owner, among other things. He said the cure is worse than the illness, claiming that more businesses have closed than the number of people who have died locally. He said he has seen people berated for not wearing masks and that his own business has suffered. He concluded that the mandates have outlived their usefulness and that people should be allowed to make decisions for themselves.

Hospitalizations by Week and Month for Knox County and the Region

Dr. Buchanan presented the current numbers and benchmarks as covered in the previous article. She noted that the 11 – 20 year old’s have had a 158% increase in cases in one week. She said the green lights for cases and for testing is a cautious rating as there have been days of statistically significant increases in cases, and decreases in testing, but not on consecutive days.

She sees signs that cases may be increasing, though tracing staff was reduced based on last week’s numbers. She noted that hospitalizations are also slowly trending upward. There have been four deaths in the last two weeks (I understood there to be 7) and that represents a reduction in deaths over the previous two week period. She said she expects demand for testing will go up in the next weeks. She’s concerned that testing may be too low and said they have reports of people avoiding tests to avoid quarantine.

Current and Previous Projections

Dr. Shamiyeh gave his weekly report, noting there have been spikes after previous holidays and expressing concern about the upcoming holiday weekend. (All charts shown here are his.) He pointed out that the rates of increases in cases and the rates of hospitalizations have slowed. He reported that current projections are better than some  earlier projects, but worse than last week due to an uptick in cases and hospitalizations. He also presented the list of patients who have died at UT hospital by age, gender and symptoms.

He also addressed several misunderstandings common in the public. He said in his decades-long career as a pulmonary disease specialist, he has never seen flu that compared to what he has seen with COVID. He said the average flu season at UT will produce deaths in the single digits and the worst year saw sixteen deaths. They’ve had 36 deaths from COVID-19 at UT Medical Center already.

Next he tackled the comorbidity issue that some have used to suggest that the deaths are not truly due to COVID. He said people who died of COVID-19 were made more likely to have died by their comorbidities, but would not have been in the situation without COVID-19. He added that the more chronic conditions you have, the more likely any particular health crisis will have a negative outcome and this seems to be more true with COVID-19.

Characteristics of COVID patients who died at UT Hospital

At death all those illnesses are listed as possibly contributing, but it is COVID that made it happen at this time. He also made clear that COVID-19 itself can produce impacts on the body, such as respiratory distress and blood clots that would also be listed on the death certificate as contributors. He also pointed out that virtually every death from the flu involves comorbidities, but they seen some with COVID-19 which did not.  He concluded by stressing that despite the CDC statement about testing last week, we still want people who have had contact with someone who is positive, to be tested.

Dr. Gregg and Dr. Plowman presented the U.T. data included in the earlier article. Dr. Plowman said they remain confident in their capacity to handle the cases and that soon they will begin surveillance testing and it may lead to an increase in reported cases, but should help slow the spread. She said plans continue to be altered in working with sororities and that the primary problems happen off campus. Dr. Gregg said he fears the students are focusing on the size of the group and not the other behaviors, thinking if the group is fifty or below, they are safe.

Mayor Jacobs asked if the UT student counts go into our county counts. She said if they are living here it goes into our counts. If they return home to another county, their case would be transferred and would drop from our numbers.

Ms. Wagoner reported on the numbers from the school system (see the previous article). She explained (something I had not understood) that their metrics are color coded like the health department. The current “red” rating is for substitute availability. She said the case rate relative to the total population is reasonable for now. She said only one staff member has been hospitalized and that was in June and no students have been hospitalized.

Explanation of Comorbidities

The group opened a discussion on the mask mandates. Dr. Buchanan said complaints have stabilized and dropped. She said they haven’t found data points that other locations are using for when they would remove the mask mandates. She said the benchmarks could potentially be used that way, like if there were four consecutive weeks of reductions in cases or if cases fell below a certain level, that might be considered a trigger.

Dr. Gotcher noted that Williamson County just lifted their mask mandate and Dr. Buchanan said she would ask how they made the decision. Dr. O’Brien said there may be a need to give people a target, but that we aren’t there at this time and its hard to know what metric to use. He said Williamson County’s decision was a political one. He pointed out that masks are helping and they are less intrusive that closing businesses or other measures.

A motion was made to expand the regulation on bars to include places that encourage and allow brown bagging alcohol. Dr. Buchanan said they are being told that bars on the strip are ignoring the restrictions. She reiterated, as per the governor, that COVID regulations cannot be used by the Health Department as part of their health inspections. Dr. Gotcher said in emails he sees that bar owners feel their late-night business is simply being diverted to restaurants.

Who Should Be Tested

Dr. O’Brien said if the regulation is being ignored it may not be worth having. It was noted that Nashville has a lot of regulation and their numbers have gone down, but they are using uniformed enforcement. Details of the original ordinance were changed to reflect current conditions and current Whitehouse recommendations. After a very lengthy discussions centered around legalities and definitions, the proposed expansion was deferred by unanimous vote. The measure may come up again, but the board expressed concern that it might have unintended consequences, such as impacting unintended businesses.

Dr. O’Brien asked if the entire curfew might need to be a recommendation in the longer term, rather than a requirement, if it is being violated routinely and can’t be enforced. Dr. Buchanan said many bars are following the mandate. The current curfew was extended for two weeks with all voting in favor with the exceptions of Dr. Drake and Mayor Jacobs.

They also discussed the public forum and whether the board desired to write their own rules. Mr. Sanders said he is working on a draft proposal with a member of the board. At issue is the public forum and whether it will be included in each meeting and how it will be handled for time and content.

The three hour and 38 minute meeting mercifully drew to a close at that time. You can watch the entire production below, if you’d like more detail.

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