February.

September 15th.

Let's say the Pledge of Allegiance.

I pledge allegiance to the flag of the United States of America.

And to the Republic for which it stands.

One nation under God, indivisible with liberty and justice for all.

All right.

So first on the agenda is review and approval of minutes, and that was from our meeting back in uh June.

Um do I have uh anybody have a chance to take a look at those?

Anybody have any uh recommendations for changes or a desire to move to approve I approve.

Second?

Second, excellent.

Approved.

Um so our last, like I said, our last meeting was June 9th.

Um so obviously we have had an entire summer uh which has gone by.

Um just wanted to mention a few important um health dates in uh September, one of which has already passed, which was the National Suicide Prevention Week, which was last week uh from September 8th to the 14th.

I did see um a decent amount of information um in the press about this.

Um another thing for health care providers is World Patient Safety Day on September 17th, you know, making our um doing our best to reduce harm to inadvertent harm to patients uh with errors.

Um so those are the big um events for September, and then obviously our kiddos in the community are back in school.

Um so um that's obviously important for uh health uh in the area as well.

Um so Dave, we'll start with the communicable disease update.

I was gonna skip ahead and do the student intern program, but I'll I'll let you do that.

Give us a little update about what's been going on.

Thank you.

Um the the world of communicable diseases, public health, public health policy and public health safety has gone substantially crazier in the three months since we last met, and it's it's really hard to speak uh on any kind of even ground about that.

But so I'll start with flu, where I think there's the least amount of of controversy and uh background activity.

These data are from the CDC website, which is the only national level uh surveillance, and I'm not aware of any local surveillance that is quantitative for flu and background activity of the A and B viruses is um very very low.

There has not been the annual fall uptick of activity as of yet.

I have no data for you on uh the uh putative um efficacy of the uh of the current vaccine.

So I'm gonna restrict myself to what I consider to be uh a discussion of optimum timing.

I think everybody should get flu vaccine who does not have a history of um of issues or reason not to get it, if you think you have a reason discuss it with your doctor, that uh the flu vaccine pro predominantly provides protection against uh uh severe disease and death, but probably has some benefit in reducing uh frequency of of disease, but you can't be assured if you have the vaccine that you won't get a case of the flu, you can be assured that it will decrease your probability.

That's on a probabilistic, not an individual basis, your probability of having severe disease or death because the protection from that flu vaccine is on the four and a half to five and a half month uh area.

Uh the optimum timing needs to be discussed because there are uh usually seasonally two uh spikes, an early spike and a late spike.

Um if you do what the commercials are recommending and you go get your flu vaccine now, you will almost certainly have no vaccine protection come the uh spring uh peak, which usually occurs end of March into April.

Uh so my policy for deciding when to give the vaccine is um to follow uh data uh uh to the best of your ability, and when you see the first evidence of an uptick locally, you should go ahead and get it.

Otherwise, if you don't see evidence of an uptick tick between October 1st and October 15th is what I always consider to be uh the best time.

That's uh clinical judgment that is uh not uh a uh an evidence-based but uh an anecdotally based um uh assertion.

Uh we've had a request for following bird flu.

Uh the CDC was uh taken out of the loop on following bird flu in the animal populations, and it was moved to the USDA.

