By Mary Alice Murphy

[Editor's Note; This is the first in a multi-part series of articles on the Grant County Commission work session and regular meeting for December 2020. At the end will be the slides in PDF format of this first presentation.]

The first presentation at the Grant County Commission work session held Tuesday, Dec. 15, 2020, was given by Renee Despres, who consults on public health issues, and Jeff Fell, Silver City Emergency Manager, on behalf of the Grant County Community Health Council's Emerging Infectious Diseases Task Force. Despres turned it over to Jeff Fell to begin, explaining that he was co-facilitating the task force with her.

Fell said Despres would cover the Covid issues and he would give an overview of what the task force has been doing, including response models.

Despres presented some data. She said she wanted to show that Grant County is in red, but to explain what it needs to get to the green status in the red, yellow, green model the governor has ordered. She said Grant County has increased its testing rate but has not reached the gating criteria of no more than 5 percent of the tests being positive. She said the Thanksgiving blip was beginning to occur. The rate is per 1000,000.

Fell presented the task force mission, vision and goals. "We are definitely a non-partisan, evidence-based, data-driven group of people who are looking to organize in a way that can be a model for other communities. We're trying to communicate accurate and science-based information." He described and showed a slide of the structure of the task force, which he said is working very well. "We're under the Grant County Community Health Council and we're reporting to you today as county government. We also have liaisons with the Department of Health on local and state levels. Our task force is comprised of a steering committee that meets every Friday at noon, and off that we have six working groups. I will talk about each group a bit later on."

Renee talked about the Swiss Cheese Respiratory Virus procedure and defense, developed by one of the world's leading virologists. She said it shows how everyone has to take responsibility for their actions, as well as shared responsibilities, and that not just one thing can help stop the spread. "We are excited that our hospital will be getting vaccines this week, but that is just one slice in this model. All the interventions have to be lined up. We have been focusing on the governor's orders, physical distancing, masking, hand hygiene, cough ethic—things that individuals can do and choices they can make. Shared responsibilities include businesses and government. Government can provide support, especially in messaging, such as 'No place like home for the holidays.'"

Some of the things the group has been doing. "We have a strong group in communications. We are trying to get information out to people. We are also working with Ken Sexton, with his specialty in airborne viruses."

The Coronavirus update site is one of the things the prevention and outreach group has created, plus sending communications to the Silver City Daily Press and Grant County Beat.

Fell discussed the education group. "It is headed up by Curtis Clough of Silver Schools and he has a pretty strong group, including Cobre Schools that just got on board, as well as representatives of private schools and the charter school." A slide shows the priorities of safety and essential needs of children and families; educating safety effectively in a COVID-19 environment, as well as safety of the workforce. Actions include the delivery of meals, online learning, professional development and broadband access and a need for access to rapid testing and contact tracing. The need from the county is transportation and support for food distribution, broadband and public health support for rapid testing and contact tracing.

He said distribution of food has been a problem even with the food pantries. "We are trying to get the volunteer fire departments to help with the distribution, especially in the more rural areas. It's not a supply issue, it's a distribution issue. And broadband is always a problem."

Fell said that law enforcement has become involved to check on children and families.

Dan Otero is heading up the Health Care and Public Health committee. Fell said it was a very well-functioning group with the hospital, HMS, Silver Health Care, Fort Bayard and sometimes other health care agencies taking part.

"We talk a lot about workforce shortages and safety," Fell said. "Fort Bayard has had some issues with their dementia patients, trying to keep them isolated. Currently our focus is on immunizations. We had disruptions in flu vaccine. Now we're focusing on the distribution of the COVID vaccines as they come in."

He said the need from the county is emergency workforce support. HMS had to close some of their facilities, but those affected moved into other clinics. He noted that Fort Bayard has needs at all levels for workforce.

Despres talked about the Economic and Workforce Recovery group, which is headed by Steve Chavira of the Silver City-Grant County Chamber of Commerce. A survey has been developed for local businesses to assess their needs.

