[Editor's Note: Due to the length of this work session, it will be broken up into several articles and some will be combined with the regular meeting. The first article will cover the presentation by the task force working on infectious diseases.]

By Mary Alice Murphy

The Grant County commissioners heard two presentations at their work session on Jan. 12, 2021. This article will cover the Grant County Community Health Council Emergency Infectious Diseases Task Force Activities Report.

The two presenters were Renée Despres, Ph.D., MPH, and Jeff Fell, Silver City Emergency Manager.

Fell began his report by thanking County Manager Charlene Webb for continuing the county support of the effort. "With everyone working together, everything is going well. The current COVID situation is the task force priority area. We are working on group priorities, actions and needs."

He said: "Unfortunately, we're going in the wrong direction. In December we were about 50 based on a population of 100,000; now we're at 73 based on 100,000 population. To date, we have had 1,107 cases, with 20 deaths in Grant County.

Despres said Fell is in charge of vaccines in the county, as she explained the Swiss cheese model.

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"The vaccine is only one slice of the Swiss cheese," she said. The model explains that each intervention (layer) has imperfections (holes), so multiple layers improve success.

"We have an emerging concern with a variant, which was found first in Colorado, and has been confirmed in California and New York, so it's spreading," Despres said. "It is much more transmissible and is affecting children more than the original virus. It's another concern."

She noted the county is helping with the current priority areas, including risk communications. "We need to keep current information in front of the public. On the vaccinations, we are always in contact with the top of the Department of Health."

Fell said Gila Regional Medical Center is doing vaccinations within the organization. Others who will be participating in giving vaccinations include physician's offices, including Silver Health Care, as well as Hidalgo Medical Services (HMS). "We have given more than 1,000 vaccinations in Grant County, mainly to the 1A group of physicians, nurses, first responders, and other health care workers. CVS has contracted to provide vaccines in long-term care facilities, such as Fort Bayard and Silver City Care, as well as in the smaller long-term care facilities, such as Sunset Vista and Millie's, which will receive vaccines later this week."

"The state has now opened up vaccinations to those in 1B, which are those over 75 years of age," Fell continued. "We have had a 62 percent acceptance of those to whom the vaccine has been offered, with 38 percent on the fence or declining the vaccine. These are not solid numbers as some are waiting to see reactions in those receiving the vaccines and some can't have the vaccine if they have had COVID within the past 90 days. Just today, the CDC suggested that might not be the best approach, because there is a wide range of those with immunities, such as the asymptomatic ones, who didn't even know they had the virus. I talked to Gila Regional infectious disease specialist William Hemmer and he said the 60/40 accept/decline ratio is about the same at the hospital. To my knowledge, there have been no severe reactions locally. I had my second dose last week and I had more reaction than the first time, but it didn't slow me down."

[Editor's Note: It was quite difficult to understand Despres when she was speaking.]

Despres said up to now, it's been mostly health care workers receiving the vaccine, and only adults and those age 16 years and up who are currently working in health care. "A reminder that we reach herd immunity only after 75 percent to 80 percent are vaccinated. In our county that means vaccinating about 17,000 people, so we need to increase the rate of vaccination." She said it's due to miscommunication, as well as misinformation. County Emergency Manager Gilbert Helton is helping increase communications.

"On contact tracing, we are in discussion with the state to do local contact tracing," she said. "The state contact tracing capability has been overwhelmed. We have an early draft of Grant County Cares, where we integrate contact tracing into a holistic spectrum. It's what the Health Care working group is working on. We want to protect our most precious resource, our hospital. We want to box the virus in, so people don't spread it to other family members. We are also seeking more funding for operations of the task force and looking at other potential sources of funding."

Fell said the task force structure has six different working groups. "We are mostly volunteers, but we are receiving a tremendous amount of work from everyone."

"Our prevention and outreach group has its priorities to prevent the disease from spreading," Fell said. "This brings us back to vaccines. The clinics are providing help on a small scale. We have high hopes to increase the volume of vaccines to the clinics. One issue we have is that we have no idea of how many people have registered with the state. We have plans for vaccinating them within facilities in the city limits. Helton is working on plans for vaccinating in the outer reaches of the county."

