Board of Health: February 23, 2021

Transcript machine-generated with Whisper speech recognition (the source video has no caption track). No speaker labels; proper names and dollar figures occasionally misheard. Click any timecode to jump to that moment in the source video.

0:01 So we’ll call, hi Elaine. Hi. Called me to order. I was too busy listening to the other meeting. Yeah. Well hopefully tonight will be a quiet meeting for us. Hi Ben. Hi. How are you? Welcome. Before we get to Ben and welcome again Ben because we always enjoy having you every year. We’re happy to have you again. I wanted to finalize the minutes from January 15th to 19th. Either of you have any changes? Sorry January 5th and 19th. Which one was the one that I had the changes, Andrea? Just that. Okay. We’re all set with that. Just striking a lid. I made that change, Elaine. January 5th. Good. So I’ll make a motion to approve the January 5th as amended. Is there a second? Second. Yep. Ms. Gottlieb? In favor. Ms. Kayslitt? In favor. Dr. Belfbeger? In favor. And then is there a motion for January 19th minutes? I’ll make a motion. Go ahead. I’ll make a motion to approve January, February 19th minutes. Second. Sorry January 19th minutes. Second. Ms. Gottlieb? In favor. Ms. Kayslitt? In favor. Dr. Belfbeger? In favor. Housekeeping is done. Let’s get right to our discussion with Ben. So welcome back. Do you have a prepared report? Thank you guys for having me. We’re happy to have you.

1:43 Okay. I can read some of it. It’s always easier to go with the flow versus read it, but I will start off. First, I’d like to thank the Board of Health for having me come here. I always look forward to our annual meeting so I can describe what’s been going on at the Counseling Center. And again, thank you so much for the $60,000 that really helps keep the center lights on and seeing our neighbors. In addition to the $60,000 this year, this fiscal year, we provided another $55,000 of what it’s essentially free counseling service to people who meet the criteria but run out of even town monies that we can use. So that’s another $55,000. Excuse me, where did you get the $55,000? Can you give us a patient that we were going to have it on hand to provide some people? I’m sorry, am I not coming through? We keep getting these pauses in the connection. Wonderful Zoom meetings. I said we do get monies from insurance companies and our own fundraising efforts, the Friends Campaign, throughout the year. And we use those monies to help pay for those individuals.

3:46 We use what we raise. Sorry, Ben, we’re losing you again. Or is it just my connection? Ben, you might want to try to turn off your video and your connection might improve with that. Any better? Yeah, it’s better now. So I’m sorry, if you don’t mind repeating the last bit of what you said. Better now? It’s still pretty funny. What I said was showing that it’s okay from my end. That’s why I don’t know. I’m saying that we, through our fundraising efforts, over and above what the town provides to us, we are able to provide services for those in need and monies represent, the $55,000 represents monies to town residents over and above. What the town provides for us. Did that come through? Yes. Okay, okay, good. So what does that represent? That actually represents that 371 Marblehead residents were provided with 3,300 sessions.

5:30 So essentially about 10 sessions per person. And then that’s individuals, couples and families. In addition, we did hire a psychiatrist in March, and the medication management, and that person saw 28 individuals for a total of 86 sessions about four sessions apiece. Obviously COVID has played a havoc with our seeing individuals starting in late February around this time. We closed the center for face-to-face sessions, and we only were seeing individuals via Zoom or another medical platform via health. For the most part, disrupt the sessions, so people were still coming in. But what we’ve found is that for children and young adults who may be living at home, it did make individual counseling a little more problematic for them. There was a little, there’s been less change seen because of that.

7:08 We did hire two therapists to meet the demand for more sessions. As you can imagine, COVID had anxiety, and so we have been getting a steady stream of individuals seeking counseling, and we did bring on two new therapists. And we hope that, we hope to bring on another three between now and June, again, to meet the demand that we’ve been. In terms of our social service program, what has happened throughout the year is that families have been hard hit from COVID. A lot of layers reduced. And for the year, we saw 60 families for our social services programs, which includes things like health with rents and medical visits and lights and heating, which represented actually a 28% increase over last year. And then for the holiday season, we helped with making ends meet, adopt a family, 74 families and 150 children.

8:48 So, we’ve been pretty active this year. I’m happy to say that despite what the things that COVID has created, we were able to continue to meet the needs of town residents. Do you have any questions later, Rachelle or comments? Yes, I have a couple. Hi Ben. If you recall, Paul brought you to my house right after your interview. I think I was the first person in town that met you, and I’ve appreciated that introduction ever since. So, we’re in your court, but I want to have a few questions. As did I, thank you. So, I want all the questions are friendly. How’s that? Okay. But I’m concerned about, I hear that you want to hire three more therapists and you’ve hired two additional therapists. How many clinical hours is that? Is it full time or how many hours is it? One is full time and one is about 10 hours. So, total clinical hours is going to be somewhere in the order of 40 clinical hours.

10:29 Okay. Well, it’s more than it was, so that’s great. And you want to get three more? Have you started to interview or is this a place that we can say that you’d like people to think about maybe, looking at that as a position for themselves? Are you looking for people? We’re always looking for people. The ad for therapists has been up every week for the last two years. So, we’re always looking. I think the way to think about it is that we usually hire some of the two new people. We’re trying to be a little more, the need is such that we’re trying to increase the number of people that we bring on board this year. Can I continue with the second question? I have a follow up question to that, Helene. So, I imagine because everybody’s doing telemedicine right now, there’s more capacity. You can see more patients at the same time. Is that accurate? We can see more patients at the same time. And when you say that the children and young adults, is it difficult for them? Is it difficult to manage things in Zoom or is it difficult because they’re not in privacy? It’s the latter. Children, I mean, parents are constantly coming in and out and if they wanted to talk about things to deal with their family, it’s kind of hard to agree when mom or dad are hovering over them.

12:21 All right. And this is my second and last question, which might be a little bit lengthy. Last week, last meeting, we didn’t meet last week because of school vacation. But last meeting, there were a lot of parents and members of the community that were interested in the anxiety, as you talk about, and the mental health and the stress around the COVID on the students, mainly. And that may change because there’s a school committee meeting tonight, which I think some action is going to be taken, but it’s going on right now. But I’m concerned about, and I’ve always been concerned about this as a former board member of the Counseling Center and as a former president, about the people from out of town that you have been taking in. Are our people in town not being seen because you’re seeing out of town people? We take…we don’t take town people, I guess is the best way to describe it. Could you repeat that? Because you sort of said… You were a little bit difficult to hear just then. Could you do that, repeat that? Okay. It is not…we don’t take out of town people in place of Marblehead people. So we don’t do that.

13:53 We tend to take…there are there Marblehead people who aren’t seen, who may have, because someone is suicidal, for example, or coming from a hospital setting and absolutely needs to see someone immediately that does have high risk. Am I coming through? I hate the… We’re here. Yeah, high risk. But beyond that, Marblehead people are always seen first. Do you have a waiting list right now? But again, there are times…we have a waiting list of everyone, and that’s primarily because we don’t…we need more therapists. The waiting list exists because we…we need the therapists, not because somebody was taking place to someone else. So is the waiting list greater now than it was before? I know it may seem… Did you hear that? Yes. It’s…yeah, I would think it’s slightly larger, yes. Because again, there are lots of young people, children, who aren’t being…who don’t feel comfortable working on…via a Zoom format.

15:28 So they work better face-to-face. So there are some young people who aren’t getting seen because of what they say. I don’t want to be…I want to be seen in person. I don’t want to be seen by a video format. Is the counseling center seeing people face-to-face? No. We are still not seeing people face-to-face. Andrew, I know the answer to this question, and you may also…are other therapists seeing people face-to-face? I mean, these kids being seen? Are they…or is the reason they’re not being seen is that no one’s seeing people face-to-face? I’m sure there are some therapists, but probably most part people are not doing face-to-face unless it’s absolutely necessary. And Ben, the reason I’m asking this is that…two or three meetings is that we’ve been having parents that are just screaming out for help. And we recognize that. It’s that what we’ve found…all I can say is what we’ve found. What we’ve found is that the sessions with children tend not to be as successful because of the interference in…it’s just…

17:06 Their home…people are barging in on them. They don’t get that sense of privacy and an ability to talk through their issues in a, let’s say, a perceived safer environment. Well, your answers help us to understand the situation in town. And I know. We tried…and I think what we’ve been finding is that…I’m sorry. No, you’ve finished that because… What we’ve been finding… …go hard to talk on Zoom, especially when we can’t see you, but I apologize for interrupting. Go ahead, Ben. I’m sorry. Video, I mean…no, no. I think that we take children and we’ll say, do you want to be seen via video? And many of them say, no. When they say no, we say, well, we’ll get back to you when… It’s the unfortunate byproduct of what’s happening here. It just doesn’t tend to work well without face-to-face for certain sessions.

