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HomeMy WebLinkAbout2020-12-6 emergency meeting Minutes for December 06,2020, adopted Dec. 17 - BOARD OF HEALTH ��,� -I/� I- # Emergency Meeting ' ' y Town of Nantucket 2020 DEC 1 o Ali in. 42 �Co �� 3 East Chestnut Street 9'°PAAtE� �" Nantucket,Massachusetts 02554 j1 www.nantucket-ma.gov Commissioners: Stephen Visco (chair),Malcolm MacNab,MD,PHD (Vice chair),James Cooper, Meredith Lepore, Melissa Murphy Select Board I Staff: Roberto Santamaria,Artell Crowley,Kathy LaFavre,Anne Barrett,Madison Humphrey -- MINUTES — Sunday,December 06,2020 j This meeting was held via remote participation using ZOOM and YouTube, 9 I Pursuant to Governor Baker's March 12, 2020 Order Regarding Open Meeting Law Called to order at 1:00 p.m. by Mr. Visco Announcements Staff: Libby Gibson,Town Manager;Santamaria, Health Director Attending Members: Stephen Visco, Chair; Malcolm MacNab, Vice chair;James Cooper; Meredith Lepore; Melissa Murphy Speakers: Gary Shaw, President NCH; Dr. Diane Pearl; Elizabeth Hallett, Superintendent of Schools; Dawn Hill Holdgate, Chair Select Board Documentation: PowerPoint®graphics; Governor's COVID Emergency Order Agenda adopted by unanimous consent I. EMERGENCY DISCUSSION a. Nantucket recent COVID-19 spike mitigation efforts Discussion Santamaria – We've seen a significant spike in cases over the last few days. It's important to understand the backlog of cases is also showing up so testing is more than one day of testing. We are taking this very seriously;though he has recommendations,he will not be recommending a shut down or change to existing orders. We are able to trace the cases. Shaw – The 64 positives is from 3 days of testing; however, it does put us into a concerning percentage and have the disease on this Island. Pearl–We report the tests returned in the past 24 hours,not tests given in the last 24 hours.We've been seeing 12 to 16 cases a day until recently. As of 237 tests sent yesterday, 14 are positive;we don't know if that will be the new trend. Majority of people are symptomatic or exposed. Today tested 148. Lepore–Asked if we know what our exact cycle number. Pearl – The range of normal and abnormal is arbitrary; you can have a strong positive or week positive. You could have a positive test because you had the infection a month ago and are not infectious. If you test positive and are showing symptoms,you are infectious. Santamaria–The cycle threshold is a conversation you hear a lot; but the Brodie Institute is one of the best lab facilities in the country.We are still seeing a lot of household transmission.Explained how transmission multiplies between households. You can't have faith that everyone you meet is taking the virus as seriously as you. Lepore–Asked the R number. Santamaria–He calculated it for the last 14 days 1.5; for the last 7 days not counting Saturday is 1.72;it is dangerously close to 2. We are seeing a strong spread. Currently he's not recommending further restrictions. We are still in the "roller-coaster"positives;the Governor's stay-at-home order is still in effect and we need to start moving back to that. We have to assume we already have it and adhere to the stay at home. We are working on an enforcement passport that will be multi- Page 1 of 6 ulti-Page1of6 Minutes for December 06,2020,adopted Dec. 17 jurisdictional for enforcement at job sites and at gatherings. Our staff will more aggressively enforce the quarantine and asking restaurants and retail to go back to call-in order as much as possible and are asking people to do take-out, delivery, or curb-side pickup. The other part of the governor's order is that it requires a maximum occupancy of 50%;we're asking employers to have people work from home as much as possible.We aren't seeing wide-spread contamination at school because they adhere to the 50%. MacNab —We have a high R number; we had more restrictions early on with virtually no cases; now we have lifted restrictions and a lot of cases.We were told when we got above 10%,it was time to go back to tight restrictions; we are currently at 11%. He has a sense tracing will become important;all we need is one person to slip out of a"pod."If we have a stay at home order,questions why restaurants and shops are still open. He wants to be confident we will stay ahead of a spike. Santamaria—The stay at home is an advisory, not an order;we need to pay attention to it.When we set the 10% threshold,we might have latched onto it too hard. The people who are showing up in the symptomatic line are most likely to be sick;so,we are seeing a selection bias toward positives. We are also seeing a selection bias for those who are taking asymptomatic testing,probably in order to travel. Shaw—What we're seeing are patterns where the largest group of infection are 20-30 years old.We should