Good afternoon.

I'd like to call the meeting recording in progress.

Good afternoon.

I'd like to call the meeting of the District Board of Health to order at 1 p.m.

on Thursday, November 20th.

Go ahead and ask for a roll call, please.

Vice Chair Andreola.

Present.

Board Member Anderson.

Here.

Board Member Brown.

Here.

Board Member Driscoll.

Here.

Dr.

Tuarte?

Here.

Dr.

Ardenko is not currently present.

She is going to try to join on Zoom.

We do have a quorum.

Thank you.

I'd like to move then to item two, which is the Pledge of Allegiance.

Mr.

Member Brown, who spent some time at the legislature.

You might enjoy doing that.

Maybe a prayer.

Oh, yeah.

Our pledge allegiance to the case.

For which stands.

One nation under law.

Individual liberty and justice role.

Thank you.

I'd like to move to public comment, please.

Comments heard under this item will be limited to three minutes per person and may pertain to matters both on and off the board agenda.

Unused time may not be allocated to other speakers.

Comments are to be made to the board as a whole, and virtual public comment may be taken when facilities are available.

A speaker's viewpoint will not be restricted, however, reasonable restrictions may be imposed upon the time, place, and manner of speech.

Irrelevant statements, unduly repetitious statements, and personal attacks that would objectively antagonize or incite others are examples of speech that may be reasonably limited.

This board carries out the business of Northern Nevada public health and its citizens during its meetings.

The presiding officer may order a person removed if the person's conduct or statements disrupt the order or safety of the meeting.

Warnings about disruptive conduct or comments may or may not be given prior to removal.

Furthermore, certain disruptions of a public meeting are criminal acts as defined under NRS, which may result in prosecution inappropriate cases.

And I do not have any requests for public comment at this time.

Thank you.

And nothing online.

No.

Great.

We'll move now to item number four approval of the agenda.

May I have a motion?

We have a motion by Mr.

Driscoll.

Second.

Second by Mr.

Brown.

Any further discussion?

Hearing none, I'll call for everyone in favor.

Aye.

Aye.

Any opposed?

Motion carries unanimously.

Oh, we got an official on our screen.

Did everybody there?

We go.

I don't know who is going to be.

Oh, you okay.

Thank you, Aaron.

Absolutely.

Is this on?

Okay.

Um thank you for letting me actually continue with the recognitions as part of one of my favorite parts of the day.

Um it is my honor to uh let you all know that Dr.

Williams, Dr.

Danica Williams, she was honored as one of the class of 2025's 40 under 40 in public health by the De Bewont Foundation.

This recognition is given to rising leaders working to improve state and local public health.

Then they work hard daily to help build healthier, more equitable communities.

Dr.

Williams dedicates herself to communical disease control for Northern Nevada Public Health and has played a critical role in protecting our community every day.

So great congratulations to her for that.

That's awesome.

All right, moving on to years of service.

Um we have four um employees that have reached the one of the five-year marks.

Um Heather Holmstadt, she's a public health investigator with 15 years.

Heather works with our sexual health team.

She investigates diseases such as HIV, and we thank her for her ongoing compassion working with our community.

Ms.

Andrea Esp is preparedness and EMS program manager for a combined 10 years.

She has played a vital role in strengthening our emergency response capabilities, supporting partners across the region and ensuring that our preparedness efforts remain proactive, coordinated, and effective.

Cara Roseboro, she is our clinic office supervisor.

So she supervises our CCHS clerical staff and billing specialists.

She is instrumental in negotiating our contracts with health insurance companies and ensure that we're being reimbursed for the services we provide.

Very important.

And then Kayleigh Barrett, she is a senior public health nurse.

She leads, and she's a lead in our immunizations program, and she is key in ensuring that our um our uh medical providers out in the community, so our doctors have the resources they need to fully vaccinate our community.

So it's a nice that it's a shared effort, and it's not just Northern Nevada Public Health.

So we thank them.

And then uh for health heroes, uh, Ms.

Franchie Rubio with the Health Heroes Committee is going to recognize this month's health heroes.

Great.

Hi, for the record, uh, French Rubio office specialist from Environmental Health Services.

Um the Health Heroes Employee uh team recognized four employees from Northern Nevada Public Health.

First one being Melissa uh Shaffer from Population Health.

Uh she was noted for the value of collaboration.

After leaving the WIC, the WIC program in July 2025 due to restructuring, Melissa joined Population Health to further her skills within that division.

However, this did not stop her from assisting with the WIC program when they needed to find an efficient way to collect staff signatures for acknowledging policy review.

Next up, we have Andrea Esp from the Population Health Division.

Uh she was noted for uh compassion and her trustworthiness.

On her own time in her car at a stoplight, she noticed that a person was on the phone with 911 standing next to what seemed to be an unconscious individual on the ground.

She didn't hesitate to pull over to assess the situation by staying on the phone with the dispatcher and starting compressions on the unconscious individual until the first responders arrived.

Her efforts immediately helped save the individual's life as it gave the paramedics a chance to quickly arrive and revive the individual.

Next up, we have um Julieta Gallardo from CCHS was known for the values of adaptability and compassion.

Um Julieta went above and beyond by using her motherly instincts.

She helped a family in need with their infant as the infant was not behaving and looking healthy.

Because of her quick response, the infant and the family are definitely receiving the care that they need.

Um and at least last but certainly not least, uh, we have uh Marisol Martinez Avila from CCHS, noted for the uh values of collaboration, compassion, and inclusivity.

