Board of Health: November 10, 2020

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0:00 Well, I’ll call the meeting to order and we have no minutes, so we will do that next time. We’ll do two minutes in a row. And I think that we just should move forward because we don’t want to be too late and then we’ll hopefully join soon. So let’s go right to the COVID update Andrew. Sounds good. So last Friday, our statewide COVID-19 public health report contained a sobering reminder of the continued severity of the pandemic. I just got to let somebody in. Commonwealth reported over 2,000 daily new cases for the first time since May. Since July, daily news cases have been climbing. But within the last several weeks, the rate at which cases have grown have significantly outpaced our growth in testing. Two other key indicators are positive test rate and our total hospitalizations are on the rise as well. The average new cases over the last seven days is 1,649. And unfortunately, the average number of deaths is about 20. The seven day weighted average positive test rate in Massachusetts is 2.3 with about 47,000 new molecular tests for COVID-19 reported daily. Hospitalizations, 558 individuals are currently hospitalized with COVID-19 statewide.

1:31 An increase of 20 from yesterday. Hospital capacity as of 11-9, so November 9th, is 33%. And Commonwealth out of 11,000 beds, non-ICU beds are available for new patients if needed. Long-term care, there are 393 long-term care facilities with at least one case of COVID-19 and 25,985 staff and residents. And the facility of tested positive so far, there’s additional information. Coming from the governor, we’ve had obviously we had five, three new orders that became effective on Friday, November 6th. On Saturday, the Baker administration announced from the COVID-19 Command Center released updated metrics for schools and municipalities. The Department of Elementary and Secondary Education also released updated school guidance. This update builds on the state’s ongoing effort to refine data that is reported publicly to track the impact of the virus in the Commonwealth. The updated metrics for communities will give school districts more data to make informed decisions regarding in-person learning. Local officials have also used these metrics to make decisions for schools and businesses and their community. Understanding the virus continues to evolve. Studies have shown that there is low transmission in schools, even in communities where there are high rates of COVID-19.

3:08 The one thing that people continue to take a look at is the daily case rate or the daily case reports online. Unfortunately, over the last 14 days, the age group, so zero to 19, has the highest level of positive tests or cases out of all age groups. So, yes, we’re not seeing transmission, but it does not mean that that age bracket is immune to this, that people need to remember that we are seeing large numbers in that age bracket. Is that in the state or nationally? That’s in the state. Yeah. So, the updated metrics adjust for the reporting of cases by municipalities’ population size. These metrics incorporate cases per 100,000 residents and the test positivity rate when determining a municipality color designation. Using one metrics to determine school reopening community by community does not reflect the state’s current understanding of the virus and the Commonwealth, that there is more transmission across the Commonwealth due to increased cases of COVID-19. So, really, what they want to do is when we see a week’s metrics, like if we will continue to talk about that, they want to take a look at it for three weeks in a row. So, we might go green, yellow, green, and so we really need to take a look at it over three weeks and not jump to conclusions based on a one-week set of data.

4:40 Now, there is a little bit of concern that if you are red, red, red, which is technically four weeks of data, that you might be behind the eight ball a little bit when making decisions. So, you need to really be paying attention at your positivity rate, where transmissions are occurring. So, there is a lot of different information that should be, that is available to us when we are making decisions about schools or businesses. And at this point, our guidelines really is to follow state guidelines, follow state metrics. The command center will continue to review metrics used by other states as well, and what is available in the academic and national data set. If they need to update matrix, it will also better account for communities that conduct a significant amount of testing. So, obviously, we don’t do a lot of testing, but there is still a lot of tests being performed in Marblehead. So, we have about 1,200 people that are routinely going to get tested on a regular basis, almost daily. So, those are great numbers that are showing up, you know, it is about 10% of our population. So, those are pretty good numbers and give us an indication of where things are trending. We are seeing more cases in the last couple of days than we have seen previously. We are seeing right now over the last three to four days, two to three cases a day. So, we know it is increasing. The hard thing, yes, we see clusters and households, but it is trying to figure out the root cause of it.

