Knox County Board of Health Meeting 9/9/2020

health Department

The meeting began without a public forum as no one had signed up to speak. The board was joined by Mr. Sanders from the Knox County Law office and Dr. Plowman and Dr. Gregg from UT.

Dr. Buchanan led the discussion of the current situation and benchmarks, which were reported in the previous article. Of the five benchmarks, one is red (cases), three are yellow and one is green. With cases, the 11 – 20 year old demographic is driving the leap in numbers and the change has been statistically significant for five of the last six days.

Testing was changed to yellow because there were dips in volumes of testing, while turnaround time is good. Investigations are still being executed in the designed time-frame, but the team is being expanded due to the increase in numbers of cases. There will be a dedicated team for the Knox County Schools and another for the University of Tennessee. The intention is for the teams to help make decisions about who needs to be quarantined.

New Cases by Week and Month in the Region and County

There were concerns with upticks in ventilated patients at the hospitals. Over the last two weeks, there have been ten deaths, causing the benchmark to be changed to yellow.

Dr. Shamiyeh reported on hospitals. The graphs in this article are his. The graphs make it clear that, for the last two weeks, the rate of new cases has increased. That increase is clearly driven by the surge in cases among the eleven to twenty-year-olds. He said the concern regarding hospitalizations is not as much a surge from the younger demographic currently being diagnosed, though they can be and have been hospitalized. The primary concern is who they are in contact with and whether that leads to increases in more vulnerable demographics.

Hospitalizations, which had trended downward, are now trending back up. Knox County’s positive test result percentage is also tracking upward and now sits at nearly 10%. Relative to the other major metro areas in the state, Knoxville stands out as the only one of the four which seems to be trending upward. Projections are now looking worse than they looked either of the last two weeks.


Age Distribution for Knox County

Dr. Plowman addressed the board regarding the situation at U.T. She pointed out there are 616 positive students and a week ago the number was 303. The number of people self-isolating has gone from 730 students to almost 2,000 in that week. The number of cases has doubled and isolations have nearly tripled. She said clearly changes are warranted.

As a result, Massey Hall residents are moving out and the entire 580 bed dorm will be for isolation, as will some rooms in the Holiday Inn. That transition will take about two weeks. The goal is to be able to manage at current levels. Other university responses are being studied, including taking a break from all activity, including in-person classes. Systematic surveillance testing will begin next week. She said the news is not good. She said there is a total of about 30,000 students and on-campus residences added up to about 10,000 (if I did mental math correctly as I typed.)

Hospitalizations by Week and Month for Knox County and the District
Hospitalization Census for District

Ms. Wagoner reported for the public schools. She said that custodial staffing has improved and will soon be represented as yellow. Substitutes continue to be a concern and bonuses are being offered. She said at Cedar Bluff Middle teachers had to be quarantined due to contact with cases. Dr. Hurt said she would appreciate seeing percentages of attendance daily, etc., associated with each metric, to know more specifically how far into one zone or another we are at a given time.

Dr. Shamiyeh asked about what happens when a student is sent home as a contact. He wondered if the family is given instruction as to how to handle the situation correctly. She said they are told to monitor for symptoms, test temperature daily and they suggest testing five to seven days after the exposure. Dr. Shamiyeh said exposure in the home is his concern. She said families are told to wear masks when they are in the same room. Charity said they are told to stay out of the same room with others and preferably use a separate bathroom.

The group discussed the current state of the mask mandate. Dr. Buchanan said they continue to hand out masks. She said there are three to four complaints (a week, I presume) about non-food businesses and about the same for restaurants. She said complaints have leveled off. Dr. O’Brien said it is too early to lift the restrictions. He implored the community to be patient.

Positive Test Rate For Knox County Over Time

Dr. Hurt said a state survey revealed that a very high percentage of business owners support the wearing of masks. Noting that the economy had been hurt by the pandemic and that people seem to understand masks help keep us safe (and by implication, the economy moving), she said the board should feel some support for their work. Dr. Shamiyeh said the masks are critical and the college rates are showing that infections are much greater in absence of masks and following the core actions. Dr. Drake mentioned a study showing much lower hospitalization rates in locations with mask mandates.

They reviewed the current restrictions on bars and the proposed restriction to extend the 10 pm curfew to restaurants. Dr. O’Brien said he spoke to law enforcement who said there was pretty good compliance at first, but that has shifted and there are multiple bars not following the regulation, including in the area of the University.

He said police are not sure how to proceed because, when confronted, the bars insist that they are not included because they sell enough food to get over the threshold. He said the regulation isn’t working and it can’t be enforced and that most cases are coming from private gatherings. He mentioned a complaint he received regarding a downtown bar.

Tennessee Metro Comparisons

Dr. Buchanan said that when we look around the state at other metropolitan areas have had success and they have been more aggressive about closing bars that violated the curfew. Mr. Sanders confirmed the Health Director and health officers have the authority to do so here. Dr. Buchanan noted there are perils to taking that path, but that it is possible.

Mayor Jacobs asked how that would be done and what the liability to would be for the county. Mr. Sanders quoted the statute that gives the Health Director authority to suspend a license or permit. Further, if they feel there is an immediate threat, they can close the business before going to court, or go to court first if they so choose. The only liability, he said, is if the procedures are not followed or the information used for the closure is accurate. The mayor said we’ll get sued and Mr. Sanders said that could be, but any suits should not be successful.

Mayor Jacobs asked what the involvement of the police or sheriff’s office might be. Mr. Sanders said citing a business would be up to their discretion. They cannot be ordered to do so. (Ed. Note: Maybe someone can help me with this. It seems strange to say that law enforcement can’t be required to enforce the law.)