Actions that have been accomplished include print, radio and social media campaigns focused on the holidays, as well as a survey to assess needed website improvements. "We created a lot of media to tell people to stay home over the holidays and to remind people to protect health care workers," Fell said. "It was an idea of Kelsi Skee of Silver Health Care. It was a successful outreach. Another idea is running ads with health care workers talking about their experiences with the vaccines. They are working also to revamp the website: https://grantcountycoronavirusupdate.org . It has a lot of information, but they're trying to make it more user friendly.

Planned actions are vaccination communications rollout and creating messages about the importance of indoor air quality and ventilation, as well as low-tech ways to minimize risk in public spaces. "They are trying to reach out to those on the fence about the vaccine, who are waiting, to give them clear and accurate information."

Despres said Sabrina Pack of SkyWest Media is working closely with the group. She has helped amplify the messaging. "Things are moving so fast, we're having trouble keeping up with the information. We are also working on care packages for people who need them."

The Education working group took a well-deserved break over the holidays, she said. [Difficult to understand again.] Silver Schools is working "with us very effectively," Despres said. "They are also working with HMS so they can offer meals to seniors as well. It's great to see these actions as a result of the collaborative work we're doing."

She said the state is now offering home testing, with an online portion to help walk a person through giving themselves the test and then sending it back to the state. "The county is also working with us on food distribution for people that need it. We know they need it, but they don't know where to get it."

Fell spoke about the Health Care and Public Health working group. "This is a highly effective group working under Dan Otero, HMS CEO. The group is addressing health care worker burnout. They are working with two groups to offer mental health options, to give an outlet to health care workers. The group has as a priority also immunizations, including flu and COVID-19 vaccine distribution. The flu vaccine is still available and will likely remain so into March. Vaccinations have been our main push lately. We need the county to help with a plan for vaccinations into the community, now that 1B is open."

Depres noted that the group is working with the county on alternative care sites for those who are ill and need to isolate away from family members. She said that the 10 days after discharge from the hospital are the most dangerous for the former patients. "It we don't monitor them, it can be bad. Dr. Skee at Silver Health Care is always helping. We are working with Doña Ana County on technical assistance on the Care to Home plan."

Fell said work force is another issue, but that it was an issue before COVID and will continue to be after COVID. The clinics have adequate staffing and "we're starting to see entities work together compiling their work force to get care and vaccinations where needed. At our Public Health office, two ladies are working tirelessy over three counties. The hospital is helping us start to plan the vaccination clinics."

The Economic and Workforce Recovery group has as its priorities operating safely in the COVID-19 environment, reimagining service delivery, the need for broadband access and workforce retraining. "Freeport has had significant layoffs and it will impact the county," Despres said. "We haven't moved into communication with the larger employers. A survey for local businesses to assess their needs has been done and there's a database of the businesses. We are also looking at how businesses can help in the vaccination efforts. Or maybe laid off folks can play a part in the response. For instance, laid off hospitality workers could be trained to do contact tracing by phone."

The Social Services and Safety Net working group is off and running. They are working at getting the information out about what resources are available. Food distribution is a major priority of this group. "We and others have heard anecdotally about the need for finding affordable housing, but we don't have much data. Domestic violence remains an issue and addressing the needs of isolated people is a concern. Share NM is creating a database of resources, so we are coordinating with them. The county is also working with us to address some of the liability issues that can arise with volunteers."

District 2 Commissioner Javier "Harvey" Salas said the cases in Grant County have exploded. "Is that because of more bacteria or more testing? Would more testing reveal more cases?"

Fell said Margaret Diaz of the DOH public health office in Silver City had told him that they have seen fewer people getting tested, so much so that they are reducing the testing to one day a week. "Everyone said the holidays would increase the cases. We anticipate seeing a rise over the next couple of weeks. Silver City and Grant County are a hub for a couple of other counties. Plus, a lot of people are moving into the area trying to get away from more populated areas. When we do contact tracing locally within businesses and I do with the town of Silver City, we find that most cases come out of family gatherings. That's the case in about three-quarters of the cases I've seen. So, the spike after the holidays is not unexpected. According to Ken Sexton, if we continue this trend, we may be looking at close to 3,000 cases by the end of March. We went from 400 right before Thanksgiving to about 1,100 now. We are one of the four counties in the state to have significant increases over the past week. Most of the counties are seeing a decline in numbers."