"Chavira has been leading a tremendous effort among local businesses to determine how they can operate in a safe COVID-19 environment," Despres said. "We've had support from Melanie Goodman from Sen. Udall's office especially around broadband access and retraining of the workforce. They are working with the COG (Southwest New Mexico Council of Governments, under Executive Director Priscilla Lucero) to develop a communications database. They've tried to help with sustainability for the smaller businesses. What we need from the county is technical assistance, and coordination, as well as accessing some of the funding for these needs. The group did receive an EDA grant to pursue workforce development and sustainability."

Fell said they didn't have reports from two groups, social services and safety net. "They just recently got off the ground this week. The director of Millie's Assisted Living agreed to be in charge of the social services committee. She is working with The Gospel Mission and The Commons to try to identify areas of the community and the county that need food or possible housing assistance while they are quarantining. She's doing some good work. Our safety net, we're trying to get off the ground."

Despres said a Silver City police officer reported he has seen a decrease in calls from at-risk people that he knows are in need of services, whether it's food or housing or neglect or abuse. "We're trying to find where the gap is. We also are hearing that statistically there is an increase in domestic violence. We want to figure out ways to address that. Some of the collective issues we have learned from the collective group are food security, and we have several resources, but we have challenges with distribution and supply lines, as well as the 75-person limit in the food stores. They reach across all socio-economic levels. Risk communications remain a huge issue and one of the things we think we can be most effective with. We have a broad range of resources in the group, ranging from communication experts, such as Sabrina Pack, who is participating with us, social media and grant writing. We are seeing too much misinformation, evolving information and no official county public information officer or incident management structure. And, of course, we always need funding. We've been pulling money out of our own pockets for some of the things we've done."

Fell said the health care system issues are helped by a strong coordination of primary care services, the hospital is becoming involved, and "we are sharing resources, have support from the New Mexico Department of Health, as well as technical support and availability of isolation facilities from Doña Ana County. We all meet on a weekly basis and sometimes more often." He said the challenges are still holes in the communication between entities; not knowing in what parts of town first responders might be exposed to Covid unknowingly; slow test results with some taking as long as two weeks; difficulty getting enough PPE and it's having to be fit tested plus it's expensive; limited contact tracing from the state and the complexity of contact tracing for employers. There are a lot of needs that have to go through county emergency management, including transportation, resource needs and alternate care centers.

He said there is room for volunteers who are doing a lot of work. "We have completed well over 2500 hours of work locally. We meet multiple times a week to make sure our response for the county to be the best it can be."

District 4 Commissioner Alicia Edwards said: "I'm amazed at the amount of work you've done. It's astonishing what a motivated group can do and succeed. I hope the county can support your efforts."

District 5 Commissioner Harry Browne acknowledged Edwards for helping to put the group together. "Has the hospital worked with you on the vaccines coming in?"

Fell confirmed that the hospital is working with the task force. "We're aiming at a fluid and fast-moving stream of information. This vaccine is so fragile, everyone is preparing for it. William Hemmer (Gila Regional Medical Center infectious disease specialist) is working non-stop. I don't know if he has slept the last week. It's changing so fast, it's hard to identify who is being vaccinated. Group 1A was the hospital staff, with 1B being first responders. We want to make sure that none goes to waste. Hidalgo Medical Services also expects to get doses, with their employees the priority and once they are vaccinated, they will open up to others. It's remarkable the plan we've put together."

Edwards asked if other health care providers, such as Silver Health Care, Cassie Health and Southwest Bone and Joint are also receiving doses.

Fell said Hemmer would be the most qualified to answer that question. "I think the hospital and HMS were the only pre-approved ones. I know Silver Health Care applied, but it hasn't heard back. I would assume the hospital and HMS will include these clinics. I will be reaching out to Southwest Bone and Joint, as well as the VA Clinic to see if they are involved. I will also reach out to the long-term care facilities, such as Silver Care. I know Millie's is in contract with CVS for administering the vaccines. I presume Fort Bayard Medical Center will get vaccines. I'll reach out to Peggy White."

Edwards said she presumes the group has worked with the hospital to get dry ice for the vaccines. "Maybe they are working with W&N Enterprises for a stable supply."

