5.21.2020 Board of Health Meeting Recap

View the meeting slides here.

Board of Health 5.21.2020 Agenda:

1. Mental Health Initiatives: Christina King from Aspen Strong
2. Suppression plan/data presentation: Charlie Spickert and Dr. Kim Levin
3. Phase 2 guidance proposals: Jon Peacock

Christina King (Aspen Strong) Mental Health:

Mental Health Team: ESF 6, ESF 8, plus organizations outlined below

Aspen Hope Center: providing support to the following groups

• first responders
• public health staff
• targeted groups: teachers, school staff, HHS essential workers, RFTA, Grocery/alcohol store staff

MindSprings:

• COVID-19 hotline calls 
• Facebook Live support groups: over 200 people in first event
• Community Calendar 
• Senior Centers 

Aspen Strong:

• Virtual support groups
• Connection with providers
• Community newsletter: recapping all support that exists, finances should never be an issue
• Community calendar

Mental Health Disaster Response and Recovery: supported by all groups and in communication with AVH to prepare for a surge

• Crisis line
• Mental health response trainings 

Common Themes/Questions:

1. We are gathering data and surveys from providers up and down the valley. There was a decline in service during the onset of COVID, but by the end of April, services doubled. This was potentially from panic and the financial burden becoming  too much for some people with that uncertainty. Hearing from individuals struggling with depression, panic and anxiety around supporting families.

2. Engagement has increased in the past month, help is potentially destigmatized and people are willing to reach out for help.

3. Important to emphasize that you do not have to feel alone in what you are dealing with- this is a global event. It’s good to reach out for help.

4. Fear around what you can and cannot do can put us all in panic mode even over small decisions. It’s important for decision makers to be really clear about what is OK and what is not OK. 

5. One of the most useful and powerful things that community leaders and elected officials can do is to share their own mental health experiences, struggles, successes, etc. with the community. Take time in your personal messaging to share your personal experience. That is what creates connection and resiliency. 

“Know Your Top 10 to ease CoronaVirus Anxiety” 

Charlie Spickert, Pitkin County Epidemiologist 

• Starting with reflecting on the history of the Spanish Flu in 1918 in Colorado. Gunnison County went into full-on suppression with closing all gatherings down, quarantining anyone who entered the town, and they emerged at the end of 2 years of Spanish flu without any cases. The lockdown caused severe economic hardship and when they lifted the quarantines, the virus found its way into the community and there were quickly 58 cases and 4 deaths. 
• Our Roadmap to Reopening includes reopening the economy and our goal now is to move from population-based strategies to individual and close-contact containment. It will require MORE personal responsibility on everyone’s parts in order to welcome more visitors and business into town. Here’s the data we are watching:
• Data Dashboard: includes all of the data that we are watching, this will be available for everyone on the Pitkin website next week so everyone can see all of the indicators we are watching as we move into Phase 2:
  • PCR testing: To date total tested 305, 21 positive results, 268 negative, 16 results pending (does NOT include antibody tests of PCR tests done by private practices, results include testing of staff, pre-op and ob patients) 
  • Case Stability: No current outbreaks or unrelated cases in past 14 days in Pitkin County
  • Symptom Tracker: self reporting on any sort of flu or covid-like symptoms. These self-reported numbers have declined in the past month, potentially due to the widely available testing for those who are experiencing symptoms, Eagle County reports similar findings.
  • Decreasing and/or Stable Cases in Adjacent Counties: Eagle and Garfield- using a 7-day average. All counties are stable in a trend of no or few new cases. Across Colorado as a whole, cases are decreasing. Worldwide, cases continue to increase (this is also the case for some Southern states as they are reopening).
  • Traffic Counts: current traffic patterns are back to within 7% of last year, people are moving about more. CDPHE is also monitoring mobility through cellphone data across counties. April and May data show people getting out and moving around more, this is an important piece of data in contact tracing. 
  • Other data being used to inform the metrics dashboard: Building permits, airport passenger traffic, restaurant occupancy, lodging reservations. Our goal is to learn as much as possible about any new cases, so that we can be catching and acting on virus containment quickly. 

Dr. Kim Levin, Aspen Valley Hospital

• Over the past month we have remained stable. We have seen an increase in testing since the beginning of May. This could be from the increase in testing capability, likely not an increase in cases or people with symptoms. 
• Respiratory tent volume: For people who may have covid-like symptoms. Slight, steady decrease in patients seen since March. A little increase since May but it is not concerning, we have remained “stable”.

AVH Capacity Matrix: this will be going live on Pitkin County’s website next week. You can check this at any time to see how Aspen Valley Hospital is doing on these variables. Think of it as a tool to understand the status at AVH, an analogy could be the daily avalanche report for backcountry recreation. See the slideshow for an in-depth look at this matrix.

