Lincoln County Board of Health
May 12th, 2021 Public Meeting
By Sally Durham

Work meeting- no decisions tonight.

0:52 Dan Clark -MSU-

Chair- re: mission statement, the public wants a lot of education. That is not our highest priority.

Clark- mission statement shows why you exist. How does Lincoln County Board of Health interpret the guidelines and come to a consensus on their purpose? Vision statement is the desired future. Timeline and intentionality of goals. What is your vision, what do you want to accomplish over the next five years? Overall and goal statements. Focus and accountability.

5:17 Chair- Vision will be dynamic, changing as needs in community change. For example, handling the pandemic, mental health, smoking cessation, etc.

6:00 Clark-Consider how do you work collaboratively with other organizations and how do you move through pandemic, and then move on to other topics. Re: Ground Rules- how do we ensure everyone feels comfortable and safe saying things they want to say without retaliation or rebuke? A diverse board is to share diverse ideas and perspective and come to policy decisions by group.

9:15 Board- how does that work with the public? Everything is being taped. You cannot have a discussion without people taking it out of context. For an unpaid board. We are doing a public service and you get slammed.

10:20 Two sets of ground rules, one for the Board to make sure the board works with each other. Perhaps having all comments directed to a neutral chair rather than debating between two people. Decorum and formality help in a heated environment to keep things from digressing. You must figure out what level of decorum you have in a local setting.

12:54 Board- That should be in ground rules?

13:22 Board must set expectations for the public or they come with their own expectations. Ground rules need to be visible. Like: stand, come to the podium, state your name, etc. Let them know what you need as a board to better understand the public opinion and massage that info and come to some sort of action. Give us solutions, ideas, thoughts, not just “I don’t like it.” That is not helpful. You can have it so that people speak and then you move on without interaction. That makes public feel disconnected. Back and forth between board and public can get out of control. They may want to ask questions. You are not compelled to answer. You decide how and what level and with who they will get answers to those questions. Board is supposed to be informed by public, but Board needs to be able to function.

18:17 Chair- Would it be a good idea to have 2 separate committees, come up with 10 ground rules. Discuss and bring together for a consensus?

19:04 Clark- collect ground rules from other organizations and decide what fits.

20:34 Board- committee can bring report with recommendations.

21:25 Would formation of committee be an action item on the agenda? Yes. Does meeting have to be noticed. Yes, they become a subdivision of government. It will still need to work according to public meeting laws. Cannot bypass the law.

24:33 There is benefit to public meeting. Story about how someone was going to be reprimanded, but they waved their right to the private reprimand and the committee did not want to do it in public.

25:06 (#23203 sub 6) law says regarding meetings. Any committee for purpose of conducting business is subject to the section.

27:01 Couldn’t I just go down to someone’s office and say, let’s look at this, then bring it to a meeting?

If you talk to one person, it is unsanctioned, two citizens coming up with a recommendation. If you start shopping that around it becomes a rolling meeting. The benefit to a committee is helping with geographic challenges. It is easier to find a good place and time for a smaller group.

28:59 Chair- I can send out a list of the ground rules. Please consider this and bring ideas to the next meeting. “Reply all” will get you into trouble.

30:15 You can send info on other subjects and discuss online. Anything in your jurisdiction and purview, the public has a right to know.

31:32 Good to know. Public sends in emails and gets upset when board does not respond. We need to address them as agenda items in a public forum. One person responding can get the board as a whole in trouble. It must be a public forum.

34:00 If it is not policy, the health department can answer questions. Experts bring in the science and then Board makes policy. Then they must balance it with environment, budget, political climate, etc. We are not the experts. People need to talk to their doctors, etc. People need to stick to their job parameters and not cross into other areas and muddle the lines. It creates angst.

37:25 The board has a responsible to use what is available as science goes. Are we using it according to guidelines and what makes sense with the science? That would be what drives policy.

It is in the board’s purview to ignore the science, but you have to answer to the public in a non-authoritarian government. This has been very visible. The best science available is shoddy at best. We may say something today that we may find out in two weeks was not the best answer. We must answer with the best information we have at the time. We are learning in the public arena. We may not be right all the time.

It would help if we articulated to the public when we get new information before we make direction changes. New Zealand handled that very well. The guy was great. (We do not know this, but what we do know is (this) and we have this study in the works that will hopefully help us learn (this), etc.) Be open and honest.

45:00 Online info is unpredictable. People may not trust the CDC or WHO, but they are still our best source of information. We cannot just put information out there, like recommending massive amounts od Vit D. That can be dangerous.

45:30 We should put out there that vit d deficiency has had a strong correlation with severe symptoms and people should talk to their doctors about their personal situation.

Cathy working on vit D presentation. I cannot tell people to take supplements. Board says to talk to your doctor. If doc does not want to talk to you about it, find another doctor. We are all unique and we all have different issues.

47:39 Mission statement.

48:49 what was the public expectations that effected legislature? There was a lack of trust. The public at time has an expectation that the government will get it right because they have greater resources and when they do not meet public expectations, public loses trust. Right or wrong, it was a moving target. History will tell if we were right or wrong, but we are just doing the best we can. We get yelled at either way.

52:00 Board is non-elective because they do not have to react to the politics. Each political extreme wants to save the people in the middle from the other side. But the people in the right are smart enough to make their own decisions.

54:50 Appreciate Clark’s training

55:40 Backlash came because there was no clear picture. What did we do that made us so bad? Public was looking for someone to blame for their fear.

We could look back at how we responded to the pandemic, what we did well, what did not work, and how to approach it better next time.

We should wait till the emotions are lower and we can look at it objectively.

