Knox County Special Called Board of Health Meeting 11.20.2020

health Department

Everyone was present for the meeting, with David Sanders representing the county law department.

Dr. Buchanan started the meeting with a report of the current numbers, covered in this space in the previous article. She also discussed the benchmarks as previously covered here. She noted the increased cases and deaths as well as the slower turnaround time for test results. She said these are the worst numbers we’ve seen, and they are not “trending in the direction we want to see.” She said the lower case number today was due to an issue with state reporting and they anticipate high numbers this weekend.

Dr. Hurt said she requested the meeting because the numbers are getting very serious and she felt waiting until next week to meet would be too late to discuss what might be done to to address the problem.

New Regional and County Cases by Month and Week

Dr. Shamiyeh gave an abbreviated version of his usual report. He expressed concern at the increases of cases among those 51 and over. He said that with our positivity rate so high, contact tracing cannot control the spread and the chance of casual contact with someone who has the illness is dramatically increased. He pointed out that not all available beds listed in a census would be available for COVID patients, noting the available beds at Children’s Hospital as an example.

Dr. Hurt asked how the current numbers compare to our worst flu census for hospitalization and Dr. Shamiyeh said it is worse. Ms. Roma asked about the level of supplies and equipment. He said right now the supply level is fine, though he said there has been an issue this week with supply of convalescent plasma. He encouraged anyone who has been previously diagnosed with COVID to contact MEDIC to donate plasma. He said so far the hospitals are not delaying the range of other services offered.

Knox County Cases by Age Demographics

The question was asked of Ms. Wagner whether all-virtual has been considered for schools. She said they will continue to monitor the metrics already established, though the schools are feeling the increase of community cases.

Dr. O’Brien presented recent mobility data for Knox County. He cited a recently published article that confirmed that certain spots serve as super spreaders in the 10 largest metro areas in the U.S. based on cell phone data. Full-service restaurants led the list. Local data showed 639 places that had large numbers of visits of longer than 15 minutes.

Mayor Jacobs asked if proximity between cell phones could be tracked. Dr. O’Brien said he didn’t know but could look into it. He said the data gave the information down to individual businesses, but not homes. It does not come with individual data, but it would be a measure of increasing or decreasing mobility. Apps, used in Europe, which automatically notify people if they have been in the proximity of someone who is positive were mentioned.

Knox County Hospitalizations by Week and Month

Vaccine news was discussed, and while encouraging, will not impact us in the shorter term. Dr. Shamiyeh said the efficacy was encouraging, but perhaps more so was the possibility that the immunity may be longer lasting than previously thought. He also noted that the first vaccine in the series of two will provide some level of effectiveness.

Dr. Buchanan said the county has been told there may be a shipment of about 975 doses in early December, but vaccines often arrive late. She also said we may get more than one kind over time and everyone must get two of the same vaccine for it to be effective. She said when it gets to the doctor’s offices we will begin to experience wide-spread distribution.

Dr. Buchanan began the discussion of what other jurisdictions are doing to combat the illness. She said there is little information on county-to-county comparisons with rates and levels of illness paired. She said mask mandates are widely in place across the country, though even within states, such as ours, some counties require them while others do not. About 35 states have some form of mask mandates, some are almost completely locked down and others have curfews.

She looked at cases per 100,000 and said there appears to be a slower increase in cases where there is a mask mandate. She said only Hawaii appears to have a stable number of cases and none of the states have declining rates. More of the states with high trajectories of increases did not have mask mandates or other restrictions. She said the White House has continued to recommend more restrictions for Tennessee and Knox County, including closure of bars and reduced restaurant capacity.

Regional Hospital Census Over Time

She shared a graphic demonstrating the impact of interventions on cases in Arizona. She said the perfect public health approach would be a lockdown, but she knows that is not possible at this time and comes with other costs. She cited a study that showed eating at a restaurant or visiting a bar is more highly associated with positive diagnosis for COVID.

Mayor Jacobs responded to her comments by noting that in the year 2020 we have seen a year-over-year 44% increase in drug-related deaths, and he said it has doubled in the 55 and over age group. He said less child abuse is being reported but questioned whether perhaps that is because it is not being reported because of reduced contact with other adults.

Dr. Buchanan acknowledged that everything about the pandemic is impacting us all and that there is a broader definition of health than simply the impact of the virus. She said interventions need to be surgical, but we have limited evidence and understanding after only a few months. She framed the issue as trying to reduce social interactions where the virus is spread without doing unintended damage. She said two deaths a day, as we have averaged recently, should not be acceptable to anyone on the board.

Dr. O’Brien pointed out that Nashville has begun requiring permits for any gathering of eight people are greater, even if the gatherings are personal or private. He said he did not think it would work here, but we need to talk about other things that may be possible, like stopping indoor dining and bars for a short period of time. He said we are not going to do what Kentucky is doing with a near shutdown for four weeks.