learn as we go to ascertain what type of tracking is necessary.We know restaurants and retail are not contributing to this;we do know densely packed homes are contributing to this where people have to work in the trades. Fortunately,we are not seeing an increase in hospitalizations. Pearl — What we know now, the 10% is now real and there is a very low positive rate in the asymptomatic testing;those who do test positive,they are coming in from other areas.The positive tests are confined to certain demographics and reasons. Shaw—We didn't have much testing in the beginning;we then decided the best way to follow this was to have a lot of testing. That created a huge pool that helps better understand this disease.The 10% is arbitrary but helps us be aware of how contact tracing works. His concern is the severity of the illness. MacNab—Asked if Mr. Shaw is comfortable with our ability to keep up the contact tracing. Shaw—He's confident we have the resources to quickly contact people who test positive and asking them to isolate and find out about other contacts.A lot of responsibility is on the person,who tests positive, to isolate;if they're not doing that, they put our community at risk. Santamaria — The tracing is working. Most people are paying attention, but there are a few who don't. Without a court order,we can't require a quarantine.We randomly check on quarantines. Shaw—We see that people who are infected are not symptomatic don't see it as a serious issue.We are asking people to stay at home to protect those people who could be very ill and could quickly overrun the hospital. If you act as if you have COVID,you would not go to the grocery store;it is time to keep a distance. Pearl—Behave as if everyone else has it;keep your distance. MacNab—He's very concerned Nantucket will fall behind the curve with the reluctance for further regulations. Lepore — She's very concerned about contract tracing and if it is working. Cited examples where people weren't contacted. Contact tracing doesn't require special training a sheet of the questions to ask is available. Also, she's very concerned about schools closing;if children are important,other businesses should shut down, so the schools can remain open. Pearl — We could consider additional people to do contract tracing because State resources are overburdened. One nurse who tested positive posted the status on Facebook,so their friends would know. Murphy — She shares Ms. Lepore's concerns on contact tracing; anything we can do to take back control from the State would help. Appreciates Mr. Santamaria's recommendations, but has concerns about rolling back to a shutdown because we don't have economic support on the State Page 2 of 6 Minutes for December 06,2020, adopted Dec. 17 or Federal level;her concern with a roll back would be an economic threat to our residents. Made a plea to the community to be the community renowned for being a considerate and caring make the right choices to keep our community and children safe. Asked Ms. Hallett what metric would be used to consider reopening the schools safe for in-school learning. Hallett—She relies on Mr. Santamaria, Dr. Pearl, and Mr. Shaw to share information and advice. WE are looking at daily positivity rates and contact tracing, what's happening within the schools. Our protocols have helped us to remain open for in-school learning. Part of the current shut down is due to contact tracing within a reasonable time and not knowing who might be coming to school when they should be isolating. Will return when case rates drop and cases in the school drop. Feels the recent spike is probably connected to Thanksgiving travel. Lepore —We have not seen in-school spread. She feels the protocols in the school are going very well. Murphy—An improvement in effective contact tracing would help bring students back to school. Hallett—It's easier for us to know when we need to do our own contact tracing and request isolation when we know who has been exposed. Another quarantine piece is staying home until you get the test result. More contact tracing would provide s sense of security. Murphy—Asked if there is more BOH can do to reinforce the State travel order before Christmas; her concern is people are travelling while being infected despite potential fines. Santamaria—That would depend what a shutdown looks like; there are ways to look into adding restrictions but that depends on the endgame—if it is stop spread with no regard to anything else, that is dangerous. We use the travel order form; the problem is it is voluntary. We can't control interstate or intrastate travel. Gibson — One thing the taskforce could do is go to lodging establishments and audit their travel forms,which they are supposed to get from interstate travelers. Murphy—She's willing to help with that;it is a small but important