6:15 It is very difficult. We always kind of stop at the household, but we can never actually figure out where that person picked it up from. Was it in the restaurant? Was it in the gym? So, that is where it always kind of stops, but yes, we are seeing clusters in schools, in youth athletics and stuff like that. We do have the new mask order, which became effective last Friday. Yes, we are seeing a lot of increased emails and phone calls regarding that. We are in the process of putting together a new signage that will be placed around town in specific locations, the rail trail, downtown areas, town buildings. And we are, you know, we are working with the graphic designer to take a look at this. We are trying to use similar graphics that we have in the past. And that mask at Marblehead is a sign that we will be deploying to remind people that you have to have a mask when going out in public places. As far as the new matrix go, so Massachusetts Department of Public Health COVID-19 dashboard, average daily incidence rate per 100,000, color calculations. Gray, so we are a population of 20,000. So we are in the 10K to 50K. So gray, less than or equal to 10 total cases. Green, less than 10 average cases per 100,000 and greater than 10 total cases.

7:50 Obviously, this is always over a 14 day period. Yellow, greater or equal to 10 average cases per 100,000 or greater or equal to 5% positive rate. The 5% positive rate is a little concerning for me. That is a very high positive rate. I am not so sure we will ever see that positive rate here in Marblehead. With the state average currently only being 2.3%, you know, and we are seeing 2000 cases a day at times. I think they are going to need to review these metrics a little bit. But, you know, we are going to follow these metrics. We will make recommendations to follow these metrics for schools. But, you know, this is new, just released. And then red, greater than or equal to 10 average cases per 100,000 and greater or equal to 5% positive rate. The yellow and the red are very similar. So it is a very, I think the need to define that a little bit more going forward. So we might have to see some more information. The other thing that the state said that they are no longer going to do is that on Thursday they used to release a color coded map that showed Marblehead or all the other communities and what their designation was. They are no longer going to do that. They will release the weekly public health report. In there, list every town and what their color coding is.

9:22 They are just not going to have the graphic for us. I am not really sure why they are doing that. They are making you go through all the data. You know, when you look at the data itself, the average daily incident rate will show you the indication like the gray, the green, the yellow, and the red. But they are not going to do the color coded map. We continue to have twice weekly meetings with TPH and getting feedback from them about where we should progress, what issues we are having, and what changes are coming. They have had a lot of changes in, obviously we have a new gathering order, a new mask order, and they had to make changes to amateur sports and youth sports. So all those changes have been made and there are new guidelines that are now out for that. Currently a lot of things are changing quickly, so you need to go to the state website to take a look at the orders and see what updates are coming. As we head into the holiday season, it is our understanding that the state will continue to release guidelines around the holidays. We are hoping to see some guidance around items like a Christmas walk, a Santa gathering, and stuff like that on best how to handle those situations. Obviously we don’t want parades, but what constitutes a gathering? Is a Christmas walk where you have retail stores open and all these people are coming and going? Are there concerns about that? We would like some guidance coming from TPH around those activities.

10:54 If a place wants to have an event, yes, they have a limit on where low risk communities so they can have 100 people. Is that 100 people moving through there in a day or is that 100 people at one time? We just need some additional guidance and we have reached out to the state to try to receive that. That is really about it at this point. Questions, comments, concerns? Michelle? No, I am just kind of taking it all in. I am not sure what my question is about the school metrics. Others, I am trying to formulate even what my question is. Go ahead. I do find the 5% kind of troubling because it does create a false sense of security. If you create a metric that will never be reached, then people will say it is totally safe. It doesn’t really make sense to me. It is hard that we are continuing to change metrics as we keep saying, kind of moving the goal posts. What we were concerned about last week when we were in the yellow, now we are not concerned. How do we articulate that to the community? Obviously, we are trying to articulate that there is a concern because we have a new mask order that says you must wear a mask anywhere in public, indoors or outdoors. If you are walking down the street, a public way or on the sidewalk, everybody must have a mask on.

12:25 Obviously, kids between the ages of 2 and 5, it is recommended. You might see some younger children out there that aren’t wearing masks and you will see adults occasionally out there without masks. It is very possible that they have a medical condition or an exemption that allows them not to wear one. People need to be mindful of that and think about yourself. We are trying to protect our community by wearing a mask and doing what is best for ourselves. Please try not to judge other people so quickly. Andrew, what is the response if a community member sends us an email or a picture of somebody that is not wearing a mask or socially distancing on the path? This individual is not complying with the mask order. I have said something to them. I am Joe’s citizen. I have said something to them. I know this has happened. We have both received this. What do we do in this circumstance? Obviously, we are trying to educate the public about what the new guidelines are. We are doing that through the Code Red, these new signs that we will be deploying. If we do not have the capacity to run out there and speak with these individuals, we are trying to do this through education. If the police happen to get the phone call or in the area, they are also going the educational route.

