Knox County Board of Health Meets Amid a Worsening Crisis, Limits Social Gatherings

health Department

All members were present for the meeting. David Sanders joined as the representative for the Knox County Law Department.

The meeting began with a public forum:

  • Sherry Garrett spoke first saying the existence of the Board is unconstitutional and they are harming the health of the county because of the mask mandate. She said limitations on gatherings are unconstitutional. She demanded the right to engage in questioning and to “cross examine” the board.
  • Vernon Henry confronted the board for not paying attention and demanded they listen. He said the board has financially ruined local families and misled the citizens by having them wear masks. He invited people to go to the homes of the board and let them know how they have damaged their lives and called on the citizens to defy their orders.
  • Christine Cruise said she would not give her address as her “gate has been vandalized.” She said there is no constitutional authority resting with the board. She said the only surge will be a result of people not counting cases over the holiday and those cases being reported as a group afterward. She attacked Dr. O’Brien for suggesting people should stay home for four days and Dr. Drake for traveling to Arizona.
  • Richard Cunningham thanked Mayor Jacobs and Ms. Roma for being responsive to emails. He thanked Randy Burleson for convincing the board not to do more damage. He said test turnaround should be one day as that is what one local lab provides. He said hospitals are busy simply because of the time of year, that contact tracing is a waste of time, and quarantines are overdone. He blasted hypocrisy among national leaders, and he singled out Dr. Drake for traveling to Arizona last week.
  • Anastasia Juneau thanked Mayor Jacobs for voting against the mask mandate and Sheriff Spangler for refusing to enforce it. She played an excerpt of an interview with the developer of the PCR test, Kary Banks Mullis suggesting the test can be misinterpreted.

The group moved directly into their agenda without a response to any of the above.

New Cases for Knox County and the Region by Week and Month

Dr. Buchanan presented the report on the current situation and the benchmarks (all of which are red for the first time). She noted yesterday’s new record for cases and today’s high number. She said the last fourteen days presented the most new cases of any 14 day period. The total number of tests has increased, largely due to testing before Thanksgiving, but that test return time is running close to seven days. She said the slower return time is true across the state.

On contact tracing she said the volume of cases has caused the Health Department to change the method for assessing this benchmark, implying that the 24 hour contact goal is no longer possible. It will now be based on an internal assessment of the capacity of public health to carry out tracing. She said the public needs to isolate as soon as they feel a need to be tested and to contact their contacts. She noted the significant recent increase in deaths and called the number of deaths “sobering data.”

Knox County New Cases By Age
Metro Area Trend Comparisons (Scales are not the same).

Dr. Shamiyeh presented the hospital data. He pointed out that the dip in cases for the most recent week was due to testing slowing during the holiday. He expressed concern that the over 50 age group is the group with the highest rate of increases. He said the concern is two-fold. First, as we all know, that population is more at risk, but further, this likely indicates that testing is being driven by symptoms, meaning many cases are being missed.

He noted that he thinks hospital data from across the state is becoming more delayed as the census rapidly grows. He said we are in a “consistent spike” and that this has nothing to do with Thanksgiving gatherings, the result of which we will see in coming weeks.

He said the decision by the hospitals to change to red for the hospitalization benchmark included wait times for beds, whether hospitals have had to divert ambulances to other hospitals, the ability to place COVID-19 patients in appropriate beds, how long ambulances are having to wait and more.

Knox County and Regional Hospitalizations by Week and Month
Age Distribution of COVID-19 patients at UT Hospital on December 1.

He said red implies that there has been a change to regular hospital operations, which is now the case. He said there has been a significant increase after Thanksgiving which, as he stated earlier, has nothing to do with Thanksgiving gatherings. He made it clear that anyone needing to come to the hospital for any reason should do so and emphasized that it is safe.

He said staffing is becoming more of an issue and it is harder this week than last. Dr. Gotcher (later) made the point that New York got staffing help from all over the country when they faced the height of their surge, but that we will not have that luxury as the illness rates are high everywhere.

Keith Britt joined to discuss publicly available mobility measures. Mobility has dropped, more so during the stay-at-home orders, but it has been steady for months. There are increases of visits to parks. Previous spikes in hospitalizations were preceded by mobility events. The current spike, he feels is more likely related to the shift in seasonal temperatures. Thanksgiving was the largest mobility signature they have seen during the pandemic. He said they expect an “unprecedented surge multiplier event expected to begin in a matter of days.” He said there is no way to stop the coming surge, in his opinion. “The bell has already been rung.”