Dr. Shamiyeh noted that the mask mandate has been a big win as far as compliance. He said regarding the curfew, the question is enforcement. He said the interventions have been based on the best understandings of the virus and that he feels there will be higher case loads and hospitalizations than we’ve seen so far, for some time to come. He said we may wait to take more definitive measures later, such as closures. He said the broader question is whether to intervene gradually or in a big way after the situation worsens.

Projections Based on Current Date and Compared to Previous Projections

Dr. Gotcher said he feels some bar owners felt relief at being able to remain open 10 pm, but he wondered if the board should not recommend the 10 pm closure rather than mandating it. Dr. Hurt reminded the board that the reason the mandate was put in place because increased alcohol consumption causes people to be less likely to comply with the core behaviors and that it was a White House Task Force recommendation. She said if alcohol is the problem, then including restaurants is logical and enforcement is easier if it applies to all businesses selling alcohol. She said compliance or lack of it doesn’t mean it isn’t a good idea.

Dr. O’Brien asked if we’ve seen issues coming from businesses as cluster sites. He noted that personal gatherings seem to be more the issue. Dr. Buchanan said the most common cluster is a community setting – a religious gathering, or other community activities. Charity Menifee said the UT spread has been through off-campus parties and Greek parties. She said tracking cases if the person has been to a bar, is done by cross-referencing to other cases to see if there is a common thread, but it is difficult since you don’t know who else was at the bar.

Dr. Buchanan said that Dr. Plowman has asked this week if the Board of Health could close bars near campus. She said Nashville has done that, though there are concerns with geographic targeting. She also said the area is large and it would be hard to know where to draw the line as students have cars and can go anywhere. Dr. Gotcher said in addition to legal issues from doing so, he would worry about the public risk for drinking and driving as students drive from campus to bars which are further away.

Dr. Shamiyeh said Dr. Plowman was very somber at her briefing yesterday. He said if nothing is done and the rates continue to increase, students will be sent home and the businesses will be damaged. At that point a legitimate argument could be made that they should have done something to save those businesses from the health crisis. Dr. Gotcher said U.T. has more power to control students than does the board and that they could do something to stop students from going to the bars.

Dr. Hurt said Dr. Plowman continues to make the point of not having additional recourse. She said the board needs to support the University in some way. She said if nothing is done, the health situation will deteriorate and there are consequences either way. Dr. Gotcher countered that being more restrictive doesn’t help if there is no enforcement. Dr. Buchanan said we are trying to change human behavior and it is a challenge to know how to do that.

Dr. O’Brien said in the absence of enforcement, the board may have to let things get worse before there is support for becoming more restrictive. He said maybe the the 10 pm curfew should be dropped, with a complete shutdown of bars if the situation worsens. Mayor Jacobs said from the enforcement standpoint on the strip, the Sheriff’s office defers to KPD and he can’t speak for them regarding enforcement.

Key Points From the Data

He said there are some things people will comply with, but this may not be one. He said a bar closure in a geographic area would, he feared, antagonize the community toward UT students. He said he would be “less uncomfortable” with UT taking action than the board doing so. He said people should be encouraged to follow guidance, but anything more strict could potentially backfire. Mayor Jacobs said some colleges have made rules that students can’t leave campus. Dr. Gotcher said the code of contact allows them to intervene.

Dr. Shamiyeh wondered if there could be a recommendation to cap gatherings at a smaller number than 50. That might give Dr. Plowman some basis for requiring that of students. He asked Mr. Sanders if a recommendation would have to be as detailed as a mandate. He said no and that it could be voted as a recommendation and formalized into a resolution at a future meeting.

Dr. Drake made a recommendation that they rescind the 10 pm curfew and Dr. O’Brien seconded it. Dr. Shamiyeh suggested they wait until it expires naturally in a week and Dr. Hurt said she agreed. Mayor Jacobs said he would go ahead since people are not complying and it isn’t enforced. Dr. Hurt said some people aren’t following the mask mandate, but we aren’t throwing that out. Not everyone complies with anything, but that doesn’t mean the law shouldn’t exist. She said she thinks most bars are really trying.

Mayor Jacobs said if it is taken off, then the responsible business owners could do business and that might help the situation by taking patrons from the places with no compliance. Dr. Shamiyeh asked that if the mandate is removed, should we do education with bars regarding what the Tennessee pledge recommends, such as not standing at a bar or serving at a bar. Patrons are to be at tables. Dr. Buchanan said most places are compliant with that.

Measures Taken by and Considered by the Board of Health and Recommended by the Tennessee Pledge

The group voted on the motion to rescind the curfew. Dr. Drake, Gotcher, Jacobs and O’Brien voted yes, while Drs. Hurt and Shamiyeh and Ms. Wagoner voted no.  Mr. Sanders said a majority of the full board (5 votes) is required to make a change and the vote was one short, and therefore failed even though a majority present voted for it.

For purposes of discussion, a motion was made to include brown bag establishments in the 10 pm curfew on alcohol. Dr. Shamiyeh, Dr. Hurt and Mrs. Wagoner voted yes, with the others voting no. The motion failed.

Proposed rules to govern the board were proposed. The only rule of note was that there would be a public forum which would happen once each month. The rules were passed after lengthy discussion.

Mayor Jacobs announced that computers in libraries will be available next week. Dr. Shamiyeh displayed the ideas (see above) that have been discussed and noted that the options are finite. Dr. Shamiyeh made a motion that the board recommend to the public that gatherings be limited to 25 within a 900 square foot space. Dr. Hurt made it clear that this would simply be consistent with maintaining social distance. The vote was unanimous.

If you’d like to enjoy the entire 3 hour 29 minute meeting, feel free:

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