1. COVID-19 Presentation: Bruce Van Zee, MD, Retired Physician & Chair, Jefferson Regional Health Alliance; Courtney Wilson, MD VP Medical Affairs, Asante RRMC; Christopher Pizzi, CEO, Providence Medical Center; Jason Kuhl, MD, Chief Medical Officer Providence Hospital.

— Dr. Van Zee: Our country and this county have become polarized over the pandemic where some believe it is a hoax, that restrictions impinge on freedoms. He wants to avoid a political discussion and rather have leaders come together to follow scientific conclusions and find common ground. At end of presentation will give recommendations to endorse guidelines, to have a uniform message. Acknowledged COVID fatigue, looking forward to the spring and vaccines, but this is not forever.

— Pizzi: Portland is experiencing a surge and is bursting at the seams and numbers are increasing locally. Caregivers are fatigued, getting sick, or are exposed and have to stay away for long periods. Locally we have problems in discharging patients to Long Term Care (LTC) and other similar facilities because of COVID. Portland, as of today, is cancelling all “elective” surgeries. Locally they evaluate daily and only cancel when they feel they must. Are expecting a post-Thanksgiving surge. Must find a way to decompress the pressure on the system and caregivers.

— Dr. Wilson: She is also a practicing physician – works in the Emergency Room and now in administration. She described an analogy: Firefighters have a red flag day, notices and warnings have gone out to all. Team is on high alert to respond as they have practiced for a long time. A fire starts and as the team rushes to the scene they see multiple people starting more fires. The team begs them to stop setting more fires but the people say they have a right to set fires and the whole thing is a hoax. The pandemic is the same. Situation has changed from the spring 2020 when Oregon could send ventilators to other states. Now the entire country is experiencing an outbreak and we cannot count on resources coming to us. We have staffing shortages, and if they become ill, they are out for weeks, employees have childcare issues. She collaborates across the state – if locally hospitals are full, there is no where to transfer patients. Masks work to prevent the spread of disease and the use of masks is associated with increased economic activity. Asking BoC to please help flatten the curve.

— Standard of Care is an issue they are now having meetings about in ethics committees. If the hospitals run out of resources (staff, beds, equipment) they will have to make very difficult decisions about who will receive treatment. Locally we could face this if things do not change.

— Dr. Kuhl: He collaborates with Asante and Providence is going through the same analysis of resources and how to ration care. Caregivers are currently exhausted, tired, sick and there are staff shortages. He heard a story of a 16-year-old boy in Portland who was assigned the task of monitoring the wearing of masks to come into a facility. The 16-year-old encountered an older man not wearing a mask and asked him to put one on. The older man went into a tirade about his civil rights. Dr. Kuhl asked that they view mask wearing as a social responsibility to the community and to each other.

— Dr. Van Zee RECOMMENDATIONS that BoC participate in a PR Campaign saying:

— Asking the public to hang in there, that a vaccine is coming and we need to comply with restrictions a bit longer.

— Emphasizing the need to take the vaccines when they become available. There is a large anti-vaccination population in Jackson County and the medical community needs help convincing them to take the COVID vaccine.

— Encourage supporting restaurants by getting take-out several times a week.

— It is our civic duty to wear a mask as it protects others.

— Consider postponing property taxes on hospitality industry. He would be willing to pay a surcharge to offset the loss.

— There is increased evidence that schools are not the super spreaders we once thought. Recent data indicates young children may not transmit the disease as well as adults. It is reasonable to look into opening classroom for children at 5thgrade and under now.

— Encourage everyone to follow all of the guidelines.

Dyer: Hope haven’t given the impression that they are against the protocols. Every death is a tragedy. They have same goals as doctors but would come at it differently and have different policies (Note: A lot of discussion throughout about setting policy. Throughout the discussion staff reminded the public that BoC CANNOT set COVID policy. They can complain and try to influence, but that is all). He has participated in recent PR messages and he’s never been opposed to following the Public Health recommendations. He wants to take all information from all sources and come to an evidence bases solution.

–Dyer doesn’t think restrictions are addressing the problem. The problem is in the LTC facilities and that’s where the bulk of resources should be allocated – daily testing, better protocols. Says the county isn’t seeing large numbers of cases in other businesses who have now been shut down. Wants surgical approach. Wants to find a way to jointly message to reduce spread.

— Strosser: Thanked the medical people for coming and is looking forward to receiving letters from them. He then reiterated that LTC facilities are the specific concern and doesn’t feel the state is allowing for nuances that are unique to Jackson County. Wants state to collaborate and consult with them. He too is doing the PR campaign with Dyer.

— Dr. Van Zee: University of Oxford study came out about 1 ½ weeks ago – Looked at restrictive and non-restrictive state policies. Correlation found between the least restrictions and the most cases. South Dakota is about 1/5 size of Oregon and now has the same number of cases and deaths. If loosen restrictions in Oregon, could expect 5 times the hospitalizations and deaths. Also, Oregon has the least number of hospital beds per capita of any other state, which shows we are at risk.

— Roberts: BoC represents a wide range of people and businesses. Want to work with the medical people and the businesses. Glad they are there. Have been hungry for information from hospitals.

— Dyer: Do they have an idea of percentage of hospitalizations coming from LTC?

— Dr. Kuhl: They don’t track that data. However, Dr. Kahn who manages the LTC facilities for Avamere has done a yeoman’s effort to manage the cases in place; that is why deaths are occurring in place rather than in the hospital. Providence has 23 cases that could go to LTC facilities under normal circumstances, but they cannot place them because of COVID.

