(11:00 AM TIME CERTAIN) Presentation - Covid-19 Pandemic Update from

1:00:56We have a a couple of time certain starting at eleven. Don't know if you wanted to get to the time certainly Time starting at eleven, eleven fifteen, eleven thirty, and I believe eleven forty-five.

1:01:09It's Mr. Chairman if we need to we can push off the eleven thirty and lemon forty five until after the public hearing. The health department's ready to go and that would be the first time certainly.

1:01:20Mm. Which one is it?

1:01:24R one oh five, the eleven A. M. time certain. Mr. McPhee is here.

1:01:27Okay. We'll go ahead and do that before we take up the consent items. So well known that.

1:01:39Good morning Commissioner is Mike Luther for the Department of Health, 10841 Little Rose. Uh I'm here to give our monthly update on the status of COVID-19. Um I believe we also.

1:01:53And I also have Dr. Levine that will be speaking from the US of Public Health at the end of the presentation about our consensus document.

1:02:07Next slide.

1:02:10Uh, just some observations about our current data as of this morning. We've had 16,544 positive cases.

1:02:19Something that's a little bit startling is that 9.5% of those total cases, 1,578, have happened in the last seven days. So we are seeing a spike in numbers, and I'll show that a little bit later. We've had 30.15% of the population has been known to be infected. We know there's more than that, and less than 0.058% of the population has uh has passed. A startling number that you'll see also is that our rolling seven-day average of cases is up to 207. When I

1:02:49stood before you in September, we were looking at 29 cases a day. So we're up to 207 cases. And this represent a hundred percent increase since the last time I came before you. Our 14 rolling day average is up from almost five percent to almost ten percent. So we've seen a similar doubling in numbers in positivity rate as well. The next slide.

1:03:13This is a report that many of you see. I like to show it because uh a couple things. It gives you kind of a daily count over the last two weeks of where our numbers have been. It also gives you identification of uh it's a little hard to see, but our average age of cases has stayed pretty uh level. About 45 is the average age. We did not see that uh decrease when we had schools opening up. We do have uh 305 uh deaths so far during the COVID, and we

1:03:44have seen a slight increase in in uh our deaths over the last uh three weeks. The next slide. I like to show this slide because uh it tells you how many tests were being done each day. It gives you relative and that's where we get our positivity rate. Um BayCare and the County Paramedics have been a great partner in identifying our drive-thru. I hope most of y'all know that uh the Sears Drive-Thru we test from eight to eleven in the morning. And we are starting to see 300

1:04:14tests a day. That was up from 30 to 40 a day back in September. So more positivity, more people getting tested, more demand for testing. The next slide is probably the most startling slide that I'll show. I know it's a little busy. I think you all have it there as well. This slide is is indicates that the the first blue lines are the daily count. The red line or orange line is our seven-day rolling average. The line that keeps going up is a

1:04:44cumulative number of cases and then uh on the the vertical lines are specific points in time where, for example, uh the mass coordinates in late June uh we had in place. Uh going through school openings to Veterans Day to Thanksgiving. The little dip in uh right after Thanksgiving, really we believe that was because a lot of people didn't go get tested during Thanksgiving, and so now we're seeing that spike afterwards. This

1:05:15is a true indication that now we're at a point where I know many of us were concerned back in late June, early July about our cases and then a percent positive. We're surpassing that now. If you notice in the first part of the slide we had a steep increase in cases. We went from a f um eight or ten to almost three hundred in a matter of two weeks, three weeks. In the case that we're in now and the increase we're seeing now, we're seeing rather than a steep increase, a steady incline over the last two months. Next

1:05:45slide.

1:05:48This is a seven-day rolling average. This is the percent positive of the number of cases. As you can see, we continue to uh our case positivity rate is not equal to what we had during the spike, but it has been consistently above 10%. The problem is that we're having more, not problem, the indication is more people are being tested, and therefore we're getting more numbers up to 207 cases a day. The next slide is really a smoothing out of those numbers. That's the same numbers, but running over a 14-day average instead of

1:06:18a seven-day average. It takes out the spikes. And as you can see, the number of cases over our 14-day rolling average is above what we had during the spike. Uh next slide. I know schools were something that I reported out last time. So far we've had 640 students that tested positive with 258 uh faculty and staff at the school system. for almost 900 cases in total. The number that's