She recently worked with a community partner and proposed the idea of hosting a health fair to provide resources to community members who need them the most.

After collaborating with her coworkers and external partners, she organized a successful event that brought valuable resources to the community.

Thank you.

Thank you.

So I'll share in your excitement.

It's a great way to start a meeting, is it not?

It's a great way to start a meeting.

So thank you for always having such a positive recognition and more importantly, even a good Samaritan Awards out there, and probably Remsa was involved in even the call with Dr.

USP.

So thanks for being great partners.

We'll move now to consent.

Does anybody have anything that they'd like to pull from consent?

We have a motion by Mr.

Anderson.

Second.

And a second by Mr.

Driscoll.

Any further discussion?

Hearing none.

All those in favor signify by saying aye.

Aye.

Any opposed?

Motion carries unanimously.

Okay, we'll move now.

We're going to move to item number so oh, it's on our screen.

We're official.

We have to be official.

Now we're official.

So now we can move to item number seven for recommendation to accept the RemSA Health Monthly Franchise Report.

Mr.

DePlantis.

Thank you.

Good afternoon.

Chair Andreola, members of the board.

I'm Barry Duplantis, CEO and president of Remsa Health for the record.

I understand you've been provided with a copy of Remsa Health's October 2025 franchise report for October and the fiscal year to date.

Remsa Health has met and exceeded franchise response compliance priority one calls in all franchise zones.

In zone A, we were 91%.

And in 90 uh and in zones B C D, we were 94%.

During October of 2025, REMSA responded to 8,500 priority one calls, and we transported 5,542 patients to area hospitals.

And those figures are consistent with the prior month.

Our customer survey report for October resulted in a score of 93.73, which also was consistent with the prior month.

Our highest score was cleanliness of the ambulance and the skill of the person driving the ambulance.

These ratings compared to the national database are slightly better than the national database for all of the participants that report into it.

And then next on the theme of recognizing people that are just absolutely amazing.

It's not my pleasure.

And I'd like to ask these two people to come up and join me.

And you'll you'll understand in just a moment as I read a little bit of why we've invited them to be here.

Please come on up and join me.

Bryant and David displayed decisive initiative on a scene of a behavioral health call, responding to reports of an individual who was walking in and out of traffic on the freeway.

As they approached the individual that was in crisis, the person's condition deteriorated even further, and the scene became increasingly unpredictable and dangerous.

Brian and David acted quickly to intervene and were able to secure this trans uh and transport this patient to receive additional care.

RemSA Health's providers respond to medical emergencies on a 24-7 basis.

So to David and Brian, uh they were just doing their jobs without expectation of any recognition.

However, we are honored to be able to celebrate their heroic actions which reflect the best of what RemSA Health brings to this community.

Bryant and David, your actions that day transcended all call of duty and showcased a level of skill, calm, and compassion that exemplifies true heroism.

On behalf of RemSA Health, I'd like to present each of you with a commendation metal bar for your remarkable service.

So allow me to um and I would like to especially just on a brief note, you know, it's not often we truly can say that we save the life.

In this case, we have tangible evidence that we saved the life through the the actions of these two uh two men who responded to this particular call.

So I wanted to thank them, introduce them to you, and um recognize them for being just absolutely amazing citizens and caregivers in this community.

Thank you.

Do you want to say anything?

Is there anything that you like to say?

Oh no, when this comes some little responsibility now.

No, it's up to you.

I'm teasing.

Um thank you for sharing that incredible story, and thanks for what you did and what you all do and how you keep our community really safe.

And I think it's uh always interesting for anyone who has ever been themselves in an emergency or ever participated and helping with an emergency, even with all the preparation, every situation has some uniqueness to it.

So I think the fact that um that's what training and education is about, is be able to react and respond.

And so thank you too and everyone at RemSA for all you do.

Thank you.

So on that note, uh, and with regard to my whole presentation, I'm happy to entertain any questions that you may have for me at this time.

Any questions for Mr.

DePlantes?

I'll make a motion to accept as reported.

We have a motion by member round and second by member Driscoll.

Any further discussion?

Hearing none, all those in favor signify by saying aye.

Aye.

See, when you say aye, it it actually activates with voice activation.

Do you notice that it does not?

Um posed?

No.

Motion carries unanimous.

Thank you.

Thank you.

Appreciate it.

We'll move now to item number eight, presentation and discussion of the 2025 vector season, including surveillance treatment, and testing and the representation.

Uh here he is right here.

Hello.

Uh West Rubio Supervisor and Environmental Health.

Thank you for the board.

And uh yes, we are here to talk about the vector born disease program.

Uh my understanding is that uh there was a request for a summary of the 2025 season.

There it is.

Perfect.

Clicker.

Awesome.

So basically, this is a very mild overview of the program elements, service requests, which are for lack of a better term, complaints, complaints from the community.

We come out, we check it out.

Surveys and treatments, adult mosquito surveillance, and we'll give you a summary of everything.

Surveys and treatments, that includes all of our surveillance.

So we go out, put traps out, come back the next day, collect traps, bring them back to the warehouse, start counting mosquitoes, identifying them, and then they go to the lab.

And that's part of the adult mosquito surveillance.

We're not only just looking for numbers, we're looking for the volume, the location, and if they have disease.

So we're looking at all three elements of those.

We'll start at the bottom and we'll work our way up just so that you can get a history of from 23 to 25.

We did just these three years because they kind of showed the most relevance.

Go a little further back, it got a little squirrely because of that fun year called COVID, and things were moving around a lot.