— Dr. Kuhl understands the concerns about businesses. Contact tracers are overwhelmed which means that because cases aren’t being tracked, it is adding fuel to the fire by adding to exposure because of no tracking.

— Dyer: Would they agree that a more robust approach at LTC facilities would stem the spread? He then went on to dismiss the Oxford Study by saying LA County in CA has his restrictions and high cases.

— Dr. Wilson: Asante is facilitating testing at LTC. They send their mobile unit to the sites. A lot of high-risk people DO NOT LIVE IN LTC. Those in LTC are not choosing a high level of care, but those who are not in LTC are not likely to choose to die at home. Dr. Van Zee pointed out that as people go to the hospital and go on ventilators, that equipment is no longer available for heart attack, etc. patients.

At this point Roberts thanked them for attending and the BoC moved on to the next topic.

2. Input from County Administrator: Harvey Bragg went over Wednesday’s agenda (routine) which includes two public hearings – one each on ambulance service in Ashland and Medford/Jackson County. There are no fee increases and only one responder in each case.

— Bragg then presented Order 188-20 authorizing the grant from state for CARES Act funds that will go to SOREDI for distribution. The BoC approved this order accepting the money. The BoC then went on to 189-20 approving the agreement with SOREDI to distribute the $2,438,226 (Jackson County’s share of $55 million announced by Gov. Brown). They couldn’t officially approve this agreement yet because they still need an insurance document. Dyer said he is “talking to a couple of businesses” about this funding. Bragg pointed out that there are specific businesses who have been impacted that will be given priority (he read a long list of small service-type businesses) and minority owned. This grant allows SOREDI to be paid an administrative fee of 5%, so if all of the money is disbursed, they could get as much as $121,911. SOREDI will review all of the applications. At the moment, the maximum amount per full time employee equivalent that could be granted is $10,000 but that will be decided after applications are received and reviewed. Dyer is concerned that the amount isn’t enough. Colleen Padilla of SOREDI was allowed to comment. She said that they are also working with Josephine County to have a consistent approach to the application process and the total amount for both counties are $3.6 million.

3. Fire Issues & Recovery Efforts:

— Bragg – Housing efforts are continuing; clean up continuing; RV park people are starting to move in.

— Roberts asked the status of the Emergency Response Evaluation – Bragg said that an Intent to Award Contract for $45,000 has been issued. The contract will be signed soon – having been delayed only by the Thanksgiving holiday.

— Dyer wanted to recognize the great job being done by staff at the EOC and other agencies. With minor bumps in the road, have been moving along efficiently and have done a great job. Hopes the efficiency will continue in the rebuilding process. Strosser pointed out that Jackson County has about ½ of the rooms in the state used for fire recovery housing. RVs are being purchased from all over the state. John Vial reported that the Direct Housing number is down a bit from +/- 300 to 282 households currently. 14 trailers are moving into So. OR RV Park and the Red Cross is moving some of their units out to Emigrant Lake. 8 Mobile Home Parks are in the clean up stage and getting ready to locate mobile home units (MHUs). Dyer then launched into his idea that the MHUs should be used for permanent housing – despite the repeated explanation that it is up to the landowner, FEMA and individuals and the process is lengthy and difficult.

4. COVID 19 Discussion and Updates: Roberts sent the 11/18/2020 letter to Wallan, Stark, Marsh and Golden. The letter was actually based on objecting to imposing the freeze metrics. Since that’s already been done it’s a tough letter for the BoC to sign off on at this time. Strosser is concerned about strategically tying metrics to the unique problems in Jackson County. Wants the state to work collaboratively with BoC instead of one size fits all.

— Dyer: Dyer then went on a discussion of statistics he quoted which he contended proves that the vast majority of cases come from LTC facilities. He is very upset about shutting down restaurants and bars and said that the restrictions would go on “indefinitely.” (Note: the medical people in #1 asked for a different message, see above).

— Jordan pointed out that the statistics Dyer is using is focused on where contact tracing has been used in outbreaks and that there are a whole lot more cases that are not being tracked and in tracked cases no everyone will cooperate by giving information. He said he goes to a gym regularly and there has been no outbreak among employees of the gym but there is no information on whether cases have occurred at the gym – simply do not have this information. Does not mean that spread isn’t happening. Don’t have a full picture.

— Dyer: (not to be deterred by facts) he said that it is reasonable to conclude that if employees are not getting sick at the gym, then no one is getting sick at the gym.

— Strosser pointed out that we do not know what employees of LTC facilities are doing or where they are going in their outside activities.

— Jordan also pointed out that Dyer did not acknowledge the 7 restaurants reported with outbreaks in the data he was using. Further, he said staff disagrees with Dyer’s conclusions and assumptions. Strosser and Dyer still feel Jackson County is unique. Dyer said that 6 of the 7 restaurants were over their outbreaks and the last one was almost done. Dyer said he is not dismissing the problems, rather he is trying to make policy on data he feels is relevant. Roberts pointed out they don’t make policy.

— Roberts still concerned about PCR tests and what they actually detect.

— Dyer again discussed concerns about kids not being able to play sports or be in school. Bragg again pointed out they can’t make policy but if people want to complain they should write to the governor. The discussion continued in this vein for some time with Jordan pointing out they don’t make policy. Eventually County Counsel pinned them down that they want to write a letter of complaint to the Governor and if they get their separate comments to him today, he will have a draft for Thursday.

— Jordan confirmed that they DO NOT want to do a press conference today.

The end.

(I hope it isn’t lost on anyone that the BoC took no action whatsoever on the recommendations made by our local medical professionals or that they ignored the information that LTC facilities are being tested and that community spread is not being tracked because contact tracers are overwhelmed, or that people are not cooperating with the contact tracking.)