Despres said the reason why "we're looking at comprehensive contact tracing is so people can stay home and not go out and expose others and because we are on an incline in numbers. This has become my mantra. Without good contact tracing, we're using testing as a diagnostic tool. Unless we can get people to stay home and if we do not do contact tracing, we can't box it in. That's when testing becomes a public health tool. I said Thanksgiving dinners will lead to Christmas deaths. Now we're seeing deaths from Christmas dinners. The spread is exponential."

District 5 Commissioner Harry Browne asked if there were any data on why 40 percent have declined the vaccination.

Fell said that he and Hemmer had had that conversation. "About half the 40 percent are on the fence and the other 20 percent are hard-nosed and not going to get the vaccine. What we're going to focus on is the 20 percent that are on the fence."

Despres said the task force is working with the state to get messaging. At that point, she said she had to leave very soon for another meeting, one with Lt. Gov. Howie Morales.

Browne said it was his understanding that no one can require the vaccination for work, because its available on an emergency authorization.

Fell confirmed that and said that right now there is no requirement. However, private and for-profit groups can put the stipulations on their employees. "I do not know the potential of non-emergency authorization."

District 4 Commissioner Billy Billings asked if Fell had an idea of how the vaccine is rolling in.

Fell said that several organizations can order the vaccine, Gila Regional, HMS, DOH and Silver Health Care. DOH at the local public health office, and Gila Regional are receiving the Pfizer vaccine and HMS is getting the Moderna vaccine. He wasn't sure what Silver Health Care would receive.

"Margaret Diaz at the DOH office here puts in an order every Wednesday and receives it on Tuesday the next week through the hub in Las Cruces," Fell said. "On that Tuesday, the National Guard brings the Pfizer vaccines. They go into the refrigerator and the hospital and DOH have five days to use them. I can't speak to the specifics on the Moderna vaccine."

"I guess my question is: I registered on the state vaccination site, but when can I get my vaccination?" Billings asked.

Fell said that has been a major frustration. "We can't get the numbers from the state to know who has registered for it. The ultimate goal is not to waste any vaccine, but we're finding that last week's order was not enough for the demand. Once we have a plan and a stable flow, I think we can do several hundred a day at Silver High School. If you have registered, you should get a telephone call, a text or an email for when you can get your vaccine."

District 3 Commissioner Alicia Edwards had a follow-up question. "The vaccination clinic will be on the Silver High School grounds and up to several hundred a day?"

Fell replied: "Yes, ma'am. The plan has been sent to the state for approval. We are also looking at Western, because we can only use Silver High School on the weekends, if the students go back to school. For the system to be running well, we have to be scheduling enough volunteers."

Edwards asked if the group has enough human capacity, for instance, to do vaccinations at Silver High School and San Lorenzo at the same time.

"We know that the Mining District is also interested and we could use Cobre High School," Fell said. "Dan Otero said the Moderna vaccine can only be given where it is stored. With the Pfizer vaccine, it will require a booster three weeks later. Margaret Diaz is looking at doing vaccination clinics twice a week."

Edwards asked if both the Pfizer and the Moderna vaccines require the booster.

"The Pfizer booster is due in 21 days," Fell said. "The Moderna booster is 28 days after the first shot."

Edwards said she was thinking about the outlying areas of the county. "We need to get 20,000 people vaccinated. Is it difficult to get it out to those areas? Can Pfizer be put in dry ice and taken to Mimbres and Mule Creek?"

Fell said dry ice is not an issue. "We're receiving it defrosted and it has to be administered within five days. If Mrs. Diaz is going to give the vaccine in Hidalgo County, she puts the doses into a cooler and takes it down there. Gilbert Helton wants to create sites in Cliff-Gila and Mimbres that can be replicated. The decision to be made is what days to do them. William (Hemmer) said the hospital is formulating a plan for reaching out to the public."

Edwards asked if the hospital was coordinating with Diaz to get out to remote areas.

"Yes, there is a lot of communication between the hospital and DOH," Fell said. "The hospital had two extra doses and Margaret found two people on short notice and gave the vaccinations to them. We have moved through the 1A folks, and we are getting into the 1B now."

The next article will address the presentation from WildEarth Guardians.

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