1:06:48a little more staggering is that we've had 9,400 students exposed, which means they've been sent home and quarantined over that period of time. and eight hundred and sixteen uh exposed uh at the school. The school I will mention is uh continuing to wear the mask uh ordinance or following their mask uh which is separate is a um Attorney mentioned that they have their own ordinance or their own guidelines and it is working. We are Seeing

1:07:18very limited transmission within the school system. It's really when the kids go home to the parents and activities after school. The next slide. Uh I presented this back in in September and we talked about in fact that's one of the topics we're gonna end with about the mask ordinance and when could we lift the mask ordinance. Back in September when we were looking at 29 cases per day, that was considered a very low case rate. And where we would consider having

1:07:49uh the mask uh ordinance removed. However, we've gone in the wrong direction, and each of those dates you can see where we're at. It should be 207 instead of 20 uh two cases per day. But we're now in the environment where we have uh considered a high case rate and um and no end in sight at the moment. Next slide.

1:08:12Uh I CDC came out with some guidance uh last week. Uh we have been following their guidance of 14-day quarantine. Uh that's the highest risk reduction if we follow a close contact. Someone that is tested positive in those close contacts, household contacts, family contacts, uh social contacts. It's recommended they follow 14-day quarantine. And that's daily monitoring of symptoms and following the C D C guidance. That CDC guidance is still in place for long-term

1:08:43care facilities and people who work at long-term care facilities. Uh the 10-day quarantine that just came out means that those that were originally in the 14-day quarantine will now beginning at a 10-day quarantine. They're reducing that by four days. But reducing that by four days is not without risk. If you reduce it to 14 days, then you have a 1 to 10% risk potential. In other words, you have a 1 to 10%, I know that's a pretty broad range, of somebody uh coming down with uh COVID after that day

1:09:1310. Again, this is CDC guidance coming to us. and that we're applying to the general public. The last and probably the most troubling is the seven day quarantine for close contacts. With that effort, it is a between a 5 and 12% risk potential. What happens is that at day six, at the end of day six, you can go get a test, a PCR test specifically. If your PCR test is negative

1:09:43on day six, then we can take you off quarantine on day seven. The problem with that is that uh as many of you, probably most everybody here has been tested, you don't get your your test results back in 24 to 48 hours. As we've seen this surge across the state, test results are taking longer to get back. So even if you went in at six day, you may end up on day 10 before you even get your results back. And so testing may not be the best answer. Um But that

1:10:13is an option out there that that the concern I have honestly is that we're we're getting to the maximum of our ability to test people currently, to diagnose people with COVID, to now have literally in the school system thousands of kids that are wanting to get tested out that will flood our our system as far as being able to test. Next slide. Um Pasco County has the highest positivity rate in the region, and at this month, at this rate, if

1:10:44we double at 200 cases a day. We could double our total cases from sixteen thousand to thirty-two thousand in the next three months if we don't do anything else. Uh that's startling. And that means four hundred cases a day instead of two hundred cases a day. We're not seeing any indicators that these rates will slow until vaccine is widely available in the spring. And I'll talk a little about vaccine in a moment. Uh recommendation at this point is to continue the emphasis of importance of social distancing,

1:11:14hand hygiene, and face covering. I know that kind of falls on COVID fatigue and people are just over it by this point. I know that anecdotally, when we spoke to people at Thanksgiving time, people did lessen the number of people they had at Thanksgiving, and we're thankful for that. But the Christmas holidays is another time when people get together and we're very concerned that we will uh we will see an increase in those numbers as well. The next slide.

1:11:43vaccine. I know many of you have heard about the status of vaccine. Pfizer has theirs. They've applied for FDA approval. That's a two-day dose system with uh twenty-one doses days between It's difficult to manage with with its ultra-cold change. Uh some of our hospitals are working through that process right now. Moderna has a two shot as well. It's twenty-eight days and that doesn't require the ultra cold. AstraZeneca and Johnson Johnson are still in the process of getting approval, but that is in the

1:12:13pipeline and a lot is still to be determined on the vaccine status there. The next slide. Um vaccine planning. Uh and it's been planning. Um The governor came out uh last week and said his priority was gonna be at long-term care facilities and we are working with the governor's office, the the state DEM and uh Andy Fawcett with the County EM to determine how we're gonna be able

