HomeMy WebLinkAboutBoard of Health April 1 2003WHATCOM COUNTY COUNCIL
Board of Health
April 1, 2003
The meeting was called to order at 10:30 a.m. by Council Chair Dan
McShane in the Council Chambers, 311 Grand Avenue, Bellingham, Washington.
Present: Absent:
L. Ward Nelson Barbara Brenner
Laurie Caskey-Schreiber
Sam Crawford
Seth Fleetwood
Sharon Roy
1. PUBLIC SESSION
No one spoke.
2. WEST NILE VIRUS PREPARATION
Don Vesper, Environmental Health Division Manager, submitted a handout
from the Cooperative Extension regarding integrated pest management (on file).
Since the last Board of Health meeting, not much else has happened. They
suspended the surveillance activity for dead birds. They have been developing an
interim plan and trying to secure resources to do enhanced education and
surveillance for West Nile virus.
In 2002, there were 4,000 people in the U.S. who were severely ill with West
Nile virus. Many more are believed to have been infected and had minor
symptoms. There were approximately 250 fatalities. Comparing West Nile virus
with other mosquito -borne illnesses worldwide, it is a minor issue. In the U.S.,
food borne sickens about 76 million people annually, requiring 325,000
hospitalizations and causing over 5,000 deaths. Approximately 50 people die every
year from bee stings. This falls in between. Control mechanisms can be put in
place for West Nile virus. The 250 deaths were in areas with education and controls
in place.
This disease is primarily a disease of birds. Birds are the hosts. Humans are
an incidental host. Part of their work plan is surveying the birds for the disease.
The human population at risk is the elderly.
The plan was developed with two key elements, community education and
surveillance. Education is about people targeting mosquito habitat and to prevent
Board of Health, 4/1/2003, Page 1
1 exposure to potentially infective mosquitoes. The education plan looks at habitat
2 reduction as a primary method of reducing exposure. Remove standing water
3 around homes. Mosquitoes transmitting this disease breed in small containers
4 rather than in large wetlands.
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6 Crawford asked how far the mosquito travels from its source of breeding.
7 Vesper stated mosquitoes do not travel far. Most of the bites occur in the breeding
8 areas. They also want to provide people with information on how to prevent bites.
9 Reduce risk by altering behavior, such as wearing appropriate clothing.
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11 There are several outlets to present these messages, including the media.
12 They engage in discussions with community groups, enhanced the website with the
13 information, and distribute information packets.
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15 The second part of the plan involves surveillance. It will look at occurrence
16 and distribution of the disease and the mosquitoes. Once the local mosquito
17 breeding sources and the distribution of the breeding species are known, they can
18 examine the most appropriate response for mosquito control. Disease surveillance
19 involves continuing with dead bird surveillance. Surveillance of birds will indicate
20 whether or not they continue to have West Nile virus in Whatcom County. Horses
21 are another source for surveillance. They will work with veterinarians to provide
22 information on their experiences with West Nile virus in horses. The mosquito
23 surveillance will trap and study the mosquitoes. If they have human cases, the
24 epidemiological data gathered will help develop more appropriate responses.
25 Mosquito surveillance looks at types, sources, and density of mosquitoes. He
26 described how they survey the mosquitoes and identify the species.
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28 The Health Department is not funded and doesn't have a mandate to do
29 mosquito control in the community. Surveillance data will provide a better handle
30 on an appropriate level of mosquito control. He's not prepared to recommend
31 forming a mosquito control district, although there may be areas that warrant it.
32 Some things can be done for mosquito control. The State Department of Health is
33 applying to the State Department of Ecology for a general permit to allow the use
34 of larvae-cides on state waters. They are asking local health jurisdictions to be a
35 clearinghouse for applications coming from pest control operators and land use
36 managers for the control of mosquito larvae in the lands under their jurisdiction. At
37 this point, they don't know what that will entail.
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39 There are a number of partners that he anticipates being helpful in mosquito
40 control, education planning, and surveillance. The Cooperative Extension is one of
41 those partners. They have the technical expertise in integrated pest management
42 and an entomologist on staff. Other partners control the public lands.
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44 The Health Department hasn't gotten any money to do this. They have
45 found a small amount of unspent State contract funds. That money will not be
46 available after June. If the West Nile virus is a significant problem in Whatcom
47 County, the Health Department will probably pursue extra funding.
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Board of Health, 4/1/2003, Page 2
1 Caskey-Schreiber asked what they are getting for the $20,000.
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3 Regina Delahunt, Health Department Director, stated they are using it for
4 extra help to do the surveillance. Fortunately, that was money that was not going
5 to be spent.