So these were kind of the most relevant data points that we could provide for you.

In 23, we had uh from mosquito abatement total service request, 99 total mosquito requests.

We had 65 abatements, 52 prior to the aerial on 718, and we did 17 mosquito fish as you go up 24, which we're gonna for the purposes of what you're gonna see going forward.

You're gonna see 24 is what we're gonna call a normal year.

So 24, there were 63 full requests.

We did 31 mosquito abatements, we delivered fish, and we did uh 19 other items treatment, surveillance, catch basins, things like that.

In 25, we bounced pretty heavily.

96 total requests, 57 for mosquito abatement, mosquito fish deliveries, and then other service requests.

Obviously, there's been some other requests out there that we also provide education and services on.

Some of those items are things that you guys are probably pretty aware of.

We'll call them rats and mice.

Um, and then also we are part of the rabies control authority, so we do provide a bunch of rabies support to the animal services.

So don't forget 24 was what we're gonna call the normal year.

So please keep that in mind as we continue talking and we'll get to that.

Again, ground larvacide treatments.

We did 650 different site visits.

I know it's really small.

Which one is the laser?

So well, that's not gonna work.

Um, and it barely shows up.

But this map that's up there, all those little dots on that, those are GIS pinpoints that our staff put in, including our interns, on a phone whenever they do treatment, whenever they do surveillance, wherever they put a trap, wherever they're told to go out and check something, catch basins, you name it.

So we are looking at everything in the community.

It also helps us know if something happens, where things are happening, all the good stuff for how we we try and keep an eye on everybody.

So that's what that little map represents.

It's little because we have a big area.

So 650 site visits, 478 mosquito control uh treatments, so catch basins, different types of things, education, all of those things are combined into all of those elements.

Uh 17 mosquito fish deliveries and 4,000 storm drains treated.

So that's a lot of storm drains when you start talking about three interns, one full-time senior, and one FTE of staff, which we actually break out to two people doing half an FTE for the year.

So that's a pretty big chunk of change.

And if you notice the reason the map is so big and everything is so small, uh, remember when I said it's a lot of area.

Well, it's a lot of drive time to get to all those little buttons.

So there's a significant amount of time involved in getting to every place in the county with that type of staff.

So we go forward.

Uh mosquito control or our mosquito pools.

570 trap collections.

So this year we focused primarily on surveillance.

Why?

Well, we weren't treating.

So we focused on the biggest thing that we can tackle, which is going to be surveillance.

All these spots are surveillance.

They're all known locations where we put traps.

We have some specific traps that we use data for.

Those ones are in places that are plugged in and long-term trap locations.

So we really have a real good history on what's going on in those areas.

Other traps, CDC light traps, gravitraps, they're put out in places for us to determine the mosquito activity in specific locations.

They're not necessarily what you would quote unquote call scientific for data purposes, because we literally place them where we think we're going to find mosquitoes.

Not to determine if they exist or not, but we are purposely placing them to find them.

So they're not really a good barometer for what's actually occurring all the time.

So we try and use our data for our own knowledge for what we need.

We use our other trap locations to really give us a benefit of what we're gonna get back to with why I'm telling you 24 was a normal year.

So this is an S this is a map of where we put everything.

Again, all of our mosquito submissions, we did 19 over 19,000, almost 20,000 mosquitoes that we tested.

They were all negative this year.

We were lucky.

Now we're gonna get into print an extra page because my eyes aren't that good anymore.

Mine's a big graph.

So 24.

Why was that a normal year?

Well, I'm gonna explain.

As you can see, we have these three years up there.

23 is that, well, at least what I can see up there is like a light green color.

You can see that it was really high for the first half of the year.

Now the question was why?

Took us a little bit to have to remember how this came out.

But the reason why was quite frankly, that was when our helicopter pilot retired.

That was when that business closed, and we were waiting to get a new pilot.

We had to fight to find a new pilot.

Coincidentally, he's still going through FAA, just in case anybody's wondering how fast that process goes.

He's still working through it.

So that was why 24 is a normal year.

23, we didn't fly until July.

So there's what it looks like on a hotter summer if we don't fly for the first half of the year.

24, we flew all year.

We actually did the way our program is designed, four nice treatments, equally spaced out, catching the beginning of the season all the way through the peak.

We were able to keep those numbers right at a nice low, moderate type of thing.

People know mosquitoes exist.

We are feeding the bats, and still maintaining a level of of service to the community and trying to keep viral load down in the in the populations and the bird populations.

What happened in 25?

Some fun things.

One, we were lucky with mosquitoes.

We didn't get a ton.

Why?

Well, we were pretty beneficial for the weather this year.

Most everybody can pretty much agree.

25 was a relatively mild summer.

We had some really nice interspaced rain.

So when our numbers did peak up, sometimes they would drop again because well, we had rain.

Mosquitoes drown in water most of the areas whenever you have some circulation.

That's why you don't find mosquitoes in the middle of the lake, you find them around the edges where the reeds are.

So that's why the graph looks that way.

That's why I said 24 is our normal year.

When we go back in history, we look at 24.

24 is what we try and do.

Nice four equally spaced treatments.

Five would be great if we could get there.

Four is working, and that's what your numbers look like.

So what do you see?

You see a really heavy peak for 25 right at the end of the season when we actually got hot.

We had no actual rain, and we couldn't control the numbers until it we hit some cold snaps.

So overall, our entire summary.

Uh, again, as you can see from the graphs, nothing I'm gonna tell you that's any different.