1:12:43to vaccinate our long-term care facilities. As you can see, we've got others that are going to be on that list, that priority list. As one knows that there is limited vaccines, so we don't have the ability to give out as much as everybody wants. We want to continue to encourage people to get the vaccine when it becomes available. Uh the phase two is that um At risk, the 65 and older, group congregate livings, uh educational settings, and and then the general population. I wish I had more

1:13:13information about it right now, but because of the questions about which vaccine, if it's ultra-cold, it takes a different logistical setup than if it's just cold storage. So we are working to um to with the state and local governments on trying to determine how we would do that. Uh the last slide. Uh face coverings. I stood before you uh the last two meetings In September, the good old days when we were at twenty nine cases a day and we were talking about well what point would we like to consider

1:13:43no longer requiring face masks? Uh I told you that I would go back to the region, Pildles, Hillsborough County and the medical community in the region and come up with a consensus of how we would approach this from a regional standpoint. I'm very proud and and happy uh I think Dr. Levine is on the on uh she's on WebEx. Uh she's a professor of public health practice and family medicine at the University of South Florida. Uh she has a wealth of experience at the state and local level.

1:14:14Dr. Lavlin is a retired family physician with sixteen years of medical practice experience, who also received a master's of public health degree from John Hopkins. Bloomberg School of Public Health. She was the top state health official in Virginia as the Commissioner of Health for four years of her 16 year tenure. As a commissioner, she held the emergency response during the H1N1, Zika, and Ebola outbreaks. This gives her a unique perspective on public health epidemics and policy associated with control

1:14:44of infectious diseases. She's a member of our review team and she'll I've asked her to be on the call to uh to talk a little bit about what that document that I believe do they have that or is that we'll put up on the screen.

1:14:57Okay. And so we'll have those benchmarks come up.

1:15:09Okay, and with that, uh Doctor Levine, are you on the Call.

1:15:14Well good morning, can you hear me?

1:15:16Yes we can, thank you.

1:15:18Okay. Thank you, Mr. Napier. Good morning, Board Chair, members of the Board of Commissioners. Thank you for the opportunity to speak to you. I'm not here individually. I'm actually here as a representative of a pretty significant group of local and regional health and medical experts and academics. Who have come together to try to support the difficult work you're doing. Let me just say thank you for all your efforts during this unprecedented time. There are no shortage of opinions, as you've heard. And

1:15:48so we've tried to work to uh look at the facts and provide you with some guidance about this issue of mask mandates and when it might be reasonable to consider releasing the mandates. Mm. Uh the mandates are really just one part of a multi-level effort to try to protect ourselves while we're waiting for definitive medical therapy and a vaccine. Uh so there are the face masks are important. And actually, from the time that we put this together till today,

1:16:19there's only increasing evidence of their effectiveness. Uh, there's a recent publication from the CD. That looks at the scientific evidence. I'd like to share that with you through Mr. Napier. Because that came out after our uh work as a collaborative Uh the document that you I guess will receive identifies the list of individuals who represent all of the healthcare systems in the region. These are the medical leaders. Including in addition to the major medical

1:16:49centers, we also have representation from the VA and Moffitt Cancer Center, and then obviously the public health leaders, and then other academic leaders, myself included, including the Dean of Public Health, Dr. Donna Peterson. So let me just explain that um we were asked to give you some guidance about thresholds uh below which it would be appropriate to consider releasing the mandate. And we had some uh really

1:17:20intense discussion about this because there really isn't any one or two metrics that tell the whole story. You know as well as I do this is a very complex issue. Uh, but we worked hard and we came to a uh an agreement that we think makes some sense based on practicality. And so what you see in front of you are really two metrics. metrics that you're already looking at. Mr. Napier's been presenting those to you. And they represent the uh number of new cases and also the

1:17:50test positivity. The number of new cases is population based, so it's per 100,000. I believe currently we're uh somewhere in the neighborhood of about 40 plus uh new cases per day per hundred thousand population in Pasco. Yeah. And we're talking about uh a lower threshold of about three per 100,000, which for Pasco would be about 14 new cases a day. That would put us back to where we were before the summer spike. Uh and then also for test positivity, you heard that