58:00 Canada still has roadblocks. People must hide visiting family in Canada. Canada has 3% vaccination rate. Blackfoot reservation took extra vaccines to border. Seattle also.

1:00:01 We are still studying pandemic from 1918. 200 hundred years from now we will have all the answers.

1:00:39 Mission statement- Chair- education is not the board’s responsibility. The department of health and the hotline should be doing that. Not listed as the powers and duties of the board of health. Board helps facilitate how to find information to work with the department of health.

1:03:14 Guidelines mention a lot of things we do not do. It identifies more what the health department does. Board of health should identify how dept of health moves forward, and effect direction through funding.

What about Epidemiology- how do we determine if that is effective?

Board member can ask, and resources will be provided. We do not have anyone with those qualifications. Board uses the information from the hospitals etc., and board makes recommendations. But the board does not track that data. We do not have capacity or time to do that.

PCR testing. We have not found out the who, where, when, how, and how bad. Health dept does not have an epidemiologist.

We hired a disease intervention specialist. Contact tracing.

PCR handout sent to the board, talking about qualitative info on positive or negative tests, but we do not know how this is affecting people’s lives. Qualitative. Many people tested positive but were asymptomatic. We have not done qualitative tests. Need to have them with clinical examination. Asymptomatic people should not be getting PCR test according to CDC guidelines. We have a lot of numbers, but not what that means on the impact on our community and the disruption of the disease.

WHO- updated IDB users. Target audience is lab professionals. Second was talking more about mutations. I do not know why would want to know that information. If I am ill, do a PCR, but there are false positives and negatives. We are not the lab professionals. We are more focused on the positives and negatives.

Need to know how contagious people are. PCR amplifications increase the sensitivity of the test. If we have to raise the threshold so high to get a positive, they could be picking up minute viral particles. But if they are not sick or a danger to other people, we should switch to qualitative. Are the people getting positive tests actually sick and how bad? I am sick, but I’ve been worse.

Anyone with a positive test has a potential to be contagious. Whether or not they had cold level symptoms, people are having long term effects. If you say they did not get very sick, but have weeks and months of lost work, poor concentration, memory issues, it’s hard to quantitate that.

1:19:01 My daughter had covid. 4 months later she has heart problems. My question is, how does that change how we treat and approach stopping the spread? Does not matter what their symptoms are, we want to quarantine to protect everyone else.

If someone is not really sick, no symptoms, they’re probably not shedding virus in a way to get others sick. If you are not coughing and sneezing. Example of people living in same room and other family members never test positive. It would be valuable to know how sick people are getting. People are terrified.

80% of people over 65 in Montana have been vaccinated. Higher population of the vulnerable. Decrease of deaths is because of the vaccines. You talk about the asymptomatic, but if you test positive you should be quarantined. It is a respect for others issue.

Asymptomatic means not showing signs of illness.

5% of tested people that are asymptomatic remain asymptomatic. Cycle threshold is not part of the rapid tests.

1:25:12 we primarily see the symptomatic people. We do rapid tests at the clinic. It is a plus or minus. PCR is not used much here.

Gold standard of threshold is 40.

That is not correct.

1:26:30- reading of study information of threshold information…

What is your recommendation?

It would help physicians diagnostic process. It would be good for a professional to know the threshold they are tested at. I would hate for misdiagnosis.

Example: Vaccinated couple needed PCR to travel. She had positive PCR. Husband tested negative. PCR was then repeated, and it was negative. People going into hospital get PCR, Sometimes, they get false positives and negatives. We need to confirm when it does not make sense.

How are we going to resolve this so we can move on?

Does anyone on Board care about the threshold? If you disagree with me, I am outnumbered.

Physicians are not wrong, but they need to contact the people making the tests and get that information. They need to treat symptoms. Microbiologist at hospital-it is just like hep C, they draw blood, do test, comes back positive or negative. If it is positive, then they need to know how sick I am. PCR helps us know if treatment is helping, but initial should be rapid test. Clinician should tell people to stay home.

What about the people who get the test in other places? Thresholds can be bumped up. To understand what is going on, we need to know more information on each person. How sick they are, how contagious.

Present does not mean contagious.

Present, you quarantine to protect everyone else.

1:37:40 What about the vaccination? What about the antibodies. Are people who get COVID, are they contagious?

Cycle threshold, can we agree per CDC guidelines that these tests should be collected from people who meet the covid clinical criteria (with symptoms or contact with covid or travel to infective areas.) We were using them widespread.

We did not have widespread asymptomatic testing.

Clinic is doing rapid test. PCR used for admitted patients. But we cannot change what they are going to do at the hospital. Pre-surgery tests to protect staff and patient.

We are most contagious before we know we are sick. PCR on asymptomatic people gives us a skewed view of what is really going on. We should not use the test for things they were not recommended for.

CA did PCR testing on general pop for statistics. It was a study.

I don’t’ think anyone will do population study here.

The test can create fear. We need to present a reasoned sensible approach. The people need to trust our perception.

(Unintelligible due to strange alarm.)

Last week we had 5 positive COVID TESTS, all symptomatic. We have never done widespread asymptomatic testing. We did not have the tests needed.

Can we agree to use the tests according to CDC guidelines?

Bring it up as an agenda. We will vote at the next meeting.

Admitted patients get respiratory viral panel checking for many things.

Asymptomatic testing to report numbers of covid in the area is not productive.

1:49:00 Next meeting in June. Rep from State will be there re: changes in the law. June 8.

No public comment.

Next work meeting should be held in Troy, so we rotate.

“God doesn’t require us to succeed, he only requires that you try.” - Mother Teresa