HomeMy WebLinkAbout2020-9-14 emergency meeting Minutes for September 14,2020,adopted Oct.22
BOARD OF HEALTH NANTUCKET
. Joint Select Board
" ' Emergency Meeting 2020 NOV 13 AM 10: 00
Town of Nantucket
Q9pORA't 3 East Chestnut Street
Nantucket,Massachusetts 02554
www.nantucket-ma.gov
Commissioners: Stephen Visco (chair),Malcolm MacNab,MD,PHD (Vice chair),James Cooper,
Meredith Lepore, Melissa Murphy Select Board
Staff: Roberto Santamaria,Artell Crowley, Kathy LaFavre,John Hedden,Anne Barrett,
-- MINUTES —
Monday, September 14,2020
This meeting was held via remote participation using ZOOM and YouTube,
Pursuant to Governor Baker's March 12, 2020 Order Regarding Open Meeting Law
Select Board Called to Order at 10:01 a.m. and announcements by Ms. Hill Holdgate
BOH Called to order at 10:04 a.m. by Mr. Visco
Staff: Libby Gibson,Town Manager;Roberto Santamaria,Health Director;Erika Mooney,Operations
Administrator
Attending Members: Stephen Visco, Chair; Malcolm MacNab, Vice chair;James Cooper; Meredith Lepore; Melissa
Murphy
Select Board: Dawn Hill Holdgate, Chair Select Board; Melissa Murphy; Jason Bridges; Matt Fee; Kristie
Ferrantella
Other Speakers: William Pittman, Chief of Police; Gary Shaw,Director Nantucket Cottage Hospital(NCH)
Documentation: PPT COVID Report 9.14;COVID September Surge Report;Nantucket COVID Response
Agenda adopted by unanimous consent
I. DISCUSSION ON POSSIBLE ACTIONS TO BE TAKEN REGARDING COVID-19 SURGE
Discussion Santamaria – The surge is 26 cases in 5 days with 4 more found among tests done Sunday.
Reviewed the metric: test rate, deaths, health system readiness, testing capacity, contact tracing,
sewer predictive incidence, age and sex breakdown, racial breakdown, case point of origin - 51%
from Massachusetts-, cumulative incidence – not the best system to use-, normali7ed virus
concentration over time from the Wastewater Treatment Plant–better system to use an allows for
pre-emptive measures. Daily incidence trendline shows a 5-period moving average of cases seen;
there are a lot of asymptomatic carriers.
Retail, food, hotels, and theatre have no associated cases. He is looking at reaching out to the
landscaping community, cleaning, and construction trades; they work together sharing tools and
houses. Next steps: 1) Outreach & Education in all 3 main languages; 2) enforcement; and 3) an
indefinite moratorium until incidence decreases.Explained the enforcement is because we are seeing
people at job sites not paying attention to social distancing and not wearing masks According to the
Governor's Order 31,we are allowed to fine up to$300 per violation and 3 violations within any 3-
day period by single business could result in suspending their ability to do any work.
We didn't go into lockdown because we know more about COVID-19 now and can more surgically
respond. We aren't looking at shutting down businesses any time soon. Right now,we want to pay
attention to where these are going with precision and contacting people who are ill and those who
were exposed.
Reviewed the Nantucket COVID-19 Response.This is not an unmitigated spike,we are working to
stop it. We're trying to flatten the curve,which is spread the cases over a larger period of time; the
means slowing things down, so we can handle the response.
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We're working on this; please pick up the phone ant talk to the Contact Tracers; there are several
organizations in the collaborative. Owners of landscaping, cleaning and construction businesses
should expect calls from the Health Department and they should allow sick employees to stay home.
Murphy—Asked if Steps 1 &2 can happen concurrently.
Santamaria—It is better to be done concurrently.
Murphy—Asked if the Health Department is using PLUS inspectors to help with enforcement.
Santamaria—PLUS and Natural Resources inspectors can be used.
Murphy—Asked of volunteers can help with outreach to overcome language barriers.
Santamaria—Yes;listed organizations he is reaching out to for volunteers.
We don't ask about immigration status and points of origin; only Health and Hosp have access to
addresses.
Murphy—Asked what metric would lead to moratorium.
Santamaria — The sewer metric and daily incidence are the reports we will pay attention to in
consideration for a moratorium.
Shaw—NCH has restarted the incident command to address all moving parts of this situation: we
are dealing with people living in higher density housing; we are reviewing all protocols to address
what comes our way; the portico is open but gotten very busy; and we have started the flue
vaccination program, which is very important in the pandemic. We don't have any COVID
admissions;if we do have a patient in respiratory distress,we will take them off Island for a higher
level of care. Mr. Santamaria's recommendations and steps are spot on;we know more about how
COVID spreads. Personal protection equipment (PPE) is the most important resource available.
Suggested people in dormitory-type housing wear PPE at home to minimize spread within the home.