Knox County Positivity Rate Chart Over Time

Dr. Shamiyeh agreed we won’t replicate Kentucky’s approach, but pointed out that they launched a $40,000,000 fund to help restaurants. He asked if that was a possibility here. Mayor Jacobs said something similar had been in place across the state, but it isn’t in place at this time and couldn’t be done at a county level. Mayor Jacobs backtracked and said he thought some of the money was still available.

Dr. Shamiyeh said that regardless what we do, the issue is to reduce risk. He said the number of people he knows who have COVID but do not know where they got it has increased. He said congregational dining is a risk and they have tried to minimize that as much as possible at the hospital, calling it a “definitive risk.”

Dr. Buchanan added that carpooling is also a risk and multiple employees are lost to quarantine if one becomes positive. She also wondered about a new push for work-from-home. She said a push via employers might be mounted, but that something clearly had to be done.

Dr. Gotcher pointed out that he is hearing more marriages may be in trouble during the pandemic. Dr. O’Brien pointed out that overdoses and suicides are higher this year. Dr. Shamiyeh pointed out that due to the pandemic and the strain of all parts of it, behaviors are going to be impacted regardless of what the board does and that we are past the point of doing something symbolic.

Mobility Data with COVID Spread

Dr. Hurt said we need to keep a clear distinction between the impact of the virus and the impact of mitigation efforts. She said she has seen studies showing that mask wearing is decreasing anxiety. She pointed out that during any natural disaster there is increased anxiety and behavioral and mental health issues. Mitigation efforts are not what is driving people to mental issues, it is the pandemic.

She noted that nationally a person a minute died yesterday. She said she thinks that the numbers are heartbreaking and that large amounts of feedback in the last 24 hours, about 6 to 1 in the 125 emails, asked for them to do more, not less. She said she would like to put things back into place for gathering size and curfews for places selling alcohol. She said they need to be enforced for people’s safety.

Ms. Roma underscored that the virus is the enemy, not increased regulation. She said to do nothing would be damaging and that she supports additional restrictions. Dr. Buchanan said she would work toward that end with Mr. Sanders if they board wants to move in that direction. Dr. O’Brien said Wednesday might be too late to meet. He said he is worried that Wednesday night in bars will be a super-spreader event and wondered if the board shouldn’t meet Monday.

Dr. Shamiyeh pointed out that we slowed the increase earlier with a shut down we are not likely to repeat, but that whatever we do this time needs to be enough to make a significant impact. Dr. Buchanan said limiting social gatherings helps and that might be helpful. She said something related to restaurants might be important. The White House Report recommended 25% capacity for restaurants and bars. She said short of shutting everything down and staying home, it is hard to know for certain what will have enough impact.

Mobility Data for Knox County for the Last Week

Currently, under the Tennessee pledge, restaurants are only required to keep six feet of distance between tables. Gym capacity was discussed. Currently the Tennessee pledge only says to observe distancing. Dr. Drake said she has had a lot of people complain about crowded yoga classes.

Mayor Jacobs asked what contact tracing has shown about restaurants. Charity said social gatherings in homes, offices, restaurants, and bars are the primary causes of spread, though exposures are everywhere at this point that it has become harder to pinpoint. She said they are working on gathering more data, pointing out that combined household groups at single tables is the problem, more so than servers spreading the virus to patrons or the virus spreading from one table to another.

Dr. Shamiyeh said that one person in an email pointed out their employer planned a big gathering because there was no size limit in place for gatherings. He said having a recommendation in place for gathering size at least gives people something concrete to point to.

Mayor Jacobs said he is uncomfortable with limiting gathering size because people will simply go to another county. He said he is uncomfortable with closing gyms because people need to be working on their health. Dr. Shamiyeh pointed out that this isn’t simply a Knox County problem and we can’t impact what other counties do. He asked Mayor Jacobs how he reconciled that.

Arizona Case Rate with Interventions

Mayor Jacobs said that is just the reality. Ms. Roma said no matter what recommendations are made, some people will not follow them, but maybe enough people will to be impactful.

Dr. Hurt reiterated that people are, by a large margin, asking for stricter regulation and enforcement. She quoted the Knoxville Chamber of Commerce as saying that the economic impact is coming from the rise in cases and deaths. She said we need to have multiple efforts and that the mask mandate should be enforced. She said there needs to be a limit on gathering and, obviously, they would not go into people’s homes, but some people are looking for guidance.

Recommendations for possible action for next week were discussed. Ms. Roma said the White House Task Force recommendations provided a list of suggestions. Limiting restaurant capacity to 25%, dropping the curfew for restaurants and bars to 9 or 10 pm and limited gathering sizes to 8 or 10 were mentioned by Dr. Hurt as possibilities.

She also noted that people can exercise out of doors and that we have to think of different ways to do things until our situation improves. She said we are talking about buying the hospitals some time. Dr. O’Brien said at least one big-box store is now requiring a face guard if you can’t wear a mask. Dr. O’Brien challenged the county to help in enforcement, saying there are large gatherings that are not being stopped. He pointed out that City Council has moved to civil penalties and suggested the county do the same.

The board agreed to meet again on Monday at 5 pm.

You can enjoy the entire 2 1/2-hour meeting below (unless you were one of the 17 still watching when it ended live!).