The regularly scheduled Knox County Board of Health meeting was held yesterday with two items of high interest on the agenda, both framed as requests to the governor. Before the meeting, one was withdrawn (that the power of the board be extended to the region). Dr. Hurt requested time to discuss the moves by the Knox County Commission to remove regulatory authority from the board and that was added to the agenda.
Dr. Buchanan started the meeting with a review of the current data (given in yesterday’s summary). She also reviewed the benchmarks, which had not been published at the time of that article. All benchmarks were previously coded red and that remained the case. She noted the high increase in deaths as the most concerning piece of data.
She also pointed out we have set records over the last two weeks in cases. She said there has been an increase in test volume, though return time remains around six days. She said the volume of cases currently overwhelms the ability of the health department to trace contacts except for the youngest and oldest cases. She noted there have been 38 deaths in the last 14 days. She reported a 21.75% positive test rate for the county.
Dr. Shamiyeh gave his report on hospitals and the charts here are his. He pointed out the jump in the last week, attributing that to Thanksgiving and noted that the month has already surpassed last month’s record. He added that, unlike two weeks ago, cases are now growing in every age demographic, whereas before it was primarily in the older age groups.
He said the increases so far have mostly been because of colder weather and gatherings, though we are beginning to see the impact of Thanksgiving. He said there is nothing in the short term that will likely improve our situation and that the impact of the vaccine on hospitalizations is still months away. He said there is significant illness among health care staff due largely to exposure outside of work. That has strained staffing and it makes opening surge beds very difficult. He said he is hopeful the staff illness will improve once the vaccine is given, which will allow them to manage the coming surge.
Charity Menefee shared some additional information compiled by Roberta Sturm, the epidemiologist with the health department. She said that in December 26.8% of the total cases have presented. 21.8% of the deaths in the pandemic have happened in the last sixteen days. She reported 51 deaths for the month (This contradicts my records which indicate 67 and is based on the numbers they have reported daily. I will follow up on this. I suspect it did not include today’s 11.) We have averaged 397.8 cases per day for the month.
They discussed a proposal to request that Governor Lee reinstate some restrictions included in Executive Order 17. After conversations with state officials, they were told to form a resolution to send as a request to the governor. Dr. O’Brien said, according to the state website, we are using masks at 60%, and are outpacing predicted deaths. He noted we were worst in the world earlier this week in new cases per 100,000.
Dr. Hurt expressed support for a state-wide mask mandate, saying it displays leadership and that it has proven effective in other states. Dr. Souza agreed and reminded everyone that mask wearing is supported by the vast majority in the state and more people would probably wear them if they were told to do so by the governor.
Dr. O’Brien said he would be comfortable simply asking for a statewide mask mandate. Dr. Shamiyeh asked if there was a realistic chance this would have an impact on the governor and Dr. O’Brien said he felt it might. He also said it might also be supported by other county or city entities.
Dr. Gotcher pointed out that the governor has indicated he believes education is the better way to go and that each county has different situations. He wondered if that might have changed. Dr. O’Brien said the governor may be more open as we are the worst spot in the world and that other Republican governors have reversed course. He pointed out we also need public health messaging as some churches have resumed meeting and some bars are defying the order.
Dr. Buchanan said she feels that if the governor supported a mask mandate it would be more powerful than a Board of Health doing so. She said she doesn’t think the PSAs are working. She suggested perhaps sending a request to other groups like various commissions in the area to support the call.
Dr. Shamiyeh said the people who have the most influence at this time may be the leaders who have resisted mandates, like the governor. He said the people who are going to listen to people like Dr. Buchanan have already done so. Dr. Souza said some industry leaders might also join in.
A motion was made to pass a resolution asking the governor to enforce a statewide mask mandate. All members voted yes except for Mayor Jacobs.
An additional resolution was discussed, which was added by the request of Dr. Buchanan. She said she has struggled with what to do given the cases, deaths, economic impact, and resistance to regulation. She reiterated that if we sent everyone home would stop the disease, but that the tolerance for that is not present in the community. She said clearly people are safest at home, but businesses need help, as well. She combined the two into one resolution.