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7 McShane stated they have potential partners. He asked what sort of budgets
8 those partners have worked out to do this type of work. Vesper stated he didn't
9 know. They've had limited discussion with these folks about the problem. At this
10 point, other than with Cooperative Extension, there hasn't been a lot of discussion.
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12 Fleetwood asked if a mosquito control district is authorized by the State.
13 Vesper stated it is not. The Board of Health would authorize it and it would go to a
14 public vote. It is a taxing authority that would be funded through property taxes.
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16 Delahunt stated that under State law, mosquito control districts, not the
17 Health Department, have authority to control mosquitoes.
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19 Fleetwood asked the beneficial purpose of the mosquito.
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21 Todd Murray, Washington State Cooperative Extension entomologist, stated
22 they are a food source for the birds.
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24 Nelson asked if the initial money would be for public education and finding
25 out the impacts to Whatcom County. He asked if the Board of Health would receive
26 a report on those activities. Delahunt stated the Health Department will give the
27 Board of Health a report on what the surveillance activities found. If there are
28 areas in the community that have a high likelihood of having the disease transmit
29 to sensitive populations, the Health Department will let the Council know. The
30 funding they have now is minimal.
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32 Nelson stated West Nile virus has a stigma attached to it. He's concerned
33 that the public will come forward to petition the Council, and the Council won't have
34 the information to respond. Vesper stated they intend to gather more information.
35 There is no threshold for establishing a mosquito control district. The Health
36 Department would combine information with other sources in the State and look at
37 best management practices. There is not a lot of information on threshold data.
38 Many areas of the country that have had cases already had mosquito control
39 districts. The risk of this disease isn't devastating. However, areas where
40 mosquitoes are a pest problem are areas where they might want to form a
41 mosquito control district to deal with the pest, not to manage the virus.
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43 Nelson stated there are many small landowners with ponds and such. He
44 asked if the methods available to large landowners, due to the State permit, will be
45 available to those small landowners. Vesper stated private pest control operators
46 should be able to control those areas.
47
Board of Health, 4/1/2003, Page 3
1 Delahunt stated she believes that, according to the State discharge permit,
2 private landowners will be able to hire a private pest control operator under. If the
3 Whatcom County Health Department is the clearinghouse for collecting the
4 applications, it may become a burden. They are still looking at what kind of an
5 impact it will have on the Health Department.
6
7 Nelson suggested amending wording in the public materials so the public
8 doesn't get the impression it can fill in wetlands. He suggested they work with the
9 Planning Division on that language.
10
11 Crawford stated the Council must be responsive to the fact that the West Nile
12 virus will continue to make headlines, regardless of the actual public health risk.
13 He suggested that the Health Department come to the Council if it needs a fulltime
14 person to deal with this problem. No amount of explanation is going to overcome
15 the perception of the problem. The County must be well -staffed to deal with this in
16 every possible way.
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18 Roy asked if they can estimate how long it will take before they can expect to
19 see human infection cases locally. Delahunt stated it's expected that there will be
20 human cases in Washington State this year.
21
22 Roy asked if it would stay in the environment forever, or move through and
23 go away. Vesper stated that in previous outbreaks, they have seen increased
24 numbers first, and then a decreased number of cases. They don't know the reason
25 for that. It could be a built-up immunity in the birds, so the virus is not maintained
26 for a while, but that is disputed.
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28 Roy asked if that is information that the Health Department would look at.
29 Delahunt stated the disease is in the animal host locally. Outbreaks may be cyclical
30 through the years.
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32 Roy asked how long has it been since its introduction in the U.S. Vesper
33 stated West Nile virus was introduced in New York in 1999.
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35 Caskey-Schreiber asked if this would affect the reserve funds that are
36 available to deal with any other crises, such as severe acute respiratory system
37 (SARS). Delahunt stated she would update the Council about that at the end of the
38 meeting.
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41 3. OPIATE SUBSTITUTION
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43 Dac Jamison, Substance Abuse Advisory Board Chair, stated he provided
44 information in the packet about a State law that has changed. Currently, Whatcom
45 County has an ordinance on the books that bans methadone treatment facilities in
46 Whatcom County. That is no longer something the County can do, even though the
47 ordinance is on the books. The State removed the County's authority to approve
48 these places. However, the County can address the siting of these facilities. The
Board of Health, 4/1/2003, Page 4
1 Substance Abuse Advisory Board looked at the different aspects of opiate
2 substitution. Research shows that it can be very beneficial for some people as long
3 as it is coupled with case management and treatment. The advisory board
4 recommends criteria for people to be eligible to receive public money. The State
5 Division of Alcohol and Substance Abuse (DASA) is looking at regulating and coming
6 up with procedures to do the morphine treatment. The advisory board wanted to
7 be proactive in developing criteria that people must meet to qualify for public
8 funding.