1:18:20we're approaching, if not exceeding 10% right now in PASCO. Um we looking at the literature through CDC World Health Organization and others, and we've referenced this in the document, in the guidance document. that uh a reasonable percentage to consider releasing this would be about three percent positivity rate. Again, would put us back to uh where we were before the spike in the summer. Uh these are uh recommended thresholds at which

1:18:50to consider, but they really aren't the whole story because obviously looking at uh hospitalizations, hospital capacity, uh for example, right now with the current spike, uh I was just looking at hospital capacity. And we've seen uh really a doubling of individuals now in the hospitals. Uh the hospitals are stretched. Uh we don't want them to be like what we're seeing in the rest of the country. Uh and uh this morning, for example, Tampa General, which has uh a

1:19:21huge number of ICU beds compared to others, was reporting no available ICU beds. So this is really a very significant time and it does require concerted effort. And it's I applaud you for taking a report. approach because that's what's really needed in a pandemic. And so these two uh metrics here are meant to be guidance for you and I'm happy to answer any questions. But again, thank you for all your efforts and Mr. Napier, thank you for asking me to report on behalf of this collaborative

1:19:51group.

1:19:55Are there any questions?

1:19:56Mr. Chairman M just one thing and and I want to do that. Um I appreciate the doctor um being on here with us today and I Mr. Napier and I were talking uh last week and and and uh obviously uh about um her expertise and and uh we're happy to have her here and I think that's one of the things some of the questions and the emails we've received from some people and you've seen them come and speak to us during the morning and show videos. Mm-hmm. Well we have a physician here that's stating, you

1:20:27know why we should be doing cer certain things and why we should continue doing certain things and they asked well you know, we you you're us as a collective group aren't physicians and I've said that many a times. We should be listening to the physicians and here we have it right here in front of us. So that's what I want to remind people, that's what we're doing here and we continue to do as a board is listen to the actual medical experts. We aren't just elected officials that are doing things just because

1:20:57we want to do them. And uh so it's important to listen to the doctor and obviously Mr. Napier and other health officials. This is what they do for a living. You know, it's not what we do for a living. We're supposed to listen to recommendations, science based, medically based. recommendations and I think that's what we've we've done and I appreciate again her you being here today um to show the

1:21:27folks that did have those questions that this is where it's coming from. Yeah, right. Thank you.

1:21:35Any other questions? Mr. Chairman Mariano. Yeah, sure. Thank you. Um I'd like to

1:21:41say Mike, nice presentation and thank you for helping me and my uh wife get tested the other day and as well as my daughter and her fiance. Um Those of you who have heard the test did come back positive. Um And fortunately for me, I have had like minimal symptoms. My highest temperature was like ninety-nine one. I had some pain in my back, which is from I think just from regular back problems that I have. Took some aspirin. I haven't had any symptoms since that are just nothing normal. So for me this this virus

1:22:12is a is a minimal minimal effect. Now my dad, his girlfriend both have it as well. Uh they spent Thanksgiving with us and they had it before, but uh their doctor prescribed to or recommended to them to take zinc. uh vitamin C and vitamin D. Um they're not sick enough to go into the hospital. Uh matter of fact the doctor yesterday, even though my dad was just kind of laying down for the most part, uh says no, he's just he's gotta go Drink fluids. uh get up and eat and and take

1:22:42care of himself. So they wouldn't give him any medicine. They wouldn't give me any medicine, uh, not even a Z Pak when I did a test with the clinic as well as talking to my doctor. So my symptoms, like I say, are real good. I'm in a I'm very good shape. But I am you know, very concerned how this, you know, obviously can affect other people. Uh Dr. Levine, if I could ask you a question before I get into a suggestion I have later. Um we saw three videos that stuck out in my mind that I've he seen and heard and and I love when experts look at these things, so I wanna get

1:23:12your take on it. But did you see all all the videos that we had that public comment? I did. Okay. So When I saw the video with the gentleman who have having the cigar cigar and showing the mass and the smoke going through and around the mask, would you comment on what you saw with that video is what you thought about that?