Numbers were relatively mild.

We were pretty low.

We got lucky, we were thankful for that.

It really helped us out.

But right around August, going into September, the numbers really high.

And you know, we did do a ton of trapping.

We did a lot of trapping this year that we haven't been able to do previously.

So for us, that was a really good barometer.

And again, all of that data was taken from those those scientific known locations where we have them.

They're a type of trap that we have plugged in at people's houses.

They know they've signed agreements, they're all plugged in and they stay there and they go back every year.

So with that, that was your that was a very quick summary, not trying to take up too much time.

So hopefully, if you have questions, let us know.

Or let our division director or health officer know, and we'll answer them.

Thanks.

Um, thanks for the graphs.

I think that's really helpful.

So it's visual really helps when you're looking at what you were trying to compare.

So I really appreciate that, but I'll open it up to questions, Mr.

Anderson.

I have a question on the first map uh where you said the uh talked about the ground larvacide treatments.

Could you let me know as far as the colors, uh, three different colors, green, uh, yellow, and red.

What do those represent?

I can absolutely answer that question once I ask Mr.

Will Lumpkin exactly what those colors are.

Okay.

I got outvoted.

Own a friend.

Uh Will Lumpkin senior in the vector born disease program.

That one there.

Yep.

That one.

So I believe there's two colors primarily.

Yeah, I I see some red on there also.

So it looked like it was green, yellow, and red.

That's correct.

The red are actually what we call small sources.

They're anywhere from 10 square feet to a couple acres.

That's basically what you're seeing is the outline of those on the map.

The actual treatments and surveys are the orange and green.

Green sites are just surveys where no treatment was made, and the orange sites where we actually put a chemical treatment or a mosquito fish treatment.

Perfect.

Thank you.

Any other questions?

I have a quick question.

I was wondering obviously since there was a pause this year due to budget constraints.

If you had in terms of aerial, if there was an increase in calls that came in to you about that were directly related to this program.

Did you see an increase?

Yes.

Okay.

But do I have numbers?

No.

Okay.

But did we get a significant increase in people calling to voice their heated opinion on what or why we were not doing it?

Yes.

There was also some some decent um public input online regarding some of that.

I know uh Scott Oxford RPAO pulled some pulled some things out for us to kind of look at.

There's also a level of confusion between a part of this county and what Carson County is doing or Carson City County is doing as far as their treatment stuff.

And there's a level of confusion there that just exists.

Um I don't know how we fix that.

Um but yes, did we get a little bit more?

Honestly, yes.

Um we but we also responded to as many complaints as quickly as we could.

Again, it's a challenge.

We I mean I can show you the the facts.

The facts of the matter, I had a staff person who spent 60 hours driving in a month for the vector program, just going to all of these sources.

So there is a hit of time to be able to respond and and effectively treat or get to the community and and provide even levels of education on what they need to do around there.

So a lot of those calls ended up being education-based.

Well, in some ways, depending on how the budget hard to say, but I'm just wondering also, because there was really a concerted effort to share what this really meant to try and avoid the confusion and set the facts straight, if you will.

And I was just curious if we saw tamper off tamper off, right?

In other words, like everyone in the beginning, there was a lot of confusion, there was a lot of press, there was a lot of information, and then the response and trying to get in front of it too was also um well postured.

But I was just curious if if you you uh had also seen that um reduction as time went by and people were maybe just seeing the result of the efforts that were still being maintained.

It wasn't like there wasn't any treatment that we're going, but was you know what I mean?

So I was just curious on that.

I figured I should have answered, I should have asked the question in a different way, because in the beginning everyone was getting calls and everyone was being inundated.

So I was just curious if it maybe tampered tape tapered off.

It in the middle of the season it did.

Okay.

So initially, yes, absolute kind of a uh solid.

If if we were to graph it, we would have had a really big blip right in the beginning where we just got all the calls about why, how you can't do this, this isn't good.

Then, as you can see from the graphs, there was a lack of mosquito activity.

We couldn't find them.

And so mosquito numbers dropped.

Well, you know what happens?

We got less phone calls.

Mosquito numbers started coming back up, and we got the phone calls, and and the phone started really hitting, and we actually started getting a lot more complaints coming through.

So we were following up on those.

So is a little of a both.

The the mid season because the numbers were low, we didn't get that much.

Well, all I would just say to close out my comment is that um thank you for your presentation, number one.

Thank you.

Thank everyone and all the folks that actually even cover 4,000 storm drains, along with all the other activity.

But I do think it's helpful to your point as you were getting those calls and having an educational opportunity that maybe we look at comparing if in fact the budget won't um doesn't allow for or continues with the pause, that as we move into 2026, then maybe we see what those comparisons are.

Um given the fact that it's equal, right?

That 2024 is the base and that it can be compared.

So I I think it's always hard to say that apples and apples always occur when you have little things like weather that you're uh dealing with and and other factors that you can't control.

But I do think it's important because with those calls, hopefully there were those educational opportunities as well.

So thank you.

Anyone else?

Thank you so much.

Thank you.

We'll move now to item number nine uh presentation and possible acceptance of the FY26 Q1 strategic plan results, Mr.

Ms.

LeBoy.

Wonderful.

Good afternoon, Vice Chair and members of the board.

Today I'm going to present the quarter one strategic plan results.

This update reflects Northern Nevada public health commitment to our ongoing effort to measure our impact as well as strengthening our accountability across the organization.