• Currently, AVH’s Capacity: “Comfortable” for Inpatient Hospitalization: >50% capacity
• Average Daily Visits: “Comfortable” Average Daily Visits to Emergency Department: <6 Covid patients, Respiratory Tent: <10 Covid patients, Community Testing: <16 tests/day.
• Essential Healthcare workers (frontline doing active clinical work) out with COVID: “Comfortable” with <6 EHCW out at one time. 

Capacity: More complicated than it may seem. Tracking things like  different types of beds/areas for different types of patients. Amount of ventilators and also considering mobile units that would decrease when patients need to be transferred to other care facilities. 

• PCU bed: 16
• Negative Pressure PCU bed: 4
• ICU bed: 4
• Ventilators: 5 (2 for transport)

Testing:

• AVH is testing everyone living/staying in Pitkin County (residents, non-resident homeowners, visitors) so we can get ahead of tracking ANY positives. These are all PCR tests that are taken with a nasal swab.  We are NOT testing any community a-symptomatic people at this point. There is no serology (antibody) testing at this time. 
• AVH is performing medical testing on patients being admitted to the hospital for surgeries and c-sections. So far, these tests have found 2 asymptomatic people, showing that the virus is still out there and there are asymptomatic carriers. 
• State reopened 34 free community test sites, closest to us are Vail and Gunnison. Hoping to get one closer to us. 

Box it In:

• Every step is essential, this strategy only works if everyone does their part. See slides for fulls strategy.
  • Testing: you can and should get tested if you have symptoms (see list below). You need a doctor to make an appointment for you. This could be your doctor, AVH primary care, or if you live out of town, your out of town doctor can call or fax in order for a test (or you can just call AVH primary care). 
  • Symptoms: ANY of the following are reason to get tested
    • 1 of: fever > 100.4, cough, shortness of breath loss of taste/smell
    • 2 of: fatigue, body aches, headache, chills, diarrhea, nausea/vomiting, loss of appetite, ST

Clinical Update:

MIS-C: multisystem inflammatory syndrome in children, possibly associated with COVID-19. Up to this date children have not been affected the way adults have. Most kids are asymptomatic when it comes to COVID.

• Over 100 cases in NY
• Children’s Hospital announced 3 possible cases in Colorado yesterday
• Similar to Kawasaki Disease
• Rare, 5-15 years old, high fever, abdominal pain, diarrhea, rash, red-eyes, red lips/tongue, couch, can have low blood pressure and problems with the heart
• If you see any symptoms in your child, bring them to their doctor or the ER. Early recognition and treatment. The hospital is safe and available. Pediatric offices are open and safe. 

5 Commitments of Containment 

A reminder! Wearing masks is essential, especially in spaces where 6 feet of distance isn’t possible (like personal services). Masks work and if you choose not to wear one, your risky behavior impacts everyone else. It is similar (not exactly the same) as the decision to drunk drive, which puts the lives of others at risk, as well as your own. Respect those around you, wear a mask!

Box It In: Charlie Spickert, Pitkin County Epidemiologist 

• This is a focus on individual containment, a more surgical (fine and detailed approach), rather than the blunt, population wide approach of Stay at Home. 
• 1st Metric: identify and PCR test 100% of symptomatic patients within 24 hours: working to encourage employers to screen, airport screening, etc. Our suppression strategies have reduced our Ro (how many people get infected by 1 person with COVID) to 1 or less.  
  • If we can isolate 90% of symptomatic patients, test them, find, and quarantine 90% of their contacts, we can reduce cases by 45%. But the fewer symptomatic people that are tested and then contact traced, the less effective we are at slowing the spread.  It falls to 10% reduction in cases if we only find 50% of symptomatic patients and quarantine 50% of contacts. 
• 2nd Metric: PCR Testing Results returned in 24 hours (48 hours maximum). Currently, results from AVH are 2-5 days. Our challenge is whether to isolate and contact trace prior to the test result coming back in. 
• 3rd Metric: All cases interviewed for Contact Tracing if Positive Test Result. Cases in Pitkin County have been so few, and with symptoms onset so long ago, that there has been very little need for contact tracing so far. One challenge we anticipate is that people don’t like to pick up the phone.
  • Incubation period for the virus is 2-14 days, typically 5 days
  • We have about a 5 day window of opportunity to find all contacts of a symptomatic person (if they report on the first day of experiencing symptoms), instruct contacts to quarantine, and get them tested. 
• 4th Metric: All Positive Cases and Contacts are Isolated and/or Quarantined and Support is offered if needed (groceries, housing, etc). Pitkin County is working on technology and process for delivery of isolation and quarantine letters, tracking these individuals. 
• 5th Metric: all isolated and/or quarantine individuals receive follow-up monitoring. This follow up includes monitoring symptoms and getting contacts tested if they are symptomatic. Our goal is to add data to the dashboard on all the individuals who are in isolation and quarantine. 