14:03 Please understand the new mask order. Do you need a mask? I have a mask that you can have. Can you please put it on? We are not interested in administering fines at this point. It is more about an educational piece. That is a good way to approach it right now. On an individual basis like this, what can we do? There can be some non-compliance and hopefully that diminishes. These are some very strict orders. We need everybody’s help in making sure that the community tries to stay as safe as possible and adheres to these guidelines. Andrew, could you just go through what the grey, green, yellow and red are again? They seem confusing to me. Tom, I can send you this. Just send it to me then. That is fine. It does say that yellow is equal to 10 average cases per 100,000 or greater or equal to 5% positive rate. Red is the exact same explanation. I was a little confused. I did not quite get what grey was. Is this for small communities? No, that was for our population size, for 20,000.

15:34 Grey is less than or equal to 10 total cases. Over 14 days. If you are under 10,000 for a population, yellow is less than or equal to 25 total cases. Red is more than 25 total cases. But we do not fall under that category. They have to revise this a little bit. Right. Thank you. Is there anybody else who wants to ask a question or comment of the participants? Okay. Well, the next item was the reopening committee update. Unfortunately, Helene is not here when she attended the meeting yesterday. So we will have to just get an update from her next time. Want me to try calling her right now again? I already texted her. You know what, I will go on mute while we are moving on and just try calling her and see if I can reach her. Sure. Okay. And we have our next meeting set. So let’s just give Michelle a moment. So I will talk about a couple of other things. So we have household hazardous waste coming back up again on Tuesday, December 8th. We are using the same company as we did the last time, ACV.

17:05 This is a pre-registration, pre-pay event. So you go online, we have the information. We are using the company as the contact this time rather than our office. So the questions will go directly to them. If you have questions or concerns, you can email them and they will respond right back to you. You can pre-pay and then you can just place the stuff out in your driveway. We had a great response last time. You can leave it out there and then go to work. You do not have to be home. We believe that this is going to be the way we will be doing this in the future. And we are hoping to hold more events. When people are able to get rid of household hazardous waste more often. Obviously we have a lot of people that are moving and so we are seeing a lot of home sales. And anytime there are home sales, people are always looking to get rid of household hazardous waste. So we are hoping to help them out with getting rid of that waste by having these events. A specific question, do they collect asphalt? They do not collect asphalt. That is one item that is not part of it. If you are trying to get rid of asphalt, you can call the office or the transfer station scale house. And they can point you to a company that you can take it to. She didn’t pick up so I left her voicemail and I hope everything is okay. The transfer station has been very busy. So yes, we will be deploying signs up there.

18:38 You will see quite a few of them when they come out. Probably in front of every container or two in front of every container. To try to remind drivers that when they get out of their car they need to have a mask on. Yes, that place continues to be very busy. The yard waste area is rocket enrolling these days with a lot of people getting rid of leaves. And we do have the curbside leaf collection going on for November and December. Please take a look at the website. We have the dates available for that. But when you are at the transfer station, we are asking you that you wear your mask at all times when you exit your vehicle. I think that message definitely needs to be out there. Yes. Obviously, our areas that we see a lot of chatter about are the rail trail. So the plan is to try to deploy signs at every intersection. So at every cross street we hope to have a sign that says, mask up, keep Marblehead safe and healthy, mask up. It is now required that you have to wear a mask in public indoors and out. And that is about it. I was mistaken. We do not have our next meeting set, do we Michelle? No, let me look. I do not think we do because we decided not to meet next week, is that correct? Yes. So then we can have this next week. I have it on my calendar, but just because I have it standing on Tuesdays, but we did not confirm that.

20:12 The 24th? Yes. That is not a holiday yet, right? No, not a holiday yet. We should just, I do not know whether we should not do this because Elaine is not here. Let us do it and then we will confirm with her. But I think it is actually good to have it before Thanksgiving so we can get any messaging out about safety on the holiday. Exactly, gatherings and whatever. I saw a really interesting graphic about it was a bubble and it says like who you think your bubble is and it was like four individuals. And then like who your bubble really is and it was all of the like Venn diagram, existing bubbles. And I think that is a really good one as we come into the holiday season because people are thinking, oh, I am getting together with my small extended family when your small extended family has all those bubbles. And that small social gathering is really the equivalent of quite a big social gathering and that messaging is going to be really important. And with masks off so you can eat and a small room. Yeah, this is a crucial time. This coming up to Thanksgiving, Hanukkah, Christmas, with the rates where we are now, our messaging is going to be really important. Alright, so our regular 7.30 time on the 24th is what we will plan and let us just cross check that with Elaine.