1:23:30Sure. Uh actually a number of uh universities have done actually similar experiments in controlled settings to what he was trying to show for us. And I think one thing people should keep in mind that um the masks aren't designed to be perfect barriers. They, in in terms of how it uh helps other people, they minimize the uh projection. ejection of those respiratory droplets in the aerosols, and as he's right, aerosols can

1:24:00travel further. Um, but they do make a difference in terms of how far that goes, uh, particularly in outdoor settings. In indoor settings, it's a little different, and that's why we're more concerned. But there's also protection coming in, and a lot of that protection, as well as the protection going out, depends on the fit, the level of fit. So wearing an appropriately level layered mask. mask, preferably a multi-layered cotton mask, and having an adequate fit uh is

1:24:30really important. And I think that's what he was demonstrating. Uh but there's no question, and again, I I want you uh to have the information that I have. That we can diminish the projection of those particles, which helps other people, and we can also protect ourselves. And then we have lots of evidence about the fact that people who were sick maybe didn't appreciate that they were sick, but still providing services, and who had clients who were wearing masks. When

1:25:01the individuals who were sick were Masks, the clients wore masks, they actually prevented each other from picking up the virus. So there are lots of good examples that are rigorous enough that makes all of us in the healthcare arena feel comfortable that these recommendations are important. And my colleague who does uh lots of modeling at USF has demonstrated that based on the models, Thanks to all of your efforts and those of the other local governments, we've probably

1:25:31prevented somewhere in the neighborhood of one and a half million cases since July. That's an estimate, it's a model. But just to give you some sense that these things really have made a difference, it could have been a lot worse. And we still have a lot of work to do, quite frankly.

1:25:49Okay. And and we I and I agree with you that these aren't foolproof, they not stoop, but that they they do have, you know, the limitations as well. When you saw the NIT doctor talk about having these maps where the it's kinda like having uh Try to put a chain leak fence to prevent a mosquito. It kind of highlights the same point, but again, projectiles, et cetera, does What did you think about the OSHA experts who were talking about it?

1:26:14So I I know what they're talking about. Um we do in the healthcare arena we do fit testing with N95s, for example, because we want to make sure that healthcare providers who are putting themselves at risk for infectious disease have the best protection. And and there is a fit testing for N95s. So you you need to make sure it actually fits your face, that you have uh appropriate fitting. And we don't recommend N95s for the general pup public. The reason that

1:26:45we recommend cloth coverings is for a number of reasons. One, they they provide adequate protection. They're not perfect. They don't need to be like N95s. If you ever wore an N95, you realize how difficult it is. And again, hats off to healthcare workers who are doing that day in and day out. Um but we're looking for adequate protection and we also uh allow adequate ventilation to um counter all of the concerns about adequate oxygenation. So OSHA is for uh is

1:27:15for assuring that the workplace is safe. And we're really talking about being out in public. We're not looking necessarily at work uh workforce places. So I don't expect OSHA would be talking about general public health measures. They'll be looking at this in workplace settings.

1:27:33And I think I greatly appreciate your being here to see all that because obviously we we do want to get all the information we can as far as we we keep on going on and and alerting our citizens to everything everything we can possibly do what they can do to protect themselves. So let me let me just tell you my experience. So with my doctor, I even talked to him this morning, uh talked to our clinical doctor as well. And when I first got tested, um what I didn't know wasn't for COVID test was to record. Just a regular uh Interview and they says, Well, you don't have any symptoms, so just you know, shrink some fluids and let

1:28:03this thing pass through. Uh usually she'll give me a Z Pac uh and I'll take that and I'll I'll be fine with the with the flu. But she says, I don't even think you got that, so just kind of like stay tuned. After that, I found out my dad had it, got tested on Friday, uh, Saturday got the results. So my own doctor says, take zinc. Uh vitamin C and vitamin D. Uh and we've got that in the house for everybody, uh for my wife and myself. Uh we got some for them. And Well we think it's a a good thing. And then my again

1:28:33with my dad I was a little concerned about him and he says, Look, he's healthy, just let him keep doing that, drink the fluids, et cetera, and and he'll he'll let let it run its course a bit before we do anything. Knowing that the hospitals are g are very full, um and we don't want to bring people to the hospitals to come in. Uh I've got a uh an idea that occurred to me today and I actually talked to Mike Napier about it and I've actually floated up to the state where uh Do you think it's a good idea that we should maybe take a look at the region, et cetera, even nationwide coming up, that we should look

