Public Health online meeting photo

The Public Health – Idaho North Central District board meeting July 23 was held via Zoom teleconference and streamed on Youtube. Pictured are (clockwise from top center) district director Carol Moehrle, chairman Dave McGraw of Latah County, board member and Idaho County commissioner Mark Frei, board member and medical doctor Glenn Jefferson, and board member and trustee Doug Zenner of Nez Perce County. The full video can be found online at youtube.com/watch?v=vDbI_v2nsBA.

“Regardless of the risk level, throughout the remainder of the pandemic, everyone is asked to do the following: Stay home if you are sick. Maintain physical distance of 6 feet from others (outside of immediate family) whenever possible. Wear face coverings in public when physical distancing is not possible. Wash hands frequently for at least 20 seconds or use hand sanitizer.”

This is part of the local public health district’s draft plan to communicate COVID-19 risk management information in the five-county area that spans Idaho, Clearwater, Latah, Lewis and Nez Perce counties. Public Health – Idaho North Central District is seeking public comment on this draft through Aug. 6, with comments being accepted via email to BoH@phd2.idaho.gov.

After the public comment, the board of health – which includes a member representing each county – will consider adopting the plan.

Beyond those listed, the draft sets out several other “mitigation strategies” that apply “regardless of the risk level.” This is the lowest risk level, which would correspond to the “Green” phase of their return to school plans.

This level in the public health draft plan calls for schools to “maintain increased awareness, cleaning and other protocols as established,” and for large event gatherings to implement “physical distancing, use of face coverings by staff and participants, increased sanitization measures, and increased personal hygiene measures (handwashing/hand sanitizing).” The draft also calls for “all individuals [to] carefully monitor their health.”

If the virus spreads, or if it sends people to the hospital, or if it kills, the draft lists “mitigation strategies” that the board of health could add in addition to those listed above. The draft lists numbers for spread, hospitalization or death that mark the “moderate risk” level. Caution about the metrics listed in the draft is in order. On July 23, when PHINCD director Carol Moehrle presented the draft to the board of health for a decision on whether to put it out for public comment, she told the board: “Once the board says, ‘Put this out to public comment,’ that’s what we’ll be doing – having those discussions with the hospitals to say, ‘Are these the right numbers?’”

Mitigation strategies that “may be considered” at the moderate risk level include: supporting city-based “efforts to pass orders requiring the wearing of face coverings while in public,” encouraging physical distancing in public, encouraging the wearing of face coverings in public, encourage limiting gatherings to no more than 150 people, encouraging elderly and individuals with health conditions to take extra precautions, recommending that people “minimize non-essential travel,” encouraging long-term care, nursing homes and correctional facilities to implement “strict health policies for staff and visitors” and implementing the “Yellow” phase of return-to-school plans.

At higher spread of the virus (20 daily cases per 10,000 population) – or with multiple outbreaks at hospitals, critical infrastructure, nursing homes, or schools – or if COVID-19 test results take longer than 10 days – or if deaths exceed 10 per 100,000 population – the draft states the board of health “may take action to consider [an] order for mandatory face coverings when in public.”

This is the “high risk” level in the draft.

The board actions at this level would be in addition to mitigations the board may approve for the lowest- and moderate risk categories. Other actions the board may consider at the high risk level would be encouraging gatherings to be limited to “no more than 50 people,” encouraging the elderly and those who have underlying health conditions to self-isolate, encouraging “limiting travel/visitors to the region,” recommending that long-term care, nursing homes and correctional facilities be closed to visitors, recommending businesses implement curb-side services or delivery as much as possible, recommend places of worship “implement virtual services where possible” and implementing the “Red” phase of return-to-school plans.

The draft lists a fourth risk level – “critical risk” associated with hospital capacity including ICU “consistently at surge levels,” crisis standards of care or “more than 100 cases sustained for five days in the district.” Draft mitigations that may be considered at this level include stay-home orders.

In addition to the metrics for exposure risk, the draft states health officials consider “trends in positive cases, hospitalizations, deaths, healthcare provider visits related to covid-like symptoms and supplies of personal protective equipment for healthcare providers/first responders.”

“The risk assessment and mitigation strategies included in the plan will be in effect until a COVID-19 vaccine becomes available, herd immunity is achieved, treatment options for COVID-19 are readily available, or other mitigating factors currently not known are identified,” the draft states in regard to how long the district’s plan would remain in effect, if adopted.

The draft notes that risk levels may be applied at a town, city, county, geographic, or regional level, with different parts of the district potentially at different levels, and with risk levels potentially rising at any time. The gauge for lowering risk level would happen based on 14-day intervals.

During the board meeting when Moehrle presented the draft, Idaho County Commissioner Mark Frei asked that the draft connect the risk categories to covid-caused deaths, and said that the health board, if it would recommend or institute restrictions on society, it should “take into account the results of those actions in other areas of people’s lives.”

“The fact that people have needed knee surgery, shoulder surgery, etc., etc., have been denied a lot of those services because the hospitals have shut down,” he said. “People’s weddings haven’t happened. People’s baptisms haven’t happened. There’s another social cost to what we do when we recommend shutdown. I think that has to be taken into account.”

Health board chairman Dave McGraw of Latah County turned to board member and Lewis County Commissioner Greg Johnson after Frei.

“I appreciate Commissioner Frei’s comments,” Johnson said, “but I am concerned when I see Kootenai County ICU at capacity. The capacities in the hospitals have to be of great concern, also, so we don’t overrun our hospitals.”

Public Health – Idaho North Central District is seeking public comment on this draft through Aug. 6, with comments being accepted via email to BoH@phd2.idaho.gov.

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