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Fleetwood asked what motivated th
e
Caskey-Schreiber asked if the advisory board supports starting a treatment
program. Jamison stated it does not. It is a neutral recommendation. DASA could
receive notification from a vendor that it wishes to start a methadone or opiate
replacement system in Whatcom County. DASA would notify the County and try to
be cooperative with the County all the way through the process. The vendor can be
denied for various reasons, but not just because the County doesn't want it here.
Caskey-Schreiber asked if the advisory board looked into how many people
might benefit locally. Jamison stated there is a recognized problem. There is no
true estimate of heroin users in Whatcom County. His estimate is about 350
people. Substance abuse providers would estimate many more than that. One
vendor can only serve 350 people.
Caskey-Schreiber asked if the substitution facilities are government -funded
or make a profit. Jamison stated some are non-profit and some are for -profit. The
non-profit agencies typically couple with case management and treatment services.
The drug cycle affects all people in the community. Every heroin user in town has
to get the money for the drugs. The general community supplies that money
through car prowls, thefts, check forgeries, and other activities.
Caskey-Schreiber asked if Mr. Jamison has an opinion on whether or not they
should start a program locally. Jamison stated this discussion is to let the Board of
Health know that the State law has changed. Also, if a vendor comes in, these are
reasonable criteria for a vendor to operate by.
Nelson stated the County put together a needle exchange program a few
years ago. Buprenorphine is listed as an alternative to methadone. The Food and
Drug Administration has not approved it for addiction. Jamison stated that is
changing.
Jackie Mitchell, Substance Abuse Program Specialist, stated there is an oral
dose now.
(Clerk's Note: End of tape one, side A.)
Board of Health, 4/1/2003, Page 5
1 Nelson stated they don't have City of Bellingham representation on the
2 Substance Abuse Advisory Board. It would be important to draw in one of the City
3 Council Members on the advisory board.
4
5 He moved to recommend that the advisory board work with the City Council
6 to look at some of those planning issues and bring back recommendations for
7 zoning changes in case an agency locates here. Be proactive in deciding the
8 appropriate places for locating these vendors. To move this along, extend an
9 invitation to the City to participate with the advisory board on this issue. He would
10 like to see a permanent position for the City on the advisory board.
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12 Crawford suggested that this presentation be given to the City Council.
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14 McShane stated the current County law prohibits methadone treatment
15 programs. He asked if the City prohibits them. Jamison stated it does not. If the
16 City decided it wants to have a facility, it would have to fight the County ordinance.
17
18 McShane stated these programs need to be coordinated. Keep in mind the
19 goal to have a treatment center away from the population and away from other
20 users. Jamison stated the State law does not say that the provider has to provide
21 treatment or case management. It could be a clinic setting where someone walks
22 in, gets a daily dose, and walks out. That's why his recommendation is to also
23 require case management. He can work with the City as requested. The County
24 ordinance is now against the new State law.
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26 Nelson restated his motion that the advisory board works with City of
27 Bellingham to come up with appropriate zoning for the vendors. Jamison stated
28 that most heroin users, if they don't live in Bellingham, will come to Bellingham for
29 the drugs. Transportation is an issue for low-income users.
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31 Fleetwood asked if the siting jurisdiction is countywide, including the cities,
32 or just in the unincorporated areas. Jamison stated the City of Bellingham takes
33 care of its own zoning. DASA will come to the County Council to work with the
34 County about the vendor, and it will be a broader public issue. If it is discovered
35 that they will need to site a facility in the city, which will probably happen, then the
36 City has a right to say what the zoning is. The County code bans them altogether.
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38 Roy asked if the Council needs to remove the conflicting County ordinance.
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40 Fleetwood stated the County ordinance would just be void.
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42 Roy asked if they could describe the parameters of a treatment program in
43 the zoning code. Jamison stated that authority rests with the State. It has a
44 number of qualifying criteria. Here, they are trying to say that they won't provide
45 public money unless there is case management included in the program.
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Board of Health, 4/1/2003, Page 6
1 Nelson restated his motion to go back to the advisory board with an
2 invitation to the City Council because it is an issue, and come up with
3 recommended zoning requirements to meet the needs of the State law.
4
5 /►Motion carried unanimously.
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7 Nelson suggested that McShane work with the Bellingham City Council
8 President to review future issues on boards that deal with joint County and City
9 issues.
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11 Crawford stated they would discuss it at the next advisory board meeting.