piece locally;they must request the form and enforce it. Lepore—Something needs to be done to make our students a priority;we're out of school,which is not ideal. We need to explore helping people who are in an industry that needs to be shut down. Murphy—What we're seeing is household spread caused by people gathering. She doesn't want to lean on the Community Foundation and their donors. MacNab —The point is not industryspreading, Peo le are spreading- it and there are going to be selfish people who don't follow rules. He would go back to a mandatory stay-at-home order;it's the only way to manage personal activities. Cooper—Asked how the Town can strengthen the Order regarding private gatherings like requiring permits. Santamaria—When there is a large event, they have to pull permits. Gatherings of more than 10 people is forbidden. Murphy—When we talk about personal responsibility, this is what we mean. In practical reality, a community facing a surge,it is irresponsible not to restrict interactions. She is aware of the mental- health impact on our students;they are not okay. Santamaria—We can't legislate people's lives. Lepore — She was in Town Saturday and saw people working, walking, and running not wearing masks.All those people should have been ticketed. Santamaria — The problem with people walking through town, there is specific methodology in order to asking for identification;not wearing a mask while walking or running doesn't fall into that methodology. We and Natural Resources and Fire are out there enforcing the mask order; and we are past the warning phase. Cooper—Asked what we can do. Santamaria—We can order any earlier suggestions rather than just recommend them or we can put limitations on specific industries. Page 3 of 6 Minutes for December 06, 2020, adopted Dec. 17 Cooper— If retail and construction are doing their job, we have to find the problem; he feels we need to do something we can control. If it has to be drastic, so be it Santamaria—With the new taskforce, enforcement is stepping up. Murphy—Asked if we could do a local order against co-mdngling households. Santamaria — Would do that as a resolution; however, a child in a custody case going from one parent to another is co-mingling. It would have to go to Town Counsel first Murphy—Would like posted on line what the current rules area;it is very confusing to follow what orders are active at this time. She'd like to see a report from Mr. Santamaria on how the new taskforce is working. MacNab—He's concerned that we don't know what will happen next;he doesn't want to wait and end up scrabbling at the last minute or doing something we don't have to. We have these meetings where we talk but doesn't know that we are accomplishing anything. In the next couple of days,we should meet again and vote on a shutdown and/or stay-at-home order. Michael Langlois — Regarding school management of COVID, asked why the schools aren't implementing a protocol of going remote until two weeks after the holidays as other school districts are doing.That's a longer period of time but provides a clear delineation.Remote learning is a viable strategy for the schools;we can legislate the schools. Hallett—We are not seeing school spread or school transmission. The Department of Education is pressuring us, based upon multiple studies that it is better for the kids to be in schools. It might come to that if we don't seem improvement in the next week. We could see something like this happening after the holidays. Dr.Howard Dickler—We've heard transmission occurs when households mix;suggested the BOH consider not allowing gatherings that include more than one household. Santamaria—We can look into ways to enforce that. Natalie Ciminero—The community is dependent upon BOH to make the decisions that will keep us safe. Obviously, not everyone is doing what they could to keep our community safe. She's afraid the numbers don't represent the actual number of positive cases.Asked what implication can tell us this unfortunate and dangerous trend is going to continue through the holiday season and when would be the correct time for a shutdown. Growing potential life-threatening surge is scarier than economic loss. Many of our community members are high risk and have to work, to make a living; there are things this community can do to protect each other.Asked the BOH to strongly consider what Dr. MacNab and others have said. Amy Eldridge — Asked the game plan for the next holiday, which is more traveled than Thanksgiving. Santamaria—Nationally we will be seeing multiple surges,whether we go into shutdown or not If we shut down, that won't stop people from coming. Murphy—Sees Mr. Santamaria's point but feels it is pessimistic.We have a commitment to increase contact tracing;would like to leave this meeting with that commitment There is