She noted that the inclusion of extracurricular activities is resulting in spread and we need to decide our priority and whether it is to stay in school or to do those activities. Mayor Jacobs said canceling activities for the spring would make him hesitant. They softened the language to simply discourage exposure as participation happens. Dr. Gotcher pointed out the ways that UT is limiting participation by fans. Dr. Wagner said there have been clusters around indoor sports. She said crowd sizes are going to be limited starting next semester.
The resolution called for citizens to “Shelter at home as much as possible. When individuals leave their homes or places of residence, they should practice appropriate social distancing, staying at least six feet apart from those outside their household; wear a facemask; and assume others are infectious, regardless of whether they exhibit symptoms.” The resolution also included a list of recommendations for businesses.
It passed unanimously.
The regulation regarding restaurant and bar closures, set to expire before the next meeting, was discussed. Dr. O’Brien said the people who are following the mandate feel they are being penalized by those who are ignoring it. He said some are asking that the regulation be removed and that they be allowed to do the best they can do. Dr. O’Brien said the two businesses which have been repeatedly cited are the tip of an iceberg and many in the county (where there is no reinforcement) are doing as they please.
Dr. Buchanan countered that it has been too short of a period to see if it helped. She said that as our numbers go up, she has a hard time letting go of something that has helped in other locations. She made a motion it be extended to January 6. Dr. O’Brien said some have asked him to extend the curfew by an hour. Ms. Roma pointed out that the board received a letter from someone who stays open 24 hours.
Dr. Shamiyeh pointed out that with spread so rampant, it will be hard to know what could have been. He wondered if masking was at 95% instead of 65% would we be having a different conversation. Mayor Jacobs questioned whether students being gone for the semester might mitigate the issue as they were some of the concern. Dr. Shamiyeh pointed out the bottom-line question is whether we are going to do anything.
Dr. Hurt reminded the board that the White House Task Force recommended more severe restrictions than what we imposed. Ms. Roma pointed out that the task force recommended 25% capacity for restaurants and closing bars and said it weighs on her heart.
The board voted to continue the measure to January 6. Mayor Jacobs placed the lone negative vote.
Dr. Hurt made the point that resistance to public health measures is as old as the plague or before and that when measures were first put into place some public health officials were even killed for trying to do what they felt best for their community’s health. She noted that none of the board signed up for this task and that it pains her to be accused of power grabs and worse.
She asked for the community to imagine taking a job, but afterward having the job change to being given the responsibility of making decisions that impact the health of hundreds of thousands of people and then being bullied, threatened, intimidated, and not being allowed to talk to each other except in public. She said it is remarkable that they’ve stuck to it. She noted that county commission has now proceeded toward disbanding them as they exist. She asked, “why?”
She said that in the past they had not made law or mandates. It was thrust upon them by the law department and now it is being taken away. Why is it going back and forth? She said since they aren’t allowed to talk outside the meeting, she wanted to have the discussion.
Dr. Gotcher said they have been given a task based on the law. He said it doesn’t matter to him who gets the job done, as long as someone does. If someone wants to take it instead, he said that is fine with him, if they are willing to make the hard decisions.
Dr. O’Brien said he hates to see the responsibility being placed only on Dr. Buchanan when there is shared responsibility at this time. He questioned the wisdom of making these kinds of changes in the middle of the pandemic and said he would be happy to talk to the commission at any time and reiterated that the board can’t talk to each other except in meetings. He asked that everyone take a breath before proceeding.
Dr. Shamiyeh pointed out that the advisory board would report to Dr. Buchanan. He said the course of action may not have been substantially different if she had been in charge all along and that it seems to him there are other things we need to be talking about – like the pandemic and the economy. He said when it is all said and done, COVID will have more impact on the economy than any regulation. He agreed it doesn’t matter to him if someone else is willing make the hard decisions, though he hates to see it be on one person’s shoulders.
Dr. Souza thanked Ani Roma for speaking to the commission and said they are all tired. She said most days she feels like a “kicked dog.” She agreed it is better for a group to share the burden.
Dr. Buchanan said it is nice to have the shared responsibility. She thanked them for sticking with it and acknowledged that when she spoke to them about being on the board, she didn’t have this in mind. She said she hopes at the least the group isn’t disbanded. Dr. O’Brien pointed out that they must be dissolved to be reformulated as advisory only. He thanked the staff at the Knox County Health Department for their hard work.
Dr. Gotcher said for the board to be careful and noted he has seen some dark things on the internet. With that, the meeting adjourned.