In this strategic planning cycle, we've put a strong emphasis on using data to inform decisions, identify opportunities for continuous improvement, as well as we want to make sure that we are making an impact here in our community.

Today's overview, I'm going to highlight some of our some of where we're seeing momentum, as well as where there are challenges.

As you're going through the performance management reports in your board packet, I just want to remind you that we do use a scoring system that is up on the screen, and really it's intended so that we can provide us a clear snapshot to our staff and our board around our progress and our performance.

This scoring system also allows us to identify emerging trends, so whether those trends are improvements or where there are things that are status quo, or perhaps uh flagging things that are potentially at risk.

On the screen, you can see that we use a colored scoring system where uh there are on target metrics, things that are in progress, either off target.

Our volume indicators are not tracked, uh excuse me, they are tracked, but they are not scored.

Over the last four years, this scoring system has allowed us to track movement across uh each quarter and has allowed us the opportunity to identify those areas where there's some improvement that may be needed and to also celebrate our accomplishments.

So, as you can see for our outcomes, a majority of those things are on target.

Our outcomes roll into our division goals, which again most of those initiatives are on target or underway at the district level.

A lot of those initiatives are on target, but you can see a majority of them are underway with a smaller section of them being off target, and I'm gonna talk a little bit about those in this slide.

So, overall, uh we have strong performance across a lot of our divisions where we are increasing our reach in the community.

Specifically, we've had successful media campaigns supporting the idea of secondhand smoke and how we reduce that exposure.

Um, we're also seeing an expansion in our reach with STD and HIV outreach at the Washoe County jails, and we've also had some significant reach in the community with our community health assessment survey.

Um, additionally, we are being a we're able to capture data a lot more consistently.

We are setting up systems in place to be able to refer to that data, which is allowing us the ability to use that data to inform some of those decisions that we are making.

Um, and then of course, there are certainly some challenges that still remain.

Um, our staff are working incredibly hard in our divisions, even though we do have staffing limitations.

Um, this has I would say maybe slowed some of our progress and maybe impacted our ability to get some of our strategic initiatives accomplished, but we are working through those challenges and trying to find opportunities where we can continue to push forward.

And of course, there has been some um uncertainty around federal budgets, and that has placed maybe more time on our plates to have more conversations about how uh the organization will look if funding um does not come in.

But I guess the silver lining in that has been that we are proactively having conversations, and that is giving uh the organization an opportunity to figure out how do we want to move forward together as a team.

And with that, I'll take any questions that you might have.

Thank you.

Any questions?

Member Anderson.

And I'm not sure if I should direct it towards you or not, but where are we seeing the biggest gap in our staffing right now?

No, I I can try to fill in.

I know it, but I'll let you because I think that you could probably provide more context, Aaron.

I'm gonna have you write it both down and see if they're matches.

So that's that's kind of where I am a little.

So whoever wants to take this.

Um I I believe our um and uh Rayona, please correct me if I'm wrong, but uh we're seeing a lot of our gaps in our community and clinical health services.

Um it we are every position that um leaves for whatever reason.

We actually have a committee now that reviews whether or not we should be refilling that position.

And we're looking at the data, we're looking at the strategic plan, we're looking at performance metrics, um, and identifying um a lot of different factors under that, including the financial factor um and identifying the the public health hit that we'll take if that position isn't filled.

All right, thank thank you very much.

Is that the same answer you would have provided?

I I would think I would also add that we have a significant gap in staffing with our population health division.

And they are also trying to work through some challenges with some um unfunded mandates that are being sent our way, and so I think we're trying to work through that as well.

Okay, thank you very much.

Yeah, thank you, Mr.

Trisco.

Thank you.

As you know, this is one of my favorite reports and recognizing what this actually does for the organization.

So I don't really have a question but have a comment.

Um, in reading all the details and looking at what is um kind of getting paused or not being able to be started because of the staffing issues.

What that shows me is we're still spending the time with reduced resource and reduced um throughput power to focus and put the effort into this report so that we know as an organization overall how we're doing and our ability to drill down in certain areas like the two we just discussed that have shortfalls because of budgetary constraints and the outside factors, including the uh federal funding and the flow through to the state.

So I think the staff is to be commended under your driving of the health officers' leadership to continue to focus on this and not have this become one of the things we just don't do because we don't have time.

So you're making the time.

I think that's critical because when all this is done, we're not gonna have to start over, we're gonna be able to just hit the ground running and go forward.

So thank you for overseeing the program.

Thank you.

I think that supports the adage.

If you don't know where you're going and it can't be measured, you never know if you've arrived.

Sure.

That's my succinct way of much more eloquent by Mr.

Dressco.

Thank you.

Any other questions?

Thank you for the presentation and thanks for everyone's hard work and thanks for putting in those metrics because it really does give you information, right?

And helps drive decisions.

So thank you.

You need a motion on this.

No.

We'll move now to uh item number 10 staff reports.

Sorry, that's for possible action.

For the presentation that just yes, it's acceptance.

I'll make the motion to accept this presented.

Mr.

Brown is on it.

Thank you.

And so is Mr.

Anderson.

Any further discussion?

Hearing none, I'll entertain uh I or hit your screen if you're in favor or not.

Hit your screen.

Gently.

We have no budget to repair screens, so don't hit it.

Okay, motion carries unanimously.

Thank you.

That was a test and a quiz that you all passed, and I failed.

So thank you.

And Dr.

Danko has arrived or has been.

So thank you.

132.

Oh, thank you.

Sorry for being late.

We're a little bit uh busy at the hospital.