Most of our population is not infectious, but rather susceptible to being infected. We understand health goes beyond “being infectious or not infectious”, it includes all the social determinants of health. The following factors impact on our health and wellbeing:

• Childhood experiences
• Housing
• Education
• Social Support
• Family Income
• Employment
• Our communities
• Access to health services

Steps for Managing COVID-19 Epidemic: 

• Reduce viral transmission with suppression strategies
• Follow with aggressive case containment via “Box It In”
• Closely Monitor data to be sure that new cases < healthcare capacity
• Follow the Roadmap to a greater level of economic health 

Contact Tracing:

• Staffing up and training contact tracers, knowing that contact tracing is labor intensive and time sensitive. 

Jon Peacock, Pitkin County Manager

Discussion of our variance request:

• As we look at sector-specific guidelines, our variance is based on the number of contacts and contact intensity of different activities and business sectors. That determines when we bring different sectors back and in which order. 
• We are making policy decisions on a super compressed timeline, these decisions would normally take years. To do this, we are working with representatives from different sectors. Lodging and restaurant task forces are underway, events and outdoor recreation are coming soon. 
• Process for developing guidance for Phase 2: 
  • Work with sector groups: restaurants, lodging events, outdoor rec, outfitters, children’s programming.
• Physical distancing and hygiene are two critical foundations for review in the reopening of these different sectors.

Timeline: see slides for full timeline

April 23- Construction/landscaping reopened with safety plans in place 

May 9- Moved into phase 1 of roadmap to reopening (7th public health order)

May 18: Variance submitted: major components of Pitkin County’s requested variance, “Safer at home order: group size limitation, travel and public transit, local and public recreation, areas of public accommodation (restaurants, theatres, music venues etc” 

*overall the goal is to align with the state’s public health orders and guidance. The variance gives more local control over implementation of Pitkin County’s “Roadmap to Reopening” *

Our neighbors: Eagle, Gunnison, Mesa counties have also all submitted variance requests similar to Pitkin County’s, none of us have heard about approval. 

May 25: State guidance for phase 2 release by Governor Polis 

May 27: “Protect Your Neighbor”, State Public Health Order 

Proposals for Phase 2 of Reopening, May 27th:

1. Mass Gathering Size: APPROVED- staff recommendation is 50 person maximum gathering to align with neighboring communities. This would require also emphasizing public health strategies of physical distancing, hygiene, and 5 Commitments of Containment (includes wearing a mask). 
2. Restaurant Guidance: APPROVED- recommendation to align with the State Guidance and the Pitkin County Restaurant Task Force. Requires physical distancing, 8 feet between tables, 6 people max table size, capacity limited to the ability to meet physical distancing and hygiene requirements (not a % or event size limitation), some standards for outdoor seating areas, outdoor seating per local licensing jurisdiction (including liquor licensing). Hygiene protocols, adapted Eagle County restaurant guidance, reviewed by task force and will be available Friday. NOTE: this is pending approval of Pitkin County’s variance. At this stage (unless variance is approved), Pitkin County will have to follow State of Colorado guidance, which is forthcoming. 
3. Lodging (50% occupancy):  APPROVED, option 2
   1. Option 1: No occupancy cap, except ability to do physical distancing and hygiene (Summit County on June 1)
   2. Option 2: Staff Recommendation: 50% occupancy of keyed units in establishment (measured daily). Assumes ability to manage physical distancing within the facility (Eagle and Gunnison counties). Pitkin had previously proposed a 35% cap, but staff now recommend 50%.
      1. 35% occupancy levels in Pitkin would be 6,102 total visitors, 50% would be 8,717 visitors. 
      2. Other factors: 80% reduction in airline service to Aspen through June (142 weekly flights to 26 flights)
      3. Higher occupancy caps enable smaller lodges that operate on smaller margins to maintain a viable business model. 
      4. Occupancy thresholds provide a control on the number of new people and potential vectors being introduced into the community. 
      5. Lodging is not limited to 50 person gathering size, but limited by ability to maintain physical distancing and achieve hygiene requirements within the facility. 

4. Lodging Guidance, Lodging Definition: APPROVED
   1. Lodging definition: recommendation to align with Eagle county “multi-unit establishments such as hotels, motels, private residence (part of professionally managed, permitted business) of resort clubs, condo-tels, ownership associations” must submit business safety plan checklist that include cleaning protocols recommended by Lodging Group and reviewed by public health Subject Matter Experts.
   2. Dependent upon state guidance and/or variance: recommend allowing rental by owner units, must adhere to specific cleaning and disinfection guidance and submit Business Safety Plan Checklist.

Additional Sector Guidance: 

• Agree to work with industry sector task forces to establish guidance for additional sectors as we move into Phase 2 with the overarching theme of hygiene and physical distancing:

1. Events
2. Outdoor recreation (playgrounds, rec centers etc)
3. Outfitters/guides
4. Summer camps and school age-programs
5. Childcare facilities