Gibson— She had meeting with a number of officials about the vulnerable population;we discussed
that these populations have concerns that if they don't work they don't eat or pay bills. Infrastructure
is in place to provide them with food and payment of bills; the issue is getting that information out
to them.There is a concern that employers are not taking this as seriously as they should and people
in employee housing are not taking precautions. We hear employers don't like to see employees in
line at the testing center; they need to allow employees to get tested. There is also the concern that
if an employee doesn't go to work, they will be fired. We know people have Pandemic Fatigue;we
need to get information out and not overwhelm the hospital. COVID is a real threat off-Island
family members and friends have died, and folks can't visit older relatives. We spent a great deal of
time trying to get messaging together.
Santamaria — Reviewed fliers they will be getting out to businesses in multiple languages on how
to prevent getting sick.
Dr. Howard Dickler—Sounds like a lot of the pressure on the affected community to keep working
comes from the employers; asked if there is an effort to reach out to them.
Santamaria — We will get information to owners of landscaping businesses and the Nantucket
Builders Association,who can get it to their members.
Lepore — For some people, $150 is a lot for asymptomatic testing. Asked if there is some way to
subsidize that;we need to start testing everyone.
Santamaria — We have a Town grant with about $50,000 left. We reached out to Julian Cyr and
Dylan Fernandes to set up testing out here; we can ask about asymptomatic testing. If you're a
business owner,we request you sponsor you staff.
Fee — We're heading into the State Red Zone; the State will help out for those high-risk
communities. We should not be afraid to ask for that. Regarding housing,we should discuss having
a place to isolate if they can't in their own home; that has worked in other communities.
Santamaria—We have an Memorandum of Understanding(MOU) with one of the local hotels for
that;we can get it back up and running.
MacNab—He wants a sense of how long we should wait before going back to some of the"March"
restrictions on these businesses.
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Santamaria—He would prefer to wait for the September 17 BOH meeting.April-level restrictions
might be more prudent. There are many businesses that have been making good efforts to be in
compliance.
MacNab —We talk about doing this "surgically"; however,we don't seem to have enough people
to do the enforcement.Asked if there is a way to get more people help out.
Santamaria — We've ironed out some of the issues with people through delegation of authority.
The issue we're running into is compliance outside of work.
MacNab—Encouraged any watching the meeting who wants to help to call the Health Department.
We also have to remind folks that the worse place to be is in an enclosed car without masks.There
is a need to restrict the numbers at gatherings.
Santamaria — The numbers at gatherings is difficult because of the communal housing situation.
He would support limiting the gatherings.
Brook Mohr— It isn't clear who to call to communicate a concern about violations. Asked if it is
legal for an employer to require an employee to get tested.
Santamaria—An employer can require an employee to get tested but can't ask for the results of the
test due to HIPPA.An Employer can also require an employee not to come to work.
Gibson—As with any complaint, call the police department.
Richard Pulice — I was a professor of Public Health at Regis and was involved with the State
contact tracing program;there is a lot of resistance to contact tracing.A lot of these folks are worried
about ending up involved with ICE. Asked how much can be done by Nantucket alone and not
involve the State or Federal agencies.
Santamaria—A great deal of contact tracing is local;we used State only recently with the surge.
Bridges—Agrees with taking Steps 1&2 together.Asked if the spread happened while these people
were working or outside of work.Thinks it would help to send outreach to retail and restaurants so
they can also focus on helping. Asked if more cases could come in today.
Santamaria—The 4 were from testing over this weekend.We need to reup all our vigilance;people
downtown are ignoring the mask rules.
Fee—Also agrees Steps 1&2 should be concurrent;we need to know who,what,and when there is
a violation for which enforcement action was taken so we can track that. Asked if contact tracers
know where a COVID case was picked up.
Santamaria — Contact tracing is our strongest tool; we can pinpoint exactly when and where the
spread happened.
Fee — Of the 30 recent cases, asked what percent did not comply with the Health Department
contact tracing.
Santamaria—He can't give that information.
Fee—Asked how we can make a policy decision if we don't know how many people are complying.
Ferrantella—In terms of enforcement,asked how much the police can be involved.Agrees starting
with Steps 1 & 2 concurrently. Asked if there is a way to predict the number of cases we might see
over this coming week.
Santamaria— If we see a spread within a household,we can isolate the household. There are two
different approaches for home and community spreads. What we've seen so far is people getting
sick in a 2- or 3-people household where the sick one can isolate. In the community housing you
can't isolate a bath and a bed.
Murphy — In terms of employer outreach, suggested reaching cleaners through the Real Estate
Association. Regarding the percentage of people responding, there is frustration with people not
responding to contact tracing; we have to empathize with immigrant families, who come from
communities were the government can't be trusted. Thinks Mr. Santamaria's proposed path is the
best route. Being punitive with folks not complying implies they are disregarding other people.
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Mohr— Ms. Murphy's point about different fears that might well outweigh their fear of the virus.