No, thank you for having me.

Thank you.

Thank you, Mr.

Vega, for your patience.

Of course.

Please proceed.

Thank you, uh Chair members of the board for the record, Francisco Vega, director of the air quality management division.

Just a few things on my report.

Um, in the first part, I did provide some information on some pretty exciting advancements in in forecasting for heat-related deaths.

Um this is kind of important again.

Uh, we're considered one of the fastest warming cities in in the country.

So this may become more and more important as we uh kind of move forward.

So pretty exciting on that news.

Um, I also did provide some information on um road maintenance and public transportation funding and how it relates to electric vehicles and air quality.

One thing I wanted to make clear is that this was not me pretending that I have all the answers.

Really, what the hope was that uh really to acknowledge that yes, we have a road maintenance and public transportation funding issue.

Um, do we need to address the gap coming from electric vehicles?

Absolutely.

Based on the data that we have seen, is electric vehicles alone the complete solution.

Again, the data is not really showing us that it is, and then also provide some perspective on you know what impacts to air quality and public health might be.

So hopefully that's kind of the main takeaways from what I put in my report.

Um happy to communicate that we had no exceedances of the ozone PM10 or PM 2.5 national ambient air quality standards in October.

Um let's see what else.

We did drop down from 100% on our plan reviews for the month of October.

Uh looks like we received and reviewed 59.

And looks like 57 of those were completed on time.

Um, but again, over the calendar year, we are still at 99 percent.

So really happy about that.

Um that's it for my report and happy to answer any questions.

Mr.

Isco.

Again, more of a comment than um a question on the vehicle miles traveled on the EV text.

That is, in my opinion, based on um the discussions that have been happening over the last four or five years, the mandates in different states that have come, gone, are being modified.

I feel like this is gonna get a federal political conversation long before the individual states will be able to do anything.

So if we're relying on this to do anything and have any movement, it's probably gonna be more complicated than we currently think.

So we'll just stand by to stand by, I guess.

Thank you.

Any other questions or comments?

Member Anderson.

Thank you.

Um had a question um on the the um science behind uh predicting heat deaths.

Looking at that and and being able to see the potential for predicting that.

Have you started looking at how maybe the division could help whether it's messaging or what what potentially we could do to help prevent that?

Yeah, excellent question.

Um I was actually part of a panel, I think that actually uh Commissioner Andrea Olet was uh was a part of as well.

Um, where we recognize there is a significant gap in our messaging uh around you know, um forecasting heat, um extreme heat days, things like that.

Again, um air quality, we try to focus on conditions on air quality, but as of right now, we're not communicating anything related to extreme heat days.

Um so we're obviously gonna keep track of what's going on in these advancements and see how we can maybe implement them into our messaging with air quality as well.

Okay, thank you.

Any other questions or comments?

Thank you so much.

And you did a great job on that panel, by the way.

Appreciate it.

Thank you.

We'll move now to item 10b, the community and clinical health services.

Ms.

Shepard.

Hi.

Hi.

Good afternoon, members of the board.

Christina Shepard, division director, community and clinical health services.

So this month, my report touched on how the federal government shutdown affected two of our programs, and I wanted to take a moment to share an update now that the um shutdown has ended.

Um, very good news to report.

Um, the continuing resolution passed by Congress to end the shutdown includes funding for WIC through September 30th of um this year.

So if the government happens to shut down again in January, we're not gonna be on a week-to-week roller coaster with our WIC program like we were.

Um, that's brought a huge sense of relief, not just for our WIC staff, but also for the families who count on this program to help feed their children.

Um, since November is a time for gratitude.

I want to say a heartfelt thank you to our partners who helped us through this week-to-week um contingency planning for our WIC program.

So our partners at Human Resources, WCEA, Human Services Agency, and the library.

Um, they helped us with our contingency planning.

They stepped up and offered temporary work assignments for our staff, should it come to that.

So very appreciative for kind of a countywide effort to make sure that our WIC program could stay operational and our staff could stay working.

And then also to our incredible WIC staff, just a huge thank you to them.

Their dedication to serving our clients, even while facing this uncertainty week to week has been very impressive.

And I'm truly grateful for everything they do.

A couple other program updates.

Our immunization program collaborated with our public health preparedness program this past Saturday and offered a flu pod clinic here at 9th Street.

We gave 115 flu vaccines and were able to use it as a public health emergency preparedness exercise for a vaccine pod.

So good news there.

And then our community health workers uh coordinated a harvest of health festival on November 4th, where we had mobile harvest here who provided food to 93 families.

Um in addition, we had some dental vision um screenings, blood pressure screenings, and then had health insurances here to help people get enrolled since it is open enrollment.

So congratulations to them on a good event.

And if you'll indulge me for a minute, I'd like to just share a story about our incredible WIC staff.

Um it kind of shows how vital WIC is to our community, especially during these uncertain times.

Uh during the shutdown, we had a family that brought in their baby who was less than a month old.

One of our WIC staff immediately noticed something wasn't right, the baby was lethargic and had barely gained any weight since birth.

After talking with parents, it became clear they were facing serious challenges, and WIC had been the only support that they had been able to access since their baby had been born.

Our staff acted very quickly.

They contacted EMS, Child Protective Services, and eventually the baby was transported to the hospital where they were diagnosed with failure to thrive.

Happy to report baby was discharged a few days later, gaining weight and eating well.

But the story is a powerful reminder that WIC is often more than just a nutrition program for many families.