also a commitment to an enforcement taskforce. Agrees with Dr. MacNab about meeting as soon as possible to see how the tests go and to see and debate actual proposals regarding rolling back or shutting down. MacNab — Recommends scheduling a meeting for later this week and the HD create a high-level draft of recommendations to ban public gatherings and requiring curb-side pick-up for retail and restaurants.As a Board,we need to make a statement going forward,not just talk Cooper—Asked what we do about the influx of people coming for the holidays and how that affects the Island as far as cases. Santamaria — It affects us greatly; we are hearing complaints from both sides. It is very rare we have evidence of non-compliance on the boats. The Hyline and Steamship Authority are still working at limited capacity. We don't have control, there is still working with other departments. The problem is behavior of travelers once they get here. However,what we are seeing right now is those of us who live here;until we get our own house in order,we can't blame off-Islanders coming Page 4 of 6 Minutes for December 06,2020, adopted Dec. 17 here. It's almost impossible to limit household-to-household contact. It is recommended that the Governor roll-back to step 2 on Friday. If there is direct action by the board and Town Counsel reviews those, we can have a meeting later this week to discuss specific orders. He needs those to come from the members in time for him to give Town Counsel time to review them before that meeting. Lepore—Asked if we have a commitment to increase contact tracing at the local level rather than relying on the CDC. Pearl—Wants to see what the numbers look like before we consider anything serious or aggressive. Across the country,we know masking, distancing, and preventing large gatherings do help prevent the transmission.Wants to prevent numbers getting to the point the hospital would be overwhelmed and would have to shut down to provide normal health care. Discussion about a meeting date to continue this issue. Shaw—If you meet Thursday,you would have only 3 days of testing available. Santamaria—He has to confirm time is available. Murphy—We have made strong recommendations:reminded people there is a stay-at-home order in effect: we have to behave as if everyone has COVID, and recommend curb-side pick-up, reminded work space has a maximum occupancy of 50% and encourage employers to allow employees to work from home;you home is your pod and gatherings with people outside your pod is not recommended. Brian Sullivan—One thing he noted was the need for contact tracing on a local level;the more in effect would help people in their personal responsibility.Asked if the BOH could take action today so the SB will create a local contact tracing group with funding. Visco—People could volunteer to be contact tracers. Shaw — Volunteering isn't that easy due to HIPPA access. We have an internal collaborative of people who can do the tracing;there is also how fast they can access the data base.Looking at school nurses,they have a link for doing tracing.Doubling down and looking at where we are and what we can achieve is what we can do. Murphy—Contact tracing should be the first thing we update when we meet. Santamaria—Thursday morning is available with a 12:30 hard stop or anytime Friday. The White House Coronavirus taskforce recommended a roll back on Friday;we don't know if he's taking that recommendation. Lepore—Friday afternoon would work better for her. That will provide another day of testing. Bob Liddle—Appreciates the suggestion of using social media for contact tracing. Murphy—If Friday is when we will consider a shutdown,we should discuss that proposal for Town Counsel to have those in time to review for implementation at that time. MacNab—Agrees we should have those written out for discussion and vote. Hill Holdgate—She's hoping this is a wake-up call to the community to dial back our own behavior. There is only so much the government can to do to regulate the community. It will take many months for a vaccine to come out and be effective. Shaw — What the public is seeing on this video is dedicated officials that want to keep the community safe.This is the time to double down as a community and to step away from each other and take this virus seriously and not think that since the illness wasn't serious for you it won't kill someone else. He's lost friends, part of the 280,000. It is in the public's hand to control what the government can't control to take this scourge out of the world. Action No action at this time. Roll-call Vote N/A Page 5 of 6 Minutes for December 06, 2020, adopted Dec. 17 Motion to adjourn the BOH meeting 3:05 p.m. (made by: MacNab) (second) Carried unanimously//Cooper, MacNab, Murphy,Lepore, and Visco-aye Submitted by: Terry L. Norton • Page 6 of 6