Fell said he will reach out to make sure they deliver the supply needed. "We're learning as we're going. It goes to Memorial Medical Center in Las Cruces as the hub, where it is kept in the super-cold freezer. After it starts defrosting, it's good for five days. As we move into spring, we will have more serious discussions. The hospital has ordered a super-cold freezer that should be here by mid-January. This is for the Pfizer vaccine. The Moderna vaccine will likely get FDA approval this week and its storage is not as stringent as the Pfizer."

[Editor's Note: The FDA did approve the Moderna vaccine on Friday, Dec. 19.]

Edwards said she hoped there would be a memorandum of understanding with the hospital for their ultra-cold freezer so it could be shared with all the agencies.

"I believe there will be," Fell said. "I think it's a good-sized freezer, especially for a county of our size. I think there will be enough. It's also portable, so that vaccines can be taken to more remote parts of the county. It's on a portable electric system. I hear the hospital is getting the first shipment today. It's likely they are giving vaccines today."

Depres said there is an informal agreement with the hospital, but "we will pursue a more formal agreement."

"Thanks to the Grant County Community Health Council coordination, the task force is just for the sharing of information," Fell said. "Through this organization, it's certainly worth it."

District 1 Commissioner and Chairman Chris Ponce said he's been wanting to attend the meetings. "We need to get together among us as commissioners to make sure no quorum or rolling quorum shows up. You're doing a great job."

District 4 Commissioner Billy Billings thanked the task force for all its work. "Commissioner Browne and I have attended a few meetings. I wonder how many are planning to attend today."

Fell said: "We understand your concern of an inadvertent quorum We need to communicate with you. We plan to make this report a regular event with you. As I understand it, the hospital expected to get 100 vaccines this week, 100 next week and 100 the third week for 1A recipients. Then we will identify the 1B first responders over the next three weeks. The follow up shot is due 21 days after the first shot. HMS has been told they will receive their first doses from Moderna, but I don't know how many."

Billings said he went out to Walmart on Sunday abut 7:20 in the morning and there were long lines. "It was really cold and there were elderly people in line. I am concerned about the children and the elderly getting their food needs met. Because of the limited hours and the 75-person limit, which is consistent with the smaller stores, I have proposed a resolution to the governor to reconsider the hour limits or the number limits."

Fell said the lines were tremendously long on the weekend, upward of 3 hours waiting in line. "I have to ask what is so important in Walmart that isn't available in other stores. We have other stores. The governor restricted the hours in October. We didn't see the line issues until recently when she put more stringent capacity limits on the stores. The reason given for the stores to close at 10 p.m. and open at 4 a.m. for employees were for deep cleaning of the stores. I wonder if other stores have the ability to expand their hours and would they. I question whether there is a need to be standing in line. It creates long waits. And this time of year, the weather can turn quickly."

Depres said Ken Sexton is working with the group. "He has been looking at ventilation systems. We would like to do a position paper on all the issues, especially in a rural area, and the four strikes rule. We feel that capacity could be increased, but it requires following the other guidelines, such as masking and distance, as well as testing the ventilation. We can use science to get back to a more open level."

Browne said he didn't understand the limit of 75 in a facility. "Why did we shift from a percentage limits, which made sense to me, to an absolute number?"

Fell said he wondered the same thing himself. "The number 75 doesn't make sense to me. It should be a percentage of the capacity."

"As of now, I share your opinion," Browne said.

Edwards asked about the four strikes. Fell said it was technically still in effect, but if a store signs up for routine testing, and they have four rapid tests, they don't have to close for 14 days. Margaret Diaz at the Public Health Office here is doing tremendous work. She said it all depends on the number of employees. If they have more than 75 employees a contractor can do the testing, if fewer than 75, it falls on Margaret to do the testing. She is working many, many hours. She was surprised she got Thanksgiving Day off, because she thought she would be doing testing that day. That program, although well intended, is putting a burden on a lot of our local people. At James Hamilton you have to list your headquarters as the address if you have positive cases. With their three cases, they responded to a request and said the cases were not in Grant County but were part of working groups on the eastern side of the state. But they had to list the headquarters. We're dealing with that in town. Yes, we had cases in the fire and police departments, but they were spread out over three different places. Those things aren't taken into account on the watch list."

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The next presentation from Better City will be covered in a future article.