It's their only connection to critical resources, whether that's food, safe sleep support, or access to other health and social services.

So thank you for indulging me in storytelling, and I'm happy to take any questions about my report.

Thank you.

I um I your stories are always compelling, and I would um given the proper permission and not uh violating any privacy.

I would hope that you would share that.

Mr.

Oxhart does a great job and communicating to the community.

And I think to be honest, not everyone is in your lane, right?

And even though people may be aware of WIC, but maybe not really understanding what that impacted, and I think that was a pretty compelling example of how a family who truly was doing everything they could within the power that they had, actually run into a situation of possibly losing a child of no fault of their own.

And so I'm just that really like that was a very all of your stories are compelling, but I I would hope that maybe that might be a consideration to share because stories resonate, right, with everyone.

Yeah.

Um, so thank you.

Any questions from Mr.

School?

Question on the SNAP program.

There was some discussion both on from WIC being funded by the federal government through the end of the current fiscal year.

Was SNAP also funded to the end?

Yeah, so SNAP was also funded.

So the 12 kind of funding packages that make up the budget, agriculture was one of them, and that included WIC and SNAP.

So SNAP is now funded as well through the federal fiscal year.

So with the additional backup that was done in the special session that just finished yesterday, that gives us a backup when and if, but in theory, nothing will happen until the next fiscal cycle, because we're okay until September 26.

Correct.

So we're it's funded now through the federal fiscal year.

So if something were to happen again in January with the federal government, agriculture is funded, which would cover SNAP and WIC.

Great, thank you.

Dr.

Danko, do you have any questions or anything you'd like to add?

No questions for me.

Thank you.

Anyone else?

Thank you for your report.

Appreciate everyone's hard work in all of those uncertain times.

That's definitely appreciated.

We'll move now to item 90, approve the subgrant agreement between the state of Nevada, Department of Conservation and Natural Resources, Nevada Division of Environmental Protection Bureau of Safety Drinking Water and Northern Nevada Public Health Effective Upon NDEPS administrative approval through September 30th of 2029 and the total amount of 262,000, right?

Am I again?

This was a test to see if everybody was paying attention.

And you know what?

They were so uh I will actually highlight some of those reports.

So that is actually one of the ones that I was actually gonna highlight.

So can actually I'll I'll throw it your way.

I was gonna say it was a perfect softball.

Thank you.

I used to play softball.

Oh yeah.

So uh for our food program, they've actually done a few things.

So we actually hosted uh some folks from Walla Walla County uh in Washington.

They came out to observe our program, uh, our food safety program as they're our mentee.

So we hosted them uh last month.

And the food team also uh held another inspection boot camp.

This one was the House of Horrors edition.

So they were able to uh find some inspection photos and uh kind of showcase them uh so that people can kind of practice uh how they would address it or what violations they would see essentially uh in that and that gives the facilities that I think the confidence to go and assess their own facilities and see what the issues are and how they can correct them.

Uh another one is, and I think this one's fairly interesting, is our staff has been working with Washoe County Health District uh as the school is looking to uh I think expand some of their culinary program.

So they're looking at potentially uh mobile food truck operations at some schools.

So they're looking at I think uh an entrepreneurship bio type class, and uh they're working with us to get whatever permitting and kitchen infrastructure in place for those classes.

So that's kind of exciting.

And then one of the other things is uh our land development team has been working on the septic regulations.

Uh so they've had over a hundred attendees, uh over fifty phone calls regarding the regs, and so they'll be bringing those to you next month, uh, the business impact statement uh for your review, and then with hopefully regulation adoption come January.

So that's uh for the board.

And then I guess uh since uh Commissioner Andriolo brought up the PFAS grant, there's a grant opportunity received from uh the state NDP, and it's to explore uh PFAS and domestic wells.

So domestic wells tend to be unregulated uh water sources.

So every homeowner on a well is responsible for kind of the safety of their water.

And so there is a uh grant that we receive from the state to investigate uh PFAS in those water sources and to see if there's anything there.

So we'll be working uh to kind of get that out into the community and figure out how we're gonna sample and uh get that message out there.

So uh that's for the highlights for my report, and I'll open it up for any questions.

So see how Mr.

Feide and I practice that.

Did you all follow that?

Well, okay, good.

Any questions?

Member Driscoll.

Mr.

Fida, in your report, you talked about the food truck program as well as the potential for commercial kitchen installation, both at Reed and uh Smith for culinary program.

Do we participate in that curriculum for the purposes of teaching all the things that we inspect for, such as cleanliness and temperature control and markings and dating and all those?

Do they ask our input for that curriculum?

Uh that I do not know.

I'd have to actually go back to the staff and find out.

I don't believe we do any education at the high school level.

I know we've done some through UNR as well, but I don't know if we go into food safety at that level.

So would seem like a good nexus.

Yeah, few future employees.

They might find interest or restaurant doors.

Any other questions?

Well, thank you for making such a smooth transition with our practice opportunity.

Thank you for all you do.

I I actually am gonna ask you one question in terms of the um ordinance that's coming and all of the um input that you've received.

Is there anything that you'd like to highlight with anything that you've seen that you are working through or challenged with?

Uh a lot of it, uh, I think a lot of the uh feedback we've been getting is uh kind of related to I guess to sum it down to a simple term is septic density.

Uh there are some folks that wish to uh increase the septic density, and this is uh with options for I guess more affordable housing, ADUs and whatnot.

And then the other half is also interested in, I guess, increasing or decreasing the septic density, so less septics per land area, and that is more to protect the groundwater.