Dr. Mark Browne, Chief Medical Officer from Covenant Health spoke next, saying that while this time of year is always busy, this year is different as they are seeing more COVID patients and the system is strained. Dr. Frank Burleuelein, Chief Medical Officer for Tennova agreed to the level of need and joined the others in urging people to get the help they need from hospitals. He expressed some optimism that there may be less flu this year due to practicing the five core actions.

District Hospital Census

Dr. Buchanan addressed the recent concerns about quarantine and isolation numbers. She assured the public that the schools are being very careful to only impose quarantine when necessary. She said it even goes to the level of monitoring video footage. She said they will be looking at the new CDC guidelines of having a negative test within 48 hours of the end of day seven or being symptom-free at day ten to be released from quarantine and instituting changes accordingly.

They discussed face coverings and Dr. Buchanan said complaints are down. The social gathering limitations deferred last week, was discussed, essentially limiting social gatherings to 10 people. The square-footage portion was returned. Mayor Jacobs said it was confusing and that it should simply be a recommendation.

Dr. O’Brien said he agreed with the Mayor that it would be confusing for businesses and, while he wants to limit social gatherings, enforcement would be difficult. Dr. Gotcher also expressed concern that people will willfully disregard it. He mentioned a letter received this week urging people to disregard mandates.

Mayor Jacobs compared the size limitations to the lane in front of a basketball goal and how crowded it is when ten players are in the lane. He said this is “great-intentioned,” but is common sense and that we should simply appeal to people to act responsibly.

Dr. Shamiyeh asked if the Memphis and Nashville orders for gathering size were not mandates? Dr. Buchanan said they are mandates and she copied much of the language from the Davidson County regulation. She said we’ve been encouraging people and now have high case and death counts. Dr. Shamiyeh said there will be no perfect regulation, but the big picture is the intent. Dr. Gotcher said he is concerned it may make things worse.

District Hospital Census

Dr. Hurt said regulations send a different message than recommendations. She said we know everyone will not comply with any regulation, but it is still worthwhile for the message it delivers. She said it really isn’t that different from the mask mandate. Dr. Buchanan says she struggles with what will work to help keep people safer. She agreed that it would be hard to enforce, but she wants us to do something that is meaningful.

Dr. Hurt asked whether enforcement is the issue or is it more that a regulation carries more weight than a recommendation. Dr. Shamiyeh said if there were dramatic examples of disregard, he would like to see it enforced. Dr. Drake said it has largely worked in Nashville and she’d like to see it be a regulation.

Dr. Gotcher said the difference between the mask regulation and the gathering regulation is that the mask regulation is less intrusive. He said he fears it would be frustrating to businesses. He said he feels the die has been cast and there won’t be any difference in two weeks. Dr. Shamiyeh countered that reacting in two weeks puts us even further behind. He said the next two months are going to be bad and we are simply hoping at this point to blunt the damage.

Dr. Buchanan brought the focus back to the intent, which is gathering for the purpose of socializing, not regulating businesses. Dr. Hurt agreed, saying it is one of the other arms of the five core action – social distancing and that it isn’t about restaurants, shopping, or church, but celebrations or parties.

Regional Hospital Capacity (In two Formats).

The new regulation of social gathering passed with Dr. Drake, Ms. Roma, Dr. Shamiyeh, Dr. Sousa, Ms. Wagoner and Dr. Buchanan voting in favor. Dr. Gotcher, Mayor Jacobs and Dr. Obrien voted against the measure.

Dr. O’Brien recommended that time be set aside at the end of meetings and/or just after the forum for the Board to respond to comments made in public forum and via email. He said responding to emails is difficult when there are so many – he mentioned 600 – that it is hard to read them all, let alone respond. It was made as a motion and it passed unanimously.

Dr. O’Brien encouraged people to watch a BBC video by Dr. Kenneth Remy showing what a patient sees when they are getting a tube inserted. (https://www.youtube.com/watch?v=LhChWNq4csM). He said we need to educate people more and he is concerned about where people are getting their information and recommended BBC news. Dr. O’Brien said he would like to hear speakers on the psychological issues and on testing.

Dr. Shamiyeh said the focus needs to be on the illness and on getting people to understand the vaccine and get them to take the vaccine. Others agreed. Later in the meeting Dr. Shamiyeh read the portion of the White House Task Force report that I quoted in my afternoon article yesterday.

You can watch the entire three hour meeting here:

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