18:38 My last question around…and then I’m sorry to my committee, I feel bad. No, no, no. Are you having any contact with the therapists in school and are they able to handle some of these problems? And are they overloaded or are they having space? Could you maybe just talk a little bit about the assistance that the school is giving and if they have more time or less time or whatever? What I’ve been hearing, I haven’t spoken to…my therapists have been speaking to counselors with their students, but what we’ve been finding is that they are having similar problems being able to connect via this hybrid system that they’re working under. What they’re finding is that it’s still just a struggle. And given the drumbeat of bad news every day, you turn on the news and you’re hearing about so many people catching it and so many people are dying, it’s kind of a child can’t navigate that. And I’m hearing that the schools are not…they haven’t figured out a way to do that as well. That’s my… I think Michelle might want to talk to you about…we’re talking about a mental health task force.

20:15 I don’t know if you’ve heard anything about it, whether Andrew mentioned it to you before our meeting, but maybe I’ve had enough time to talk. So I think Michelle could ask you that if you want. I’d love to be on it for sure. Right. Andrew, is this a good time, Todd, to mention this? I was going to do it as part of the COVID report, but Ben, are you planning to stick around or do you want to…while you’re here, we can… I can stick around as long as you guys need me. Okay. Why don’t we…Okay, Michelle, go on into it. Okay. Yeah, it certainly seems relevant now. So we had talked at previous meetings. We’ve heard, I would say primarily from parents, but we’ve heard from many community members, as you can well imagine, about mental health concerns in the community and have been asked, you know, what is the Board of Health doing? We know this is within the purview of the Board of Health, and we as members of the Board of Health feel concerned and a level of, you know, a mandate and responsibility to address beyond our, you know, funneling of funds to the Counseling Center, which we’re very happy to be able to do. But we also want to be able to address the particular concerns in the community and the needs of the community that are happening as a result of the pandemic.

21:56 And…but we know that this is beyond our capacity, just as a Board, and that this is something that needs to be addressed with the skill set of across the community. And so Andrew had talked to Jason Silva, the town administrator, and talked to him about making this a truly townwide task force. And so what we’re proposing is, and we’d like to discuss at the meeting tonight, and given the opportunity of having you here, you know, pick your brain on what thoughts you might have around kind of the purview of this task force and also your participation on it. But we’d love to think about a task force that kind of cuts across different, you know, membership in the community. And I’ll just kind of give you a thought, all of you who are here, what we’re thinking or what I’m thinking about membership on this task force. And we know that we don’t want it necessarily to be too broad, too big, just because we want it to be effective. I asked, we have a couple of folks from Council on Aging, Lisa Hooper and Karen Smith were both with us tonight.

23:36 And I think we’ve had a lot of folks from schools, I mean, from parents who’ve talked about that vulnerable population, then we know we have another vulnerable population in town. And I think that we’re going to be more vulnerable, you know, the elderly or people who are isolated and, you know, might not, who might be ever more isolated during the COVID pandemic. I’m sure there are other folks who are particularly vulnerable frontline workers, other people who might be at risk. I’m sure there’s a lot of folks who are particularly vulnerable, particularly vulnerable, who are the people who are at risk. And I think we’ve had a lot of conversations about, you know, like who are we particularly targeting, you know, the community at large, but I’m sure there’s particular subpopulations, you know, BIPOC folks in town who might be more at risk. And I think there’s a lot of folks who are the particularly vulnerable people whose mental health might be most at risk. But in terms of representation as we form this task force, and because this is not something that we formally had on the agenda tonight, we wanted to talk about the formation of this, but we will kind of formally convene this task force at our next meeting. So, I would like to take a presentation from the Board of Health, one of us, somebody we think from the Board of Selectmen, somebody from the school administration.

25:19 An additional person from the school mental health community, somebody either from guidance or health or somebody who’s specifically tasked in the schools of addressing mental health. And I think we’ve had a lot of conversations with the board about the mental health professional in the community, such as yourself, Ben, perhaps another medical professional nurse and or physician in the community. And I think we’ve had a lot of conversations with those two citizen representatives and wanted to discuss, you know, with the board how that might happen. And I think we’ve had a lot of conversations with those who are all of the folks that I mentioned of kind of having a discussion with them and kind of appointing or asking, selecting them to be on that. And, you know, asked to be representatives on the committee and I’m presuming that I’ve never formed a task force in town, but I’m presuming that there’s some kind of protocol or way that this has happened before that somebody here can tell me or somebody else in town could tell me that there’s a way that this normally happens for the citizen representation.

26:52 So that’s the process that I would propose. And what’s the goal of the committee? And so I would say the goal of the committee to be discussed here, and I would love input on this, but is to address what, you know, we as the board and other community members have brought to us as an increasing crisis and of, you know, growing mental health crisis around as the pandemic reaches a year in duration. You know, people being isolated from friends, family, school, etc. And to, and, you know, we’ll need to work as a task force to figure out what interventions we will address, but to work together as a community to figure out what appropriate forms of

27:57 education we can do as the task force around mental health and also what appropriate interventions at the right level to target the specific populations that we want to look at to address this concern. And I would say that we need to be able to address the concerns around mental health. And, you know, I would say that that’s probably up to this task force to determine the scope and scale of what we would want to address. And I think that this is a massive issue, and we’re not going to be able to bite off everything, but as a task force we can meet and discuss what’s realistic for us as a community to begin to tackle, you know, perhaps doing, you know, some educational events, perhaps figuring out in the schools, what are some of the best strategies, you know, working with the Council on Aging, what are the best ways to you know, help bolster their resources for reaching isolated senior citizens. I mean, there’s a whole host of things, and I think we can also put our heads together and tap into resources that are available throughout the country. So, yeah, I’ll stop talking. You asked a couple of questions. Do you mind if I just go ahead and then of course you know we have been here so would love to get his thoughts on all of this but I know I throw out a lot out there.

29:37 I’d like to hear from Ben too, but let me just quickly answer a couple of questions. I like the name, the groupings that you selected, I think as far as the citizens, I think, and Todd would probably agree because we’ve done this before when we had to form the transfer station committee we asked for recommendations I don’t think it would be too difficult to do that. The others I guess we would just add. I think it’s a good idea to ask the various boards in town, including the counseling center, to send their representatives. I think a basic goal is fine, but I’m sure the task force would form their own goals. I think it would be up to them to do that. I have formed several task force in town, some that are under the auspices of Selectmen, which work much differently because they work under the Open Meeting Law, as we do. I think that it would be up to, I think the way the committee is formed, whether it’s going to work under the Open Meeting Law or not. Again, I’m going back to the transfer station that did not work under the Open Meeting Law. I don’t think did it. Just did. Oh, did? Okay, well then you’re going to have to do that. And there have been task force in the past. There was a heightened drug crisis back in the 80s. There was a task force. I hate to say it. There were a couple of things that I don’t even want to mention, but there were a couple of deaths in the community when we had a suicidal kind of, it was a short term thing.

31:12 We had some people in to speak, but there was a task force that sort of brought that group together. So it can take a lot of different ways of running, but I’m glad that we clarified that would probably be… Does the reopening committee for the schools, does the reopening committee operate as an open, under the Open Meeting? No, it’s not. It’s not under the Open Meeting Law. So those are things that I’m sure that Jason and Andrew will advise, but it seems like if we had it, we posted those meetings for the transfer station, we might have to fall into that. So go ahead. I just want to answer those things. And also, Sandra has had her hand up as well. Yeah, we’re going to do public. Okay. Well, I think then these… Well, again, I think a task force, given that this is a system-wide, town-wide problem, it will require a town-wide task force to look at it and maybe make suggestions. I think in the end, my personal goal would be to try to… If the anxiety is here, to try and bring it down to a place where people feel that they have some ability to move forward as opposed to being paralyzed by this.