21:43 And just one final reminder about, so yes, we do a lot of contact tracing. So anytime there is a positive case, we are in touch with that positive case, we get all their contacts and then we need to call them and interview them. So please pick up phone numbers that you do not recognize. We could be trying to contact you because you have been identified as a contact and we need to do an investigation and we need to interview you to get all the information possible that we can gather. Oh, I am sorry, here we are trying to wrap up, but I do have another question that brings up for me around contact tracing. We are going to have a lot of kids coming back from college that week. And where are we considering their domiciles, their residents at this point in terms of, you know, if they show up positive, like what, how are we going to be classifying them, given this complication of what they are doing? Where they have been living, where they are living, where they are going to be going back to? What considerations have you been giving to this? Yeah, so currently when we get a case from a student that is at college, it gets pushed off to where they actually are residing currently. So at college. However, starting at Thanksgiving break, that might be a big change because it is very possible that students will not be going back to school after Thanksgiving break.

23:19 So we will be talking and discussing that with DPH. And if when we do the initial interview and find that they will be residing in Marblehead, isolating or residing here for an extended period of time, we will need to change their, count them as our numbers and keep them under our control as far as investigation goes. But yes, that is something that we have to figure out. And it is going to be difficult because it might be a case by case issue where we have to talk to the student, see what their school policy is. Are you going back to school or are you home until February, March of next year? Yeah, it is really interesting. They may come home, they may be positive. Contract tracing may indicate that they contracted the virus elsewhere, but we need to count them as a case because in terms of where they are going to be possibly transmitting it in town, they are living here. I mean, I know I have a kid who is coming from Maine, but he is going to be living in Marblehead for at least December, most likely December, January, and who knows how long, you know. So yeah, this is a question for Dr. Catherine Brown that will be asking and she will have to give the exact guidance. Yeah, it becomes very complicated though. The virus came from somewhere else, but they are isolating here, they could be transmitting here, so we have to be very careful with that.

24:54 And just one other question on that. The guidelines now say quarantine 14 days or until you are tested. So if you are in contact with a positive case. No, no, no, no, no, I just mean travel wise. Sorry, not COVID. Yeah, so if you are, but that, it doesn’t specify, like so say you are driving from Maine, like I assume, you know, and assume you are coming from a, you are driving from a state that is not exempt from the travel ban. So assume you are driving, you know, you could either quarantine for, you know, 14 days, or like say, you know, you could come and test. But what if, what are the guidelines to give people, since it is not really specified in there, what are the guidelines if you are flying in and you are not coming from a, you know, you are flying in and you could presumably test, but you don’t want to test right away, because that is not really accurate. Because you have been on an airplane, like, no, it is not specified in our guidance, but is there guidance to give people, because I am concerned about all those kids coming in from college flying and testing before they get on the plane.

26:26 Because presumably a lot of their colleges are going to test, they are going to come home with their negative test, but they will have been on an airplane, which we know is fairly safe, but still have been in airports and who knows what. So any thoughts on that? So yeah, during these, you know, increasing positive cases, everybody has to be very vigilant about their own personal health. And, you know, ideally you go back to taking your temperature twice a day, looking for any symptoms, doing your COVID checklist before you go to school. You know, oh, do I have, you know, the cough, you know, loss of smell, loss of taste. Go back to those checklists that you should be doing regularly, but if people have gotten out of the habit of it, they should be doing it all the time, when we are coming back for these holidays. Yes, technically you would be following the guidelines of having a test 72 hours before or testing afterwards once you land in Massachusetts. But yes, there is all that concern about what happens if you contracted the virus while you were traveling. And some of the data is showing that air travel is fairly safe. However, during these busy seasons, is that the same test that we are looking at when they are comparing it? Right, right. Yeah. Complicated stuff. Well, hopefully you will have some information from DPH by the time we have our next meeting. Yeah, hopefully we will. Okay. All right. Thanks.

27:57 Okay. If that is all, then Michelle, motion to adjourn. Yeah, I will make a motion to adjourn. I will second it. Michelle Gottlieb. In favor? Dr. Belspecker. In favor. All right. Well, everybody have a good night. You too. All right. Let us know if you hear from Helene.