So there is a balance to strike uh a little bit with these regulations, and I think that's the simplest way to boil it down, but we've seen a lot of commentary from both sides of that uh argument.

So that's interesting.

Well, thank you.

Thank you so much.

We'll move now to item D, population health, emidemiology, statistics, informatics, public health preparedness, emergency medical services, and more.

Thank you.

Good afternoon, members of the board.

This is Nancy Dow, Division Director of Population Health.

You have my report.

I don't have anything to change or add to that, but I would like to give more closer this month a quick update on the respiratory front.

So respiratory virus activity, which right now includes for us the surveillance of influenza, COVID-19, and RSV.

That still remains low, but flu activity has begun to increase.

Washoe County's ILI or influence influenza-like illness is currently below the Nevada and regional baselines, but has been continuously increasing.

COVID cases reported and hospitalizations do remain low at this point, but there were three COVID associated deaths reported this season thus far.

All were in the over 65 age group, and there has been no influence uh associated deaths uh currently.

Uh seasonal flu activities remain low nationally, but is also increasing, primarily among children.

So the timing of the increasing activity is similar to uh several past seasons.

Uh nationally, a variant to the uh H3N2 subtype called subclate K is circulating.

And this strain is mutated compared to strains used in the current seasonal vaccine.

So H3N2 mutation happened over the summer as it spreads through the southern hemisphere, and currently other nations are seeing a more noted increase in uh flu driven by this H3N2 mutation.

In Washoe County, however, right now, the current dominant influenza virus uh type reported by the Nevada State Public Health Lab to us is still uh H1N1.

We're also continuing to see an increase in our cases of pertussis this year, currently at four times, or actually over four times now the total cases reported compared to the previous two seasons.

Um there were no currently identified outbreaks, um, and the majority of our 2025 cases are unvaccinated or undervaccinated.

And then finally, our outbreaks in November uh do remain steady compared to October.

The majority of the our outbreaks in October has been hand-foot mouth disease.

Uh but now we're again seeing this shift back to the respiratory and gastrointestinal illness uh outbreaks as expected for this time of the season.

Um I do also want to quickly mention that our epidemiology team completed an overhaul update to our disease manual, which includes 67 chapters covering 90 reportable conditions, so huge pile.

Um, this regular review and update and just the creation of the disease manual ensures our consistent investigation process and rapid, efficient responses.

And we have also shared our chapters with some of our epidemiology partners in other jurisdictions and our state partners to support uh their investigation chapter processes.

So that's all my update and happy to answer any questions.

Thank you, Dr.

Dow.

Any questions?

Dr.

Danko, any questions or comments.

No, no questions or comments from IM.

Thank you.

Thank you so much.

Thank you.

Thanks for that heavy lift on how many chapters was it?

67 chapters.

Yeah, just a few.

Just a few.

We'll move now to the Office of District Health Officer report.

Good afternoon, good afternoon, Aaron Mason.

Uh you have the report in front of you.

I would just like to highlight two um items.

One is want to thank staff for all their hard work at the Family Health Festival.

Um, it was the last one of the season was held on October 8th.

Um, really great uh community partnership and thankful for the for the team for all their hard work on that.

Uh the special session has ended.

We were tracking um uh part of one specific bill that had to do with immunizations.

We do not believe that the final bill will impact our current um uh processes as it primarily impacted um what pharmacists can do for vaccinates.

Um but we are always grateful when uh more vaccines can get in more arms.

So we're thankful for that.

And then also um, I do want to report that our TB clinic building.

We were able to um it's getting to the point where you can walk through it.

Um we were able to take our TB staff over there so they can envision what it's going to be like in the next few months when they get to move in.

Very excited to give them this opportunity.

That's it for the report.

Happy to answer any questions.

How close are we?

Uh we should have we will definitely be in there before April 1st.

I'm hoping for like mid February, early March.

Great.

Thank you.

Any questions for Ms.

Dixon?

Well, that was a great report.

Thanks for stepping in for Dr.

Kinsley.

Gosh, really, you don't want to ask for any tough questions or anything.

I wish I could come up with something.

No, thanks to you and everybody for all you do.

Seriously, for you guys are the unsung heroes of our community, really.

Thank you.

Thank you.

It's very impressive, and it's it's very it's an honor to work with the staff that we have.

They do incredible work.

Doing a lot more with less.

Yes.

Thank you.

We'll move now to public comment.

Do we have any public comment?

Comments heard under this item will be limited to three minutes per person and may pertain to matters both on and off the board agenda.

Unused time may not be allocated to other speakers.

Comments are to be made to the board as a whole, and virtual public comment may be taken when facilities are available.

A speaker's viewpoint will not be restricted, however, reasonable restrictions may be imposed upon the time, place, and manner of speech.

Irrelevant statements, unduly repetitious statements, and personal attacks that would objectively antagonize or incite others are examples of speech that may reasonably may be reasonably limited.

This board carries out the business of Northern Nevada public health and its citizens during its meetings.

The presiding officer may order a person removed if the person's conduct or statements disrupt the order or safety of the meeting.

Warnings about disruptive conduct or comments may or may not be given prior to removal.

Furthermore, certain disruptions of a public meeting are criminal acts as defined under NRS, which may result in prosecution inappropriate cases.

We do not have any requests for public comment.

Thank you.

We'll move now to board comments.

Any board comments?

Dr.

Denko, any board comments?

No comments for me.

Thank you so much.

Okay.

Well, hearing none, we are adjourned at 2 02.