32:52 And I think doing it in a joint way has a potential for greater success. And of course, what I’d love to see happen is that by the time the task forces form, the crisis is over and we can go back. But I don’t think that’s going to happen. And I think the residual effects of this are not… Even if we’re in a better place as we begin to vaccinate and our case numbers go down, I think the residual impacts of this crisis are still with us, even as things improve. So I don’t believe that our need for a mental health task force goes away, even as we kind of reenter society. I think the lingering impacts are real. So I… Yeah. My concern is that it’s such a massive issue that it’s very easy to get overwhelmed. So I think that going into this, it should be a very specific attainable goal. And then you can go off of that. I think that if it’s too broad, it will be successful. That will be just kind of… That’s my concern is that it will just… It’s such a massive issue that I think we got to start small and then once one goal is attained, then go the next one and the next one.

34:31 Or else it’s just going to get overwhelming and nothing is going to get accomplished. That’s a concern of mine. Yeah. I hear you, but I do think I don’t want… I want the town-wide group to be charged with making that bite-sized attainable goals. And I think… I agree with you. I think you don’t want it to be so massive that nothing can be achieved. I think it… If I were to help convene this, I would very much have that in mind and work to do that. But I believe that it shouldn’t necessarily be the purview of us right now as we form it to determine what that is. Because I think it needs to happen in concert with a more diverse set of eyes on it. If we’re going to do this formally at the next meeting, could we be thinking about a directive for the task force and then they set their own goals? I think that’s reasonable. Yeah. At a high level, though. I think a high-level directive. So we’ve got some things to think about. And if others think about different people on the committee, you named nine people… You can point out that even if this stuff goes… I just mentioned this to you. I think nine people seems like a good… It doesn’t seem like it’s too unmanageable.

36:05 And I think that that’s a good number. But if there are members that want to add or subtract, I think we can talk about that next week or next time whenever our meeting is. Ben, what were you saying? I was just going to point out that I’ve had clients who now are closer to 40-ish back when the Challenger launch went up and blew up. And many of them were schoolchildren, set being in the classroom when they… Because the teacher was on it and they had it going live and blew up. And they still carry the trauma of that, even though they’d grown up and it’s sort of like, oh…

37:06 Oh, I really want to hear what Ben’s saying. You cut out again, Ben. You cut out. Ben, maybe go off video again. We can hear that. I’m trying to remember that. Just because those were vaccinated and people were being moved back on their…

37:30 Ben, maybe turn off your video. We missed what you said about the Challenger and we really want to hear what you said. Can you repeat it? Okay. What I said was that I interview lots of people and lots of people point to that particular moment when they were students in their classrooms watching the Challenger go up and then blow up. And it’s sort of like they just turned off the TV and moved on to the next lesson, but they’ve carried this trauma with them for all these years. And so just because we’re beginning, hopefully, to round the corner of the pandemic doesn’t mean that this trauma of hearing all of this death and… and pain and isolation goes away just because we’re around the corner. And I think to that point, a task force very focused, is paid. We lost the last couple of sentences, Ben, about a task force.

38:55 I think we got the gist, though. I feel like you’re saying… I think we got the gist. It will help people beyond COVID dealing with… The post trauma of this long, unprecedented time.

39:16 We have two guests from the Council on Aging. Do either of you… I know you came specifically to talk about this. Do you have any insights? Social isolation is something that we’re always working on, and it never goes away. And we’re very interested in participating and seeing how we can help the seniors. We did find in the opioid committee that that was more focused on children because seniors were less apt to share. And this may start more with children, but it could grow in helping us reach seniors at all the different levels. It’s interesting because I think the people that came to our meetings were generally speaking to us out of concerns for kids and wanting their kids back in school and concerns about teens. But we know from anecdotal information, from knowing about our own senior members of the community or whatever, that there’s a lot of concerns about increased social isolation beyond what normally happens because of COVID. So I think this really can’t just be about youth in town. This has to be about other vulnerable populations and all of us.

40:50 And I think especially as we start to go back to normal, I think so many of the seniors have been isolated for so long and have been told to stay in their houses that there’s a real fear about what is safe and what that’s going to look like. So I think it’s really important to address that too, as the crisis starts to kind of wrap up what that’s going to look like for them as well. Good. Well, thank you for coming and thanks for offering to represent that community. I think it’s going to be really important. It is important to have the whole spectrum of town residents represented. Sondra, you’ve had your hand up for a while. Is this specific to a task force? Sorry, guys. I’m trying my best to listen to you guys in the school department meeting at the same time, so I might have missed this from Ben. I just wanted clarification about, and I’ll make other further comment later, but I just wanted clarification. What is the current wait list for children that want to start virtual therapy at this time? How long is the wait? For a child that wants to start, it’s about 30 days for a child who wants to start. So, Ben, there is a wait list?

42:24 There is a wait list. I’m sorry if the impression was there was. There is a wait list. We get, because we’re on insurance panels, we get calls from everyone who has a particular insurance. And we tell them that it’s a long wait. But again, for Marblehead residents, it’s not as long, but it’s still a wait. There’s still a wait. I mean, I’m run up against that I only have so many bodies in my building, virtual building. And there are still children who do want to be treated remotely. It’s not, it’s not. Right. It’s not none, but it’s the number who want to be treated. There’s a subset who want to be treated virtually and then there’s, I would say, a larger piece that doesn’t want to be seen virtually. Is the 30 days because of the numbers or is it because of waiting for the insurance approval or both? It’s the numbers, not the insurance. We take people. And again, it has nothing to do with outside town, outside communities. No, no, not at all. Not at all. So, Ben, the priority… It’s not because of other… Go ahead, I’m sorry. Please.

43:58 The priority is to Marblehead students first before opening up the, opening up sessions to non-Marblehead? Oh, absolutely. Yes. Absolutely. To follow up, so say a Swamscot resident, you know, maybe in a Delta something that has been seeing you for maybe six months. Are you going to tell them that you need to end the sessions because… No. So they are taking up a spot? Well, yes, but they’re taking up a spot because they’re taking up a spot. I mean, it’s not… No one… It is not… It is not ethical to drop someone just to bring on someone else. That wouldn’t be medically advisable either. So we’ve taken people. Again, slots are filled, and we don’t kick somebody out to take somebody else. I would never do that. Well, would you take… Now are you taking outside people right now when you have a wait list of Marblehead people? Not really. No. I mean, that’s why I have a wait list. And my last follow-up question to you, Ben, is the treatment plan, have you guys had to adjust that because of COVID? You know, traditionally we have some… You know, I can only speak… I only take care of pediatrics. So this is a huge, huge, huge issue that I address every day with patients.

45:29 I mean, I see them for respiratory issues, but socially that’s the majority of my visits right now. Have you guys had to alter your treatment plans? I know some therapists traditionally might have been doing virtuals weekly or biweekly and just… Now, because of the demand, you know, these kids are getting, you know, seeing a therapist once a month. So have you had to alter that? Or is the expectation based… Is the therapy still based on what the therapist thinks is appropriate for that child at that time, regardless of COVID right now? Yes. We try to… For the same level of care that’s necessary for the individual. And we don’t take shortcuts. We won’t take a shortcut like that. If a person needs therapy, mental health therapy, to say, oh, but we’re only going to see you once every five weeks, I wouldn’t call that therapy. I mean, what are they doing? Just a check-in? I mean, we might end for people who’ve been with us for a while so that we can bring on someone new. But we certainly wouldn’t start off anyone like that. That wouldn’t be medically advising. So did that help? I mean…

46:59 Yes, it did. Thank you, Ben. So why don’t we, for this task force, why don’t we… We’ll put it on the agenda for the next meeting and we will officially create it. And Andrew, I’m not sure. It’s been a long time since we created the last task force. So I’m not sure exactly if we need to have a mission statement or anything like that to officially form it. What do we need to do aside from voting into existence? So I was in here when you created the subcommittee for the land to leave there. That was before me. So yeah, you would officially create it through a vote. And then as far as acquiring other members, you’re going to have to draft a letter to go to all these various… the selectmen, the school committee, and try to get there buying too so you can do this. You might have to go to their meetings to talk about this and get there buying as well. So we’ll put on the agenda for the next meeting. And if we know any more details then about how to go about it, we’ll make a plan then. Maybe, Michelle, could you reach out to Jason to see if there’s any legalities or loopholes that we might be not being aware of? Mm-hmm. Yeah, Jason’s the right way. Is that the next logical step? Yeah. Well, I think we want to keep it under our umbrella because I think it would be… but I think that he may have some concerns that he may want to share with us.