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14 4. SMALLPDX PLANNING UPDATE
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16 Regina Delahunt, Health Department Director, stated the stage one
17 immunization process is what they are going through for public health and hospital
18 workers and the military. In Washington State, 350 public health workers and
19 hospital workers have been immunized. Forty-five individuals in region one, which
20 is five local counties, have been immunized. In Whatcom County, five public health
21 workers have been immunized. The Center for Disease Control (CDC) put future
22 immunizations on hold because of heart problems that have occurred. The CDC is
23 redefining its screening tools. It will take a week for those to be vaccinated to go
24 through the new screening process, and immunization clinics will start up again in
25 two to three weeks.
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27 Event planning for smallpox outbreaks has been going on at the regional
28 level. Individuals from different counties volunteered to be part of a smallpox
29 response team, should there be an event. They are working on a regional level to
30 ensure that people who have been immunized and trained are available to respond.
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32 Fleetwood asked for a primer on smallpox.
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34 Dr. Greg Stern, Health Officer, stated it is a virus that was eradicated in the
35 1970's. It now comes from repositories of the virus in the U.S. and Soviet Union.
36 The issue is the security of those repositories. There is a question of whether the
37 virus was distributed clandestinely. There is conjecture that it has happened, but
38 no case has been diagnosed since 1979. These preparations are for the intentional
39 release of smallpox as a bio-weapon.
40
41 The infection is passed through close contact. There is a respiratory phase
42 when people develop lesions in their throat. It is followed by a rash that sheds the
43 virus. About 30 percent of those infected would die. The vaccine is derived from a
44 related virus. It provides immunity from smallpox. The vaccine is very effective in
45 preventing the disease. If given within a few days of exposure, it can stop the
46 infection and reduce its severity. When they eradicated smallpox, they found that
47 it is best eradicated when they arrest the spread of the virus.
48
Board of Health, 4/1/2003, Page 7
1 They are working on smallpox emergency response teams that will assess,
2 treat, and vaccinate people. Stage two and stage three are the expansion of the
3 vaccinations. There is controversy in the public health community about the need
4 to do that. The vaccine is potentially dangerous. It can cause several serious
5 reactions. The CDC is revising its screening guidelines.
6
7 McShane asked if there are anecdotes for blood and nerve agent attacks.
8 Stern stated that would be a question for the emergency response teams. They are
9 looking into having adequate supplies of drugs needed to treat attacks of nerve
10 agents. The Health Department doesn't have it.
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13 OTHER BUSINESS
14
15 Crawford stated the severe acute respiratory syndrome (SARS) disease is
16 going into Canada and the Chinese population is large in Vancouver, B.C. He asked
17 the appropriate response they should take if SARS takes a hold in Vancouver.
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19 Dr. Greg Stern, Health Officer, stated they should see what the Center for
20 Disease Control (CDC) and State Department of Health recommend so they don't
21 make policy on their own. There are a lot of good minds responding to this. In
22 terms of SARS in Canada, Toronto has had a lot of cases, but they are limited to
23 those who have traveled from the infected areas and health care workers in close
24 contact with those people. There hasn't been a spread in the general community.
25 It is the same situation in Vancouver. They are isolating those contacts. Measures
26 are being taken. They are working out guidelines for evaluating patients. The
27 dilemma is that the symptoms of SARS overlap those of common respiratory
28 illnesses. If they do a major response, a lot of people with just colds will have to
29 be isolated for ten days. There needs to be a balanced response. He looks to the
30 public health professionals to provide the appropriate response.
31
32 Delahunt stated the State Department of Health is hosting a conference call
33 to discuss what a suspected case would look like.
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35 Stern stated the Health Department will provide recommendations to the
36 County Council if public policies are needed.
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38 Caskey-Schreiber asked if the Council needs to respond to the State public
39 health financing memo from Ms. Delahunt, dated March 27 (on file).
40
41 Regina Delahunt, Health Department Director, suggested that a
42 councilmember attend the State Board of Health meeting.
43
44 Crawford stated he doesn't know what to say in a letter. The Council could
45 put its blessing on a letter during the next Council meeting.
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47 Delahunt stated she could draft a letter for the Council to approve.
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Board of Health, 4/1/2003, Page 8
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Nelson asked if the proposed property tax requires a vote of the people of
the state or the local jurisdiction. Delahunt stated it requires a vote of the people
of the state.
Crawford suggested that they just discuss in the letter the concerns about
funding issues.
McShane suggested keeping the letter very simple.
ADJOURN
The meeting adjourned at 12:01 p.m.
Q�
Jill Nixon, Minutes Transcription
These minutes were approved by Council on April 8 , 2003.
ATTEST:
Dana Brown -Davis, Council Clerk
WHATCOM COUNTY COUNCIL
WHATCOM COUNTY, WASHINGTON
1
1
Da McShane, Council Chair
Board of Health, 4/1/2003, Page 9