1:29:03at maybe we should start really pushing out zinc, C, vitamin C, vitamin D, and getting people to take that as preventative medicine. So at least if they do get it, they'll uh be in better shape for it or maybe even they could even push the the disease back from any effects it might have. Do you do you think it's something we should take a look at or your group could take a look at to to try to make a procedure for the future? Yeah,

1:29:25we we'd be happy to take a look at it. And there's been some work to look, particularly around vitamin D and some evidence that that could help. But let me give you some perspective here because underlying uh through studies that have been done in the past, we we know that generally, particularly in the United States and other developed countries, we our diet does not necessarily provide us with adequate uh vitamins. And so I think Before we do that, I really would encourage people to review

1:29:55their diets and think about a uh a more holistic approach to their diets to assure that they're getting because all the things you mentioned can be um obtained through good nutrition. And so I I've been talking a lot through the media to to the public and saying, you know, going into this season with Potential for flu, we really need to be as healthy as possible. So obviously getting rest, exercising, dealing with your stress, but also a good nutrition, nutritional approach is

1:30:26really in a holistic approach nutrition is really critical. So everything you just mentioned could all already be uh obtained by making sure that you're uh eating well. And I would push that first before taking supplements. because the the proof on supplements isn't a hundred percent. There's a lot of opinion on that uh and there is some evidence around vitamin D, but I think it has more to do with the fact that we're all a little bit vitamin D deficient to begin with, even in Florida.

1:30:54Well, I was personally we we eat very balanced meals. We eat a lot of organic food. We we get I think we eat well. Uh but at the same time, if it's something we could do to others that may not be able to do that, especially some of our our poor folks uh that don't have the facilities for that, if we could make it available, and I would even look at using our carers money that we have to actually go supply this for you know, our children, our seniors, et cetera, just to give them that extra protection level to try to minimize what might happen. Um if you'd work with us on that, that'd be fantastic.

1:31:23Yeah, I appreciate that. And I'm I'm sorry to hear about your diagnosis, but I'm glad you're doing well. And I do think uh I do think those approaches are worth some thought. But like everything else, you know, just like with masks, We have to be real very careful when we uh make recommendations for the general public, you know, and and we do take that seriously, and I know people have lots of opinions about that. So I think the important thing is to make sure the evidence supports uh those approaches. And in the meantime, I would tell people, uh, really do your best

1:31:53to take in a a full holistic nutritional approach to uh being well.

1:31:58Yeah. Well thank you very much. I greatly appreciate it.

1:32:00You're welcome. Thank you.

1:32:03Any other questions from the board?

1:32:04Commissioner. Chairman M

1:32:06Excuse me.

1:32:07I think it's very important that they mention that Tampa General has no ICU beds and Tampa General is a recommended hospital for specific high risk patients. So I think it's very important that this population and others to help this population taking the considerations to take all the necessary precautions to help them. And saying that, w how are the vacancies in the other ICUs in the surrounding areas. Are there

1:32:37other hospitals with a plethora of ICU beds or are we limited on those beds?

1:32:42Uh I don't have today's numbers. Yesterday we had a hundred and twenty-three individuals that were in the ICU beds. Um 127 is the highest I've seen. And when I talked to uh Chief Riardan, who is the uh fire rescue paramedics, delivers people front to the hospitals. They're not on standby. Uh I believe Zephyrhills have Hell Safford Hills was at a point where because they were dealing with some clients coming out of uh prison and they had

1:33:12an outbreak there, but I'm not aware of any hospitals that are at stamp or are at um bypass or at capacity at this point. I don't know if you have anything different.

1:33:23Yeah, I was just wondering about the availability. Are there a lot of availabilities if we do have a spike and they do need the bets?

1:33:31Two weeks ago and the numbers are about the same now based on the vet availability we had a fourteen percent capacity is what we had two weeks ago. I don't know what it is today, but I know that two weeks ago they gave me the number of fourteen percent. And again, bed capacity is dependent on the the when they do uh um uh voluntary surgeries where where they don't need to have to necessarily it's something they can put off. If they if the hospitals start to see a surge then they can and put off elective surger elective surgeries. Then they um

1:34:02they uh can put those off to make more bed availability for the ICU beds.

1:34:07Okay, thank you.

1:34:08All right. Thank you. All right. Any other questions? Thank you, Commissioner. All right, thank you. Thank you.