48:40 And Ben, stay tuned for this. I’m looking forward to my next invitation to come. Well, you’ve already offered to be on the task force. Right. So I’m looking for the next invitation to come. All right. So thank you, Ben, for coming. Thank you, Lisa and Karen, for coming. And we look forward to more discussions soon. Thank you. Thank you. Thank you for having us. Thank you. You’re all welcome to stay, of course. Yes, of course. All of our COVID fun or not fun, you know what I mean? Time for a COVID update. All right. So it does seem that things are trending in the right direction. As of last week, we pulled the numbers on Thursday still. The report came out Monday due to me being off last week, but we had a total of 1,146 cases. That’s up 36 cases from the week before. We have 35 active cases. We’re still only trending at 31 deaths. We had 21 individuals at the zero to 19. We had 14 individuals 20 to 29, 10 individuals 30 to 39, 5 individuals 40 to 49, 13 individuals 50 to 59, 11 individuals 60 to 69, 200 individuals 70 to 79, and we did not have anybody in the 80 plus.

50:17 The concern that I have with this is that we are still trending the highest, not zero to 19. So we need to continue to track that. And obviously, we will continue to do that. But that has kind of been the trend across the state as well. It’s just not a Marblehead specific thing, but we need to be paying close attention to that. We have an average daily incident rate of 28.1. That’s down from about 52. And our percent positive for the last 14 days is 2.23. And that’s also considerably down from just over 4%. In the last two weeks, 3,775 tests were taken. I would imagine the next week, this will probably be slightly higher due to vacation. We’ll probably have several more people testing. The other thing that we’re looking at trending across the Commonwealth is that our hospital capacity is still pretty high. And the reason why our hospital capacity is still pretty high is that at this point, as COVID cases start to go down, we’re seeing more and more people actually decide to admit themselves for other issues. So that hospital capacity is going to stay at a pretty high rate for a little while now, till they can catch up with the backlog. People are feeling comfortable that they can go to the hospital at this point. And so they are doing that. So that hospital capacity is going to stay high for a little while. Obviously, we’ve had some capacity changes and gathering limits that occurred on February 8. Most of the capacity limits are stuck at 40%. Our outdoor capacity is no more than 25 people. And the indoor capacity is no more 10.

52:04 Obviously, restaurants and other establishments have different capacities based on the 40% capacity limits. So please pay attention to some of that stuff. So really, you know, at this time, we are really doing both case coordination, looking at active cases, new cases that are coming in, and dealing with vaccine. So we’re trying to have clinics at least twice a week with the five surrounding communities that we continue to work with. Swamscott, Salem, Danvers and Beverly. Unfortunately, obviously, vaccine is extremely limited supply. So the Baker-Plato administration is committed to the effective, efficient and equitable administration of vaccines throughout the state. According to the CDC, Massachusetts on February 16 was number one, number nine in the U.S. for vaccinations per capita. First doses capital. Massachusetts was number one for total shots administered per capita this past week, amongst the 24 states, at least five million people according to Bloomberg. Now, there’s going to be a lot of debate and a lot of looking at these numbers and how you arrange them to try to put yourselves in the high category. Obviously, I think a lot of us have seen the report from the Harvard professor that gave the state an F as far as, you know, vaccine rollout. Again, one of our biggest challenges is that we don’t have enough vaccine to administer. As of Monday, more than 251,000 of our residents ages 75 and older have received their first dose.

53:43 And I actually will give you the Marblehead statistics for first dose and second dose at the end. This represents 51% of the statewide population exceeding the national average of 47% of residents 75 and older. I actually saw that about 60% of residents in Massachusetts 75 and older have received their first dose at this point. But again, we are still struggling with vaccine supply. Obviously, the other day, we have added another category. So we’re now working into phase two. We have individuals age 75 plus, and we now have individuals 65 plus and individuals with two plus certain medical conditions. You can go online and you can look at the medical conditions that qualify you to pull you into that category. Now, there was a lot of back and forth we’ve had with the state was this the correct thing to do. Obviously, you know, we really want to make sure that our elderly are 75 plus get vaccinated, you know, it caused some panic to add this 65 plus that’s an additional million people. Unfortunately, we are only seeing 139,000 new doses a week coming into the state. So that’s going to take us some time at 139,000 doses a week to vaccinate that additional 1 million people. So, you know, we are concerned about that. There has been a lot of press about the vaccination companies trying to ramp up supply and push this out.

55:22 But at this time, you know, there’s an extreme anxiety about getting vaccination. It’s extremely challenging. And, you know, they do have two and one call set up for people that are unable to use the Internet, even those, you know, the two on one system is being flooded. Some of the numbers that we heard today during the peak hours, they were receiving 2500 calls a minute. So unfortunately, you know, we are trying to push people to those areas. Luckily, we have Lucy, Lisa Hooper and the COA to assist us with trying to get people vaccinated. But again, we understand the frustration and act to add to that frustration. The state of Massachusetts uses what we call prep mod for our vaccinations and signing up and that crashed the other day. So they are doing with that system. They’re trying to make sure that it has higher capacity. But they’re still working out some of the bugs. So really, you know, as far as vaccinations go, they’re really trying to push vaccinations through these mega sites. So they are pulling vaccine away from local health departments and from local hospitals, unfortunately. So we are on it continued to be in talks with the state to say, hey, we don’t feel that your vaccination plan is adequate. We feel that we should be part of this plan. We have a certain role in this plan and we need to be part of the system. We need to be part of your plan and we’ll continue to have these communications.

56:55 There’s actually a legislation group tomorrow on Thursday that’s meeting. And I believe Governor Baker has agreed to testify about his vaccine rollout. The public health side has written a four page letter to the governor that was signed on by many state reps addressing some of the issues. Some of the concerns we have with his vaccination rollout plan. So, you know, please, if you have questions about that, you know, please reach out to us. You know, same thing with our office. Our office is extremely busy. We know all the time that people try to call and they say we can’t get through. We can’t get through. So now really the best way to email us, we try to recognize that and use our cell phones when we’re in the office. So we try to keep the office lines open. But, you know, again, we are extremely busy office and at times it’s really hard to reach us. We do. We have clinics running this week at this Salem State University. Today we were servicing congregate care on Thursday and this is their second dose. So these are for individuals have already received their first dose. So you would receive an automatically regenerated email to get your second dose. So today we service congregate care. On Thursday we have anybody in phase one to all public health workers. And on Friday we will be servicing the second dose for 75 plus. On Thursday I will be meeting with Lisa Hooper and Terry McDonough to talk about how we can begin to tackle our Marblehead housing.

58:28 We had a good conference call with the state today and there are doses allocated to that group. That have been set aside. So that is a good thing. So that will probably be our next vaccination group. So we will have a meeting on Thursday to coordinate that. The clinics will be held again in Marblehead to service Marblehead housing. But we’ll be working on transportation and all the logistics of how many days we’ll be and stuff like that. So that’s to come. Any questions on vaccinations and stuff like that? I just know it has been. I have a handful of patients who are 65 years old and older this week who have been just venting to me about how hard it’s been for them to even begin to get connected. And it’s just a shame that in this day and age they couldn’t have had an efficient website or something that wouldn’t get over when you think that the capacity and the possibility is there. And it’s too bad that whatever sites were chosen just weren’t up to stuff. And it’s unfortunate because there were some good practices in place. The hospitals had a good system. Partners was doing really well. Some of these other healthcare systems had some great organizations. So your patient could get onto their patient gateway and sign right up. It was really easy. Unfortunately, the state decided to remove vaccination from those facilities at this point. So I know there’s some added in, you know, increased frustration with the hospital.