get it otherwise if you don't see evidence of an uptick tick between October 1st and October 15th is what I always consider to be uh the best time that's a clinical judgment that is uh not uh a uh an evidence based but uh and an anecdotally based um uh assertion uh we've had a request for following bird flu uh the CDC uh was uh taken out of the loop on following bird flu in the animal populations and it was moved to the USDA uh surveillance is uh voluntary so I don't know what the uh what the value of the numbers uh um are uh but there bird flu is essentially endemic in wild birds migratory and and local populations and it is episodic on uh domestic birds so um the thing that you follow are outbreaks in the poultry and in uh in in the poultry uh populations and in dairy cases there are no uh alarming outbreaks that have occurred since we last met and there are no new human cases reported there so um on opinion basis bird flu has been watched carefully as possibly the source of a next uh uh highly fatal pandemic uh there is no evidence that that has happened the longer we go without that happening uh probabilistically you might say the the lower the probability but there is some level of of surveillance I would interject that everybody in the public health space will tell you that we were ill we have been ill prepared for all of the pandemics that we've seen and we were less well prepared now for the quote the next one than we have and there's actually a book out by um one of the the best public health guys out there um uh Mike Osterhol Mountain uh Minnesota we are really poorly prepared if we were to confront quote the next one um RSV there's a uh an eight page um dis discussion of exactly who should get which vaccine on the CDC website uh based on the ACIP committee's recommendations uh um I would just summarize uh that the RSV uh vaccine is recommended for uh adults over 75 uh for adults 50 to 75 with a risk factor which includes lung disease heart disease immunodeficiency diabetes BMI greater than 40 neurologic disease neuromuscular disease chronic kidney disease chronic liver disease or uh chronic hematologic uh disorders uh I that's one where I strongly recommend you consult your health care provider and deciding whether you're going to have a uh a vaccination um october through March are the peaks for the uh for the disease and so vaccination uh the vaccination is protection is long lived so uh vaccinating now if you're going to get the vaccine uh does make sense um and with regard to vaccinating young children it is beyond my can to be able to make recommendations please consult your pediatrician neonatologist obstetrician gynaecologist for advice in that regard uh and that brings me to COVID um just to discuss the epidemiology there was another summer peak it was the smallest summer peak since the uh outset of the uh pandemic it looks to have uh have peaked at the end of June and we're talking about following um uh cases ER visits hospitalizations and death which are each one is a uh a following curve from the other there was a peak in each of them and again the peaks were small compared to previous years um the biggest uh issues now are who should be vaccinated um and it is a really really hard to decide who should be vaccinated um the great political discussion right now is less over who should be vaccinated than who should be paying for the vaccine should you decide that you need the vaccination because you fall into a category of risk uh not included in any of the risk evaluations is the risk either of getting a subsequent infection of reactivating long haul COVID if you have it or the uh the probability of getting long haul COVID if you have not had it uh we do not have any data on the the morbidity and mortality of the current um uh predominant strains of COVID so I don't really know how one would make a recommendation uh for vaccination in in that circumstance because after the initial phase of pandemic where this was clearly a life-saving um uh and disease preventing phenomenon we do not know at this point the degree to which getting the virus will threaten your life and as a consequence we don't know the degree to which uh protection from severe disease and morbidity and mortality uh will will balance the potential of any adverse effects that one might get so I I I don't know how one makes recommendations in that regard and that's all I've got do we mention that the numbers are high right now in the community for Montgomery Cavany for COVID for COVID I

Uh so I I don't know how one makes recommendations in that regard.

That's all I've got.

Do we mention that the numbers are high right now in the community for Montgomery Cavany for COVID?

For COVID.

I I'm seeing it anecdotally at work, and I'm hearing um hall office buildings are out, people are missing all having COVID right now.

So I know several people who uh said their whole floor of their office was out.

Yeah, Lisa's nodding her head.

I would just remind people to use very good hand washing technique.

Some nasal saline is always good to flush out pathogen load uh and just be careful at this time.

I I think you raise a great point.

Uh I I restricted my comments to vaccination because that was in and of itself enough uh time spent on it, but truthfully, all the other ways in which you can prevent uh COVID are uh prevent any respiratory virus should always be emphasized.

I I I and I think that real hand washing is critically important.

Non-face touching.

So develop a habit of not touching your face is also really important.

And if you feel that you have a significant risk if you're exposed, I I I also think anecdotally there is a lot of COVID around now.

Yes.

And by wastewater, there's a lot of COVID around now.

The numbers just are not worth the the numbers aren't good enough for me to go into them because I don't know what they tell you.

But um, it is also absolutely true that if you use a well-fitted N95 mask, mask wearing is protective uh against a lot of viruses and COVID in particular, which is uh in the respiratory-borne uh um clades, it it absolutely has value.

Um what we don't know now is that with all the mutations of of the virus are there other the original virus was almost certainly respiratory droplets followed by aerosol, it was highly respiratory spread.