The accusations and condemnations out in the public are not helpful in encouraging compliance
with contact tracing.
Fee — His intent was that everyone should be complying with tracing and that we should provide
them a safe place to isolate if they can't in their home. It's important to find a way to get everyone
to work with contact tracing;that's the only tool we have. If only 10 out of 30 people are responding,
we are in big trouble.
Joanna Fajardo—As a community, we need to have an empathetic ear and information has to be
accessible in other languages. This meeting is available only in English. There needs to be outreach
in different languages and for different levels of education. There are genuine fears and access
barriers.
Pulice — Isolating industries is short-sighted. He hopes there is a plant to emphasize compliance
within the hospitality industry. Regarding alternative housing, overcrowding is a problem;you need
a strategy to reduce the overcrowding—20 people living in a house is not acceptable. He's happy to
help in any way needed. This spike is a message some of these other issues need to be addressed
now.
Hill Holdgate — She's concerned about singling out specific industries. Everyone has gotten
complacent regarding precautions;we got through the summer with few cases. Outreach is key for
everyone; she'd feel more comfortable doing education and enforcement across the board.
Murphy — It is important to get community members to understand the need for contact tracing
and that there are no punitive measures. If people can't isolate at home, reaching out to National
Association of Registered Agents and Brokers might open up empty houses or rooms.
Linda Williams —The Unitarian Church has a database that would helpful to get fliers in multiple
languages to the immigrant community.
Mary Mack — She used to have a house cleaning business; could ask the cleaners to bleach after
themselves when doing turnover cleaning and making the turnover 24 hours.
Bridges —This is a good opportunity for the community to come together;everyone has different
fears that we need to cut through and help.
Charity Benz—Encouraged getting churches involved in terms of helping with tracing,they might
be more trusted than anyone else. Something that won't be lost on people in the trades is if they
don't help in the tracing,people won't employ them.
Visco — He's heard a lot of good comments; he doesn't know any other community that is more
empathetic and giving than Nantucket. Mr. Santamaria has a good handle on things;we need to be
more diligent on protocols.
Lepore—Asked if the Police are going to come on board.
Pittman—Police are on board with this;we're just not the primary enforcement agent.When groups
don't break up,we call in the Health Department;Health Department then follows up.
Santamaria—We have been getting case numbers and reports from Police and follow up. He has
been out at 8 p.m. on Saturdays to check weddings and beach parties. The Tom Nevers wedding
this weekend would have been ticket worthy.We can suspend licenses of caterers who willingly cater
gatherings of over 50 people. We need to step up weekend enforcement and offer overtime.
Fee—The Police log shows 2-3 COVID incidents.Mr. Santamaria shouldn't have to be up at night;
in his mind having people in place to do the work has been a missing piece.
Lepore — Asked if Health Department can know when a tent permit is issued and for when and
where.
Williams —Tent permits are issued by the Building Department. At the Tom Nevers wedding this
past weekend, to her knowledge there were never more than 50 people at a time in the tent.
Santamaria—The Tom Nevers wedding posted on-line pictures and films supporting overcrowding
in the tent.
Murphy—Asked if a vote is needed at this time for implementation of the initiative.
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Santamaria — We can do Step 1 & Step 2 concurrently. He'd like endorsement of the plan. He
doesn't recommend shutting anything down at this time; that can be considered if the surge
continues.
Action Motion to Accept Santamaria's initiative pending review at the Thursday, September 17th
meeting. (made by: MacNab) (seconded)
Roll-call Vote Carried unanimously: MacNab-aye;Murphy-aye;Cooper-aye;Lepore-aye;Visco-aye
Matt Peel—It's concerning which direction things are heading;he feels this is turning into a racist
issue because it impacts a certain race in our community. It's been very clear there is no tracing
back to the restaurants. Feels the Select Board is impacting the all industries just to prove they are
not racist.
Hill Holdgate—There hasn't been any evidence any race is being singled out;as she understands,
the spread is across the board in terms of race.
Santamaria—This is not a race issue;the virus hits everyone.
Peel—He doesn't want to see this become a race issue.There's lots of overcrowding on this Island;
he's heard there are people supporting an entire industry shutdown.
Fee—If this surge continues,we have no choice but to shut down.Mr. Santamaria is talking about
tightening up where things have slipped in the hopes of preventing that. The virus does not
discriminate.
Murphy—Currently the virus is being spread within a certain industry,but we need to realize that
it won't stay there,and we need to go back to the protocols:masks,handwashing,social distancing,
etc.The whole community needs to take this disease seriously.
Motion to adjourn the BOH meeting 1140 p.m. (made by: MacNab) (second)
Carried unanimously by roll-call vote.: Murphy-aye;Cooper-aye;Lepore-aye;MacNab-aye;Visco-aye
Motion to adjourn the Select Board meeting 1140 p.m. (made and seconded) passed by roll-call vote
Submitted by:
Terry L. Norton
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