1:00:00 We have expressed our concern to the governor about this. Unfortunately, he has not been listening to public health during this pandemic as much as we would like him to be listening to us. But we will continue on. The other big stuff that came out was from the CDC. Last week, there was a lot of discussion about the CDC operational strategy for K-12 schools through phase mitigation. I know Todd set this out to all the board members. And obviously, there’s a lot of different things that they talked about. Mitigation strategies to reduce transmission of SARS-CoV-2 in schools, phase mitigation and learning modes, levels of community transmission, and kind of their different metrics that they’re using to identify this, and then additional COVID-19 prevention in schools, testing vaccination for teachers and staff, and the communities as soon as possible supplies allow. Obviously, we’ve had a lot of discussion about vaccination for teachers. Massachusetts still is keeping them in the same category as everybody, you know, as other first line workers, not first responders. And that hasn’t changed at this time. Todd, did you want to add anything about the CDC guidelines for K-12? I wonder, since we’ve been following the CDC since the beginning, what they recommend, I wonder if we should make a vote to recommend that the school department follows the CDC’s latest guidelines.

1:01:39 I think that would be consistent with what we’ve been doing from the beginning. And they have very well put out documents. And if you two agree with that, I think we should take a vote to recommend that the schools follow that. I know that there’s a school community meeting at this moment, but we have been going with the CDC since the beginning. Well, I don’t know if anybody else, I want to see that Sondra’s been going on. I’m not on the meeting. Well, I’m at this meeting, but I was there for the first half hour. And I know that they’re rolling out K-6 in the next few weeks. And they are keeping the six-foot distancing. But what interested me about this, about the CDC’s operational strategy is how they described sports and extracurricular, both at the elementary and the middle and high school level. Could I read that to you? Sports and extracurricular activities with mass and physical distancing of six feet or more required. That is not what’s happening in our school department. So if we recommend this, they still would take it as a recommendation, of course. But it is not what’s happening. Football began this past Monday for practice. I don’t know when their first game is going to be or if ever, but they are practicing among themselves.

1:03:10 And this is the yellow. In fact, even the lower, what is that, green? I’ve got a black and white, so I can’t tell you what color that is. Do you ask, Elaine, if it’s when it’s moderate transmission? Moderate, yes, is the yellow. But the one lower than that, the lowest, it still says sports and extracurricular activities with mass required. So physical distancing of six feet or more to the greatest extent possible. That’s the only, to the greatest extent possible, is different than the moderate transmission of yellow, which says six feet or more required. So there’s just a little bit of different terminology. Where does our community fall right now, Andrew? Would we be yellow or? So we would be yellow. So you’d be still using the average daily rate. So when I say we were moderate, we are 28.1. So I would like to make a vote and make a recommendation, but I want you to know that that’s not been happening ever since the basketball and hockey season. And certainly they can do as they wish, because we’ve been telling them all along that we’re recommending. And I don’t think we can cherry pick different things from this document. I think we have to do all or nothing if we’re going to recommend the schools follow it.

1:04:44 I personally actually agree with this document. As do I. Well, there we are. There’s a majority right there. So, okay. Do you want me to make a motion to accept the PC? Before you do, Michelle, did you have any comments? No, I mean, you know, I think, sorry, I’m having a dinging problem with my computer that I can’t turn off. Yeah, I mean, it’s a bit frustrating to. This is everything right now, because we’ll be making recommendations that, you know, it’s, you know, we’re meeting at the same time as the school committee is operating, you know, Sandra, Sandra is listening to the meeting right now. It feels a little bit empty to me right now to be making recommendations from our, you know, federal guidance on this. Well, you know, things are happening at the state level in Massachusetts. Things are happening at the community level. So I just need to voice how. What a mess this all feels like right now. So, but that, that, but I’m fine expressing our support of what we feel are some sensible guidelines.

1:06:16 That said, I feel like, you know, there have been some just as sensible guidelines put out, you know, what I’ve shared numerous times with you, the Harvard, you know, healthy school opening reports, etc. that I think are just as smart and wise as all of this, what the CDC has put out. So, and we’ve shared that with the schools all along and which I think share very much of the same information and go even more in depth and have even more good information. And, you know, so yes, I’d like them to look at this, but I would even further appreciate, you know, folks in the schools going even deeper and looking into ventilation and other information. This is a good document. It is a, you know, one or two page. I can’t see, you know, on this electronic document I’m looking at now, one or two page piece of guidance when there’s a lot more information. That I hope that they’re looking at as they move towards reopening that we’ve provided to make this really a robust and safe reopening. So I’m happy supporting this and passing it along and expressing our, you know, support of a document like this.

1:07:47 But I think that there’s more and better that we should continue to be sharing and supporting. I think that this is not the be all end all. I agree with you on that. But I also think that we have been saying from day one that the CDC is a good resource and DESI, for example, is not a good resource because DESI doesn’t deal in public health while the CDC does. So that’s why I do think that, of course, this is not the only thing that should be looked at, but I think this is a good thing for us to put our weight behind. Well, the Commissioner of Education put out something today. And it was sent to me as a member of the reopening committee. And I haven’t read it because it came very late. And it is he’s quoting CDC and DESI within the same document. I have to do some comparison, comparing with it. But I know that the Commissioner has sent this out. Yeah, I mean, they’re probably just looking for a rationale to go down to three feet where they need to. Well, I’m looking to see if there’s anything on sports. And I, as I just perused it very quickly and the print is very small, I don’t see anything about athletics here.

1:09:21 So and there’s a lot about athletics. It’s one third of that second page from CDC. All right. So should one of us make you want to make a motion, Helene? I’d be happy to make a motion to adopt the CDC operational strategy, the K through 12 schools through phase mitigation as a recommendation to the town and to the schools. Is there a second? Can we rephrase that a little bit to be a little more specific? Of course. May I say motion maker? Yes. Yeah, I mean, well, I don’t. Yeah, I’m just can you know what what what are we. May I? Yeah, I would say that we would make a motion to recommend the CDC’s operational strategy for K through 12 schools through phase mitigation, which is the name of the document. As the recommended school department follow the CDC’s guidelines. So moved. Well, I’m not making the motion. All right. So. Michelle moved. Yeah, I moved it. Sorry. I think it’s a good idea. Well, no, I’m the motion maker. So I all right. Well, I I I don’t have to ask me to accept the motion.

1:10:53 OK, go ahead. I jumped in front of you. So that wording. What’s the difference? Andrea, forget the town. Yeah, town the schools. OK, I just felt that their teachers. All right. OK, I’ll accept that. Drop the town on my motion. Got that, Andrea. Michelle, you seconded. I can not miss easily. Yes, in favor. Miss got lean favor. Dr. Belfecker in favor. I didn’t mean to say that I was the motion maker because I was the motion maker. It’s Robert’s rules. That’s what I want. And I heard I heard Michelle say second when she said, you know, I said I said so moved because I was just trying to make it easy. And all right. OK, so the last little bit of piece of information that I want to make sure everybody’s aware of. So when we pull information from the state regarding the weekly health information, all like all the numbers and everything at the very end of that, it’s a very long document. But at the end of that, it talks about active clusters across the state. And so people should be aware of this also. It talks about 24 seven congregate settings, childcare, colleges and universities, corrections, hospitals, households, industrial, industrial settings, K through 12 schools, long term care facilities, offices, organized athletics and camps, other other food establishments, other health care, other workplaces, places of worship, recreational, cultural restaurants and food courts, retail services, senior living shelters, social gatherings, travel and lodging.

