PAYETTE COUNTY — During a public meeting that lasted longer than three hours on Tuesday, Southwest District Health Board of Health opened its meeting to feedback from proponents and opponents of social distancing measures related to the COVID-19 pandemic.
Comments were split between those who don’t believe mandates are necessary or within the Board of Health’s scope of authority, and those who pressed the board to step up and create mandates for wearing masks, rather than recommendations.
The move to allow proponents to talk caused outcry from health-care leaders in a separate news conference that started sometime later.
After nearly 3 hours, the board came back to make a unanimous decision to revise its current mitigation strategy, but still did not move to issue a mandate regarding social distancing measures.
And when it comes to contact tracing, some people who test positive may have to fend for themselves.
“If they test positive, we should be contacting them,” said Nikki Zogg, director. “We will contact somebody after they test positive if we’ve gotten results within 72 hours of the test.”
Senior Data Analyst Rachel Pollreis presented a list of recommended changes to metrics used by the agency to investigate COVID-19 cases and determine health alert levels. Following is a summary of her recommendations.
• Percent of cases that have been interviewed: Intended to replace the average follow-up time for new COVID-19 investigations, this would indicate what percentage of total cases have a non-null symptomatic field. Action would be required when investigators contact a patient or a caregiver.
“Basically, it’ll just be a better representation of what we were tracking with the follow-up time with investigations,” said Pollreis. “We have new operations and policies how our investigators are making contact and how those cases are assigned to our investigators, and that’s kind of caused that metric to not really represent what we thought it was representing.”
• Local testing capacity information: Instead of being measured and classified along the health alert level scale (gray to red), it would provide qualifying information such as number of testing locations including mobile ones, as well as the number of facilities testing asymptomatic individuals, as one more means of determining said health alerts.
“As we go through these alert metrics, it comes up almost every week and it’s something that we talk about and I think it’s important information for the community to have as well,” said Pollreis.
• Average follow-up time for new COVID-19 investigations: Pollreis said this metric did not accurately reflect response capacity or investigator case load. Cases are presently assigned to data entry specialists or office administrative staff until an investigator is available to reassign and contact patients.
“We have new operations where our administrative staff or data entry specialists will assign themselves cases and then reassign to an investigator and they’re kind of managing workloads in that regard.” said Pollreis. “It’s not really showing us actually the amount of time it takes from reporting a positive lab result and having the interview conducted.”
• Percent of individuals diagnosed with COVID-19 that were asymptomatic: Pollreis cited a lack of clear evidence of what percentage of COVID-19 cases are asymptomatic. She noted that while estimates vary, at least 40% of cases show no symptoms.
“When this first all started, there was the estimation of 20% asymptomatic … now we’re thinking it’s closer to 40%.”
Pollreis further cited a New England Journal of Medicine article which stated only 10% of cases among young men joining the U.S. Marine Corps showed any symptoms. She further indicated this metric could become useful once more robust testing becomes available.
• Percent of new cases traced to a known source: Instead, it was recommended that this be changed to a percent of new cases who have identified a potential exposure source. Pollreis said this recommendation stems from the Centers for Disease Control removing guidance for known source and community spread from its website and instead directing readers to their local health department.
She explained that even if an individual only identifies they work at a high-risk workplace, this satisfies the known source criteria even if they can’t identify a specific individual.
• Adding a procedure for “Renouncing community spread”: Renouncing a declaration of community spread would occur once a 14-day period passes in which all cases in a geographic location have an ‘epi-link,’ or known point of exposure.
• Mitigation strategies: Pollreis recommended removing the word “or” from the language of the agency’s mitigation strategies. She also advised recommending all individuals limit participation in high-risk activities like contact sports or singing in groups, or attendance at events where physical distancing cannot be maintained. The present language recommended that vulnerable populations limit such participation.
Vice-Chair Kelly Aberasturi motioned to approve the changes to district metrics, with board member Georgia Hanigan seconding. A voice vote to approve was unanimous.