1:12:31 So it talks about the clusters that have been identified. And that’s a big piece to it. What the main job of contact tracing is to prevent the spread of the disease. It’s not always to identify the start of it, but it does recognize these are confirmed clusters. And so it is a good idea for the board to be paying attention to this to see, obviously, the most prominent place that we have clusters is in households. Makes the most amount of sense. You know, we see it on a day to day basis, especially with these new variants. We’re seeing more spread in the households quicker than we did in the springtime. And so, yes, the other places that we have concerns about restaurants and food establishments, we see clusters there, combination of taking your masks off for a long period of time and activities of employees doing poor, you know, bad behavior. Childcare is very high on clusters. Again, when we talk about the weekly case count and we talk about the zero to 19 ages, there’s very often students or children in the child care age. So it is a good source of information. It comes out weekly. It’s on, you know, begins usually on page 31. It talks about what’s a cluster and all that information. So I recommend that, you know, people are looking at this information. They should take a look at that as well. That’s really about it. I did have an opportunity to meet with the Marblehead Democratic Committee last night and spoke about, you know, my involvement in the pandemic and allow them to ask any kind of questions that I wanted to.

1:14:12 Obviously, we always want to do, you know, public outreach to reach different ages and groups to see if they have any questions and get their personal opinion on how it’s working. But really to get some feedback from them and see how them understand that we’re always available to them. And really the best way to reach me is through email. You know, obviously, I really try to get back to every email that I receive in a timely fashion. But that’s really it for the COVID update. One question. Could I just say I tuned in on Andrew and he was excellent last night. I thought he was talked. Thank you. If this weren’t recorded, I’d say some other things. But, you know, I wrote them to you personally, right? Yes. Do you, can you get into a little bit because there are more and more people getting vaccinated. What are the rules or how should people act once they’ve had the vaccine or the second dose even? Are there different ways to go about it? So really, when you get vaccinated, you really shouldn’t be changing any kind of behavior, unfortunately, at this time. So you’re going to have to continue to mask up any time you’re outside, you know, any time you’re outside your personal home. So when you’re out in the community, you still have to follow all the rules and regulations. You know, the state of Massachusetts still hasn’t adopted some of the CDC guidelines. CDC came out and said, if you have been fully vaccinated and you’ve reached your full vaccination after that period of time, if you have become,

1:15:50 if you are a contact of a confirmed case that you don’t need to isolate, Massachusetts hasn’t adopted that yet. I’m sure that’s in the public and I’m sure people are doing that currently. But we’re still waiting for Massachusetts to adopt some of these things. But yeah, once you get vaccinated, you’re still going to need to follow all the rules and regulations, just like somebody that hasn’t been vaccinated. It’s still pretty early. You know, these vaccines went through a very, you know, they were created in a very short period of time. So they didn’t go through these long, year-long trials, multiple year trials. So we still don’t have all the information that we would like to have. So as it goes along, they’re going to gather more and more information and things will change. Some of the leading countries looking at how long vaccinations are going to last are Israel at this time. They’re doing, they’re investing a lot of money in looking at this stuff. But as more data comes available, the CDC will look at it and make recommendations. So unfortunately, this time, you really need to still follow all the guidelines. Make sense. Yep. And obviously, there’s a lot of, you know, talk about COVID vaccines will probably, no, there’s a potential built, they will be part of our flu vaccine in the coming years. So it will be like a multiviral or, you know, a flu COVID vaccine, you know, similar to MMRs and stuff like that.

1:17:26 Okay, thanks. That’s the end of our agenda. Sandra, you said you had another question. I’m just more of some housekeeping quick things that maybe Andrew could, I know a couple of times, Andrew, you said you were waiting for a lot of outstanding death certificates and we weren’t sure how many of them might have been turned over as COVID. Where are we with that? We pretty much caught up. Is that 31 pretty accurate still? Yeah, so the 31 is pretty accurate still. So we are, so I’ve gone through all the death certificates up until, I think it’s like through January 15th that I received from the town clerk. And, you know, that’s what I feel like looking at cause of death one, cause of death two. But when I go through Maven and I have to go back to this, they also have a running tally. However, what happens is that if our out-of-town resident comes into Marblehead and is in our long-term care facility and passes away, Maven is recording that as a death in Marblehead. It’s not a Marblehead resident per my, you know, per how we would generally report that. But I just need to make sure that, you know, people aren’t falling through the cracks or whatever. And then second is, are you, you know, Elaine had mentioned this and I’m not following the high school sports and listen, I definitely have some concerns, especially with football. And do you know what the requirements are going to be for them? Clearly they’re, I don’t know if you have been involved in any of this in regards to the high school level, what their requirements are going to be.

1:18:57 You know, I can only imagine, I mean, these are aggressive face-to-face. I mean, how well if mask is going to stay up, are they going to be required to be double mask or mask with a face shield? I don’t, I’m just curious to know if you’ve had any involvement or what the protocol is going to be for Marblehead? So again, you know, we try to generally follow the state and look for state guidelines. And obviously the biggest concern right now is these new variants and how they’re behaving compared to the new regulations or recommendations on should we be wearing double mask? So hopefully if the state comes out and says, hey, we are recommending your average person to be double mask, that some of those recommendations get pulled into the sports as well. Obviously, there’s been a lot of clusters around hockey. And so they’ve been really looked at hockey about, you know, and obviously the cold temperature on the ice has caused some issues and allows the virus to stay at kind of head height for a longer period of time. There’s also some poor behavior and some other people involved in hockey. So that kind of skews the number a little bit. We’ve seen a regression though in that since they ended up mandating the mask wearing, correct? I know it was an optional if you were a center, like I really discouraged it with my patients before all of this or they had to wear a mask. And then follow up, you know, you had mentioned something about the clusters and I’m not sure if you have this information. Some of these daycare clusters, I’m just curious to know, do you know at all if the clusters that we’re seeing in the daycares, if they’re mandating mask use or are these clusters possibly without those under five kids that are actually wearing masks? Or, you know, I know that, you know, that’s a question that I ask my patients all the time.

1:20:32 Does your child wear a mask? Is it mandated or is it optional? I’m just curious to know if that might have some reflection in some of these clusters and you might not know that information. So obviously, like you have the CDC recommendation about when, you know, how old you should be to wear a mask. And then you have the real life, you know, how well does it work? How much is the kid pulling it down? So it’s really hard to say. And obviously, when they group clusters together, they’re not pulling out little age groups of, you know, this is below the mask wearing age and this is the cluster above. They group everybody together. Okay. I wasn’t sure what that those dynamics. And I totally agree with the whole frustration with these vaccine rollouts. You know, I thought this V safe that they rolled out. My practice actually happens to be one of the clinics that is vaccinating. I see kids during the day we vaccinated night elderly and the frustration that these elderly are going through. And it’s really frustrating to see something as simple as V safe where these elderly people just scan their phone. Yet they have to go to multiple sites to, you know, book an appointment. They’re such a disconnect. They want the information of how these people are tolerating the vaccine. A simple, easy to use. They get a text message yet you’re requiring these poor elderly people that are not tech savvy to be logged into five or six different multiple sites is just so, so frustrating. So, you know, I am really discouraged to hear that the hospitals are losing their access to vaccines. We are still vaccinating, but there’s only so much we can do. So, yeah, I fully support and how this rollout has been is definitely been problematic.

1:22:11 Like I said, you know, we’ve expressed, I mean, we have attorneys that work for us for our professional organizations and they’ve been with us, you know, from day one supporting us looking at different issues. We have them on our conference calls every week with us. And we have written, you know, the letter that was written February 17 to the governor is a very strongly worded letter about all the disappointments about the vaccine rollout. The companies that are running these mass vaccination sites, the fact that, you know, the computer access is so hard trying to address all this stuff. They do have a legislation meeting that’s occurring on Thursday. This was signed on by quite a few state reps. But unfortunately, I don’t think it’s going to go anywhere, you know, which is really frustrating. It came up in the press conference today. I don’t know. Did you listen to it, Andrew? I only have a chance to listen to it a little bit. And, you know, again, he’s saying, look at us. We’re doing such a great job about our numbers are this and our numbers are that. Where we have a Harvard professor say, I’m giving you an F, like this isn’t the way it’s supposed to be done. Well, he mentioned the, you know, a question came up about specifically about boards of health and vaccinating at the community level. He wasn’t talking about, but, you know, and he said something like, well, you know, the mass vaccination sites are, you know, the way to go because we, you know, it’s just it’s the way to get more shots in the arms and more shots in the arm.

1:23:45 And he said, but moving forward, you know, we expect that doctors offices will be, you know, and providers will be a much more important access point or whatever and alluded to the fact that. But, you know, yet we know that, you know, partners isn’t able to do it anymore. So I don’t know. It was a little bit of a disconnect. I can tell you from a pediatric, we they requested our numbers for over 16, six weeks ago of our high risk. And yet we have no idea when we might start vaccinating that that group of kids. So they wanted the information, but nothing’s happened at this point. And, you know, Secretary Sutter has always said, well, you know, we’re going to try to get, you know, local public health vaccine. But with that comes the caveat that I have to do 750 doses a day. I can’t even get a hired company, Cataldo, to do that for us right now. So it’s impossible. You know, we max out about 250 doses a day. Now, a four hour clinic turns into six to seven hours of face to face patients. And then you have set up and break down, which is another two hours. So, you know, and trying to do this on a day to day basis, along with all our other work, you know, is really tiring. How’s the rollout? I have not been able to volunteer any time at the Salem State site. And it sounds like you’ve been there. Have they had any major issues over there with their rollout staffing? People know showing. I know that there was an email that went out a couple of weeks ago that the vaccine never showed up and there was major cancellations that occurred within 24 hours.

1:25:20 How did they even deal with that? I’m just curious of any info or intel that you have. So unfortunately, you know, that was when Cataldo was supposed to be running it. You know, we had some storm delays and any time we have storms across the country, it’s been affecting vaccine deliveries. I mean, we got an email last Thursday to say if you have vaccine coming to you that was supposed to show up on Friday, it might show up on Saturday. You need to sit in your office and see if it shows up. And so it’s just, you know, like we have tracking devices. Can you tell us where it is? This is, you know, this is ridiculous. I know exactly when my Amazon package is three deliveries away. Why can’t you have the same tracking for this stuff? So it gets a little frustrating, but, you know, we need to continue to deal with it. Our biggest concerns with these mass vaccination sites is the equity of it. So I’m concerned that obviously, you know, I could get there, but can a 75 year old get there? And then obviously they say, oh, okay, we’ll start this program of somebody can accompany you. So then all these scams started to happen. The next day after they opened that up, you know, Craigslist was full of, hey, I’ll take it up to a mass vaccination site so I can get vaccinated. We’re like, that’s not what we want. We want to make sure people are secure and safe and being taken care of. We don’t want somebody, you know, grabbing a senior and bringing them to a mass vaccination site so they can get vaccinated and then ditching that person somewhere else. So we’re always trying to express these concerns. You know, at the same time, trying to get as many people vaccinated as quickly as possible.

1:26:58 And obviously the idea with that originally was that if you just flood the market and have vaccine available at mega sites, you know, town sites, CVS, you can vaccinate a lot of people very quickly and everybody’s comfortable with where they’re going. So these mega sites, do you know if they have certain protocols of how are they dealing? You know, that whole catastrophe that happened at the double tree where a lot of people canceled and then they started telling people we had, you know, 300 doses that were drawn up. Does each individual site of these mega sites have their own protocol of how they’re going to handle excessive? You know, that’s the other issue that we run into. I, you know, I read an article recently, I think it was the hospital in New Hampshire, who said, listen, we’re not going to open it up to, you know, we have people that wait in our parking lot every night. That they said, listen, if we have excessive doses, we’re not going to have a backup list. We’re going to call the next group of people that have scheduled appointments because their information’s already there and then we’ll notify them to. But I was just curious, obviously the mega sites, we in our office literally are counting every patient. So, you know, we’re drawing doses as opposed to the mega sites, you know, we’re drawing 20, 30 at a time, but these mega sites are drawing hundreds at a time. So it’s really kind of almost thousands at a time. So yeah, the protocol is that you’re supposed to have a backup list of eligible people. And so people get, you know, what’s an eligible person? An eligible person is in that category. So at this time, an eligible person is anyone in phase one and people in phase two, 75 and older and 65 and older, or those two co-morbidities. Those are eligible people.

1:28:32 So yeah, we are trying to maintain that list, but what we do for making sure that we are trying to capture every vaccine is that when we, so we pull our list of when we’re having a clinic, you know, the night before. So I’m going to have 165 people there. Depending on if I’m using Moderna or Pfizer, I know that I’m going to get 10 doses out of Moderna or I’m going to get six doses. We will cut it short and say, I will only bring enough for 160 people knowing that I can squeeze a couple more doses out of those vials and get up to that 165 rather than bringing 170 doses and having to find other people. We have to tell our volunteers that just because you’re volunteering doesn’t mean you’re going to get a dose. So that’s interesting because I got a letter that someone, they were so desperate that I got a letter from Lisa Jackson saying, if you volunteer, I will give you a vaccine. And I was like, Ooh, this might create some problems. Yeah. So that has been very challenging. And when she gathers, you know, she does a tremendous amount of work for us. You know, she’s our MRC coordinator. And yes, but when we actually talk to our volunteers at our level, we say it’s not a guarantee. You know, we really want to try to get you there, but we have to calculate. We can’t waste any doses. And because of that, you know, we’ll invite you to do that.

1:30:30 We have a list of people who are trying to get signed up and we can pull people in. That’s the best way to do it. If we start to run through that and we don’t have a list, we will form a list in my office that I will have to control. But it needs to be that eligible person. Obviously that’s where a lot of confusion comes from. I have to ask the state, what do you consider an eligible person? Anybody? Or is it somebody that fits into the categories that we’re serving? So we’re going to move on, but you have questions. Of course feel free. No, I’m good. That was all I had. Andrew’s always available. I’m speaking for you, Andrew. But you can always email me any time. So we have just a little more housekeeping. The annual report Andrew emailed today. So just look it over if there’s any edits or anything, send it to Andrew. By when? As soon as possible. Kyle’s looking to finalize this in the next couple of days. Take a look at it. It should be pretty close to being there. I’ve added everything. She wants it by the end of the week because I’m doing one for her too. The last big piece I have taught is the waste management contracts and talking about the waste management contracts. So we’re entering into our final or fifth year of this contract.

1:32:03 It’s actually the sixth year technically in the contract. So with waste disposal, we don’t have, we can go out and get quotes from different companies and go through this process. We’ve been dealing with waste management for, since I’ve been here, I think you’ve been dealing with waste management for maybe, you know, for a really long time with Wayne. The one thing that we are slightly different as far as other transfer station goes is that we mix households, solid waste with construction and demolition material. We have a permit to do that. We’re allowed to do that. But that’s very different than a lot of other things. So with that, the C&D, construction demolition material can only go to specific landfills. So waste management does have some landfills that can service this. So we have a proposal from waste management and they actually gave us four different options for our contract. Our current contract now, our final year, the cost per ton is $97.38. So $97.38. Our largest year so far occurred in fiscal year 2019 and we did 12,470 tons of material. That is, so for next year when we’re running into $97.38, that’s $1,214,358.79

1:33:40 of cost for disposal. Now we do, we have commercial tonnage that we sell. So we take commercial tonnage in, we charge, our current rate is $185. Regenerate approximately, you know, just giving those tonnage numbers $670,000 is brought in through that tonnage, through the spreadsheets that I have that Bob Ross had created originally. Our disposal fees, our disposal budget that we have is $725,491 this year and moving forward, that’s what we propose for next year. That gives us a total budget of $1,395,942. However, our historically, we always spend out of our budget is $592,000. So really the commercial tonnage offsets that. Remember that we have a revolving fund and so as money comes in for commercial tonnage, it’s paying that out at the same time. But that’s kind of the comparison. So I have a three year, a five year, a seven year and a 10 year. You know, the hardest thing about waste is that, you know, there’s only, at the very end, it always has to go into a landfill. Even if you burn it, the acid’s going into a landfill or you’re going to

1:35:11 another landfill. The one that we’re using currently with waste management is Keystone, New Hampshire. It is a methane capturing landfill. So yeah, it’s slightly different than getting burned and the ash incinerated. The methane is captured and that methane is used to heat UNH. But the concern is that landfills are filling up in Massachusetts and obviously at some point there’s going to be zero capacity and that means longer and longer trucking. So when we’re looking at these prices, our prices includes trucking. So trying to compare our costs to other communities can be very difficult. There’s always so many communities that do the exact same thing as us. The most recent contract that was signed was by Winchester. They recently went out to bid. The winning bid was $90 for just tracks. No trucking. We estimate trucking to be anywhere between $25 and $30 a ton. So at $90, they’re paying approximately $110 to $120 a ton to get rid of their trash. So when we’re talking about $97.38, that’s a very good number compared. So we’re only paying, you know, apples to apples. We’re paying $7.38 for trucking, which is a ridiculous number for trucking. But just to try to look at all this, so option one is three years, option two is five years, option

1:36:43 three is seven years and option four is 10 years. Now, the 10 years has some great numbers in it. However, it still goes up by 4%. Year two is where we see our biggest increase. Right now, they’re kind of a little bit behind in their contracts. So they need to jump up. So in option one, the second year would go up to $120. Option two, second year would be $113.45. Option three, which is a seven year, would be $111.01. And option four, which is that 10 year, would be $110.09. Now, all of them, after that year, option three and option four go up by 4% every year. Option two, going from year three to four is 3.5%. And I believe option one is also 4%. Now, we have a JRM contract that’s a 10 year contract that’s ending in January 30th of 2006. Yeah, January 30th of 2026. But 2026. Yeah, 2026. It would be nice at that time to possibly put these both out to bid and you might get a very good price because you’re doing both collections disposal. So my recommendation is to go with option two, which is a five year contract. And that would that would align those two contracts

1:38:14 together. This contract would end July 1st or actually June 30th. So you would have, you know, you’d be missing a couple months. But what we would do is we would be looking at the contracts for this for collection, and try to get them aligned as quickly as possible. And that’s pretty easy to do. Usually what we do is we jump into a contract earlier and then one contract and get them to align together. So yeah, unfortunately, trash, it’s going to continue to go up. Yes, we have a pretty big jump from the 97 38 to the 113 45. But after that, you know, for option two, it’s a three and a half and then a 4% increase every year. The other ones, it’s a 4% increase every year. You know, so we’ve always talked about during the budget season that this is a number that the town needs to continue to pay attention to. It’s always increasing in the town. You know, again, this is a very large budget item. You know, at the end of option two, we’ll be paying almost $1.6 million to get rid of all our trash. And the budget needs to reflect that obviously we can’t have a shortage. That’s correct. So, you know, currently our budget is able to sustain for, you know, the next two years. But we’d have to really start to pay attention to that. And you can be looking at two different things. So obviously, you should always be looking at your commercial disposal costs. We are currently at 185. We’re probably one of the cheapest disposal for commercial trash around. When we look last time, I think our average at other, you know, municipalities

1:39:45 or other facilities, it was around the $200 mark. So that’s something that we continue to raise up and try to, you know, fill the void there. But, you know, at some point, you might have to increase our budget to deal with the, you know, the residential trash. Residential trash tends to be about 70%. Commercial trash tends to be about 30%. And the money from the commercial licenses does not really offset much of that. I mean, how? Now, the commercial licenses, the stickers, so there’s no sticker fee for a commercial. There’s sticker fee for residential. And yes, there’s a pretty large offset with that. And yes, the commercial covers the cost of all disposal and covers some of the costs of the residential. Elaine, you had your hand? So a couple of things. One, I like the idea that five years to be in sync with the both of the groups. I also wondering, would you want to raise the residential because you raised the commercial last year to increase, I mean, increase the pricing for the residential. I know it’s always hard to do that, but I don’t think we’ve done it recently. I think at this point, because we’re in a COVID period, and, you know, it has been a very challenged mentally, physically, and financially for a lot of people. I think you need to keep that residential sticker exactly where it is at this time.

1:41:15 I agree with you, but we need to keep that in the back of our minds. Maybe when we, the contract, it goes into effect, what’d you say, 2026? Yeah. And obviously we should be paying attention to, you know, the residential sticker fee on an annual basis. And the same with the commercial tonnage fee on an annual basis. And we can review that, you know, and making sure, and if things start to get a little, if the Delta starts to decrease, then we can talk about increasing those rates. Did you want a motion for tonight? I do. I would like a motion to enter into a five-year contract with waste management. So moved. You muted Michelle. I’ll second that. Okay. Miss Aislett. In favor. Miss Gottlieb. In favor. Dr. Belfbecker. In favor. So obviously, this will just start the process. So I will go back to waste management. I will speak with Lisa Mead. They will need to drop, you know, draft the contract. The way it usually goes is waste management takes a stab at it. I hand it over to our town council, who essentially has the file say, they might go back and forth a little bit, and then we’ll come up with the final contract. And I will bring that back to you guys for your signatures and final approval. Okay. Any other questions on trash and stuff like that? And obviously, as it’s always a concern, the recycling market is improving a little bit,

1:42:49 but it’s not improving a great amount. But we do have a great collection contract with JRM, where we do not have to pay disposal fees for our recycling at this point. So please remember, in September 30th of 2026, there’s going to be a very sharp increase in collection costs. You want us to remember that right now? I’ll put it on my 2026 calendar. I’ll talk about it every year, that doesn’t remind you. Maybe we should factor in more budget so we can be prepared for that without a huge jump. I don’t know if that’s something we can do. Yeah, I mean, it’s something that we just need to continue to talk about, Todd, and really looking at the numbers. You know, it’s been a pretty good average. I can send you guys the spreadsheets that we have on trash that we have been tracking. Bob Ross had done a really good job of putting the spreadsheets together. So you can see it a whole bit different ways. I have a waste comment that’s just kind of just to bring awareness that Hamilton Mass was in the news this week because they are now requiring composting in every household. I am not suggesting we investigate that at this point, but I like seeing that composting is getting more and more in the news and is becoming more of a thing. So I think that’s also going to, the more people compost, the less waste we have at the transfer station.

1:44:19 And I just did, you know, I’ll go back and take a look at my emails. I did receive our time for composting this year from Black Earth. So I will share that with you guys. And so you can understand what the savings are by, you know, using the number of trash disposal as opposed to the, you know, the savings that’s being made by composting. Currently, we have over 550 residents signed up for compost collection on a weekly basis. And we’ve upped our compost containers at the transfer station to 665 totals every week at this point. Great. We’re going to have a meeting. We’re going to talk about next meeting. Yeah, I have one last thing. You guys were very kind and sent us lunch at the office and sent coffee and everything up to the transfer station. So I have a thank you note from all the employees up at the transfer station. So this is addressed to Marblehead members of the Board of Health, attention to Dr. Belfecher, to the members of the Board of Health, thank you for the shoebies delivery to the transfer station. We appreciate the bagels, butter, cream cheese, jam and coffee with all the condiments. Oh, and the two juices. Nothing went to waste. Deal with our residents is often quite trying at times. And I’m sure you all know, we all try our best. And we thank you all over the board for the recognition. Mike, Chris, Ralph, Marty and Kay.

1:45:50 So thank you very much. We really appreciate that. And that’s it for me. We thank you Andrew. We’ve been talking about instead of meeting weekly, meeting every other week because it just seems like it’s a better quantity information in two weeks rather than one. I think that that could be a good thing going forward. What do you two think? Why don’t we try it next? We tried it this time. Let’s do one more shot and see because I think there’s going to be a lot going on at the schools and I think a lot more into the community. We may see a surge in the next two weeks. I don’t object trying it one more time. Yeah, if we need to go back to weekly, we can… Yeah, we all have our time. Instead of making it a finite thing, I’d like to say let’s meet two weeks from now because there’s a lot that’s going to happen. We may not, I don’t think in one week we’ll know the numbers over February vacation. I don’t think we’ll have that. We’ll know a little bit more about the weather. We’ll know more about the shots in the arm. I’d like to say let’s go two weeks and then we can make a time decision in two weeks. Is that all right? 7 30 on March 9th. Okay, we need a motion to adjourn? I’ll make a motion to adjourn. Go ahead, Michelle.

1:47:20 I’ll make a motion to adjourn. Second. Michelle, Ms. Gottlieb. In favor. Ms. Hazel it. In favor. Dr. Belfbecker. In favor. Good night, everyone.