Routt County commissioners, public health officials answer COVID-19 questions live from audience | SteamboatToday.com
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Routt County commissioners, public health officials answer COVID-19 questions live from audience

Dr. Brian Harrington, Routt County Public Health chief medical officer, answers audience questions Thursday during a live virtual town hall.

Editor’s note: Due to an abundance of questions not all could be asked during the live session, but the Steamboat Pilot & Today followed up with additional questions and will publish the answers when they are received.

STEAMBOAT SPRINGS — In a town-hall style meeting Thursday, the Routt County Board of Commissioners and public health officials answered questions from residents about the county’s approach to dealing with the COVID-19 pandemic.

Questions ranged the spectrum of issues surrounding the virus. Testing concerns, vaccine confidence, local restrictions and how they were put in place were just some of the topics broached.



Routt County Public Health Director Roberta Smith and Routt County Public Health Chief Medical Officer Dr. Brian Harrington joined the commissioners, Tim Corrigan, Beth Melton and Doug Monger, to field questions virtually. Some questions were submitted prior to the meeting, but many were gathered from the live audience watching via Facebook.

The town hall was hosted by the Steamboat Pilot & Today and moderated by editor Lisa Schlichtman.



Here are some of the highlights from the live town hall.

 

Is the county going to force people to get vaccinated?

“No,” Smith said. “In public health, we don’t force immunizations on anyone.”

Smith said there are many recommendations out there about who should be vaccinated, but there is not going to be a mandate for the vaccine.

Harrington added that the vaccine will be free for everyone to get.

What is Dr. Harrington’s confidence level in the vaccine?

“My confidence has grown with the Pfizer vaccine and I would now put it at a I high confidence with it,” Harrington said. “This to me is a trust and verify thing. I trust our vaccine process in our country, we’ve done great through the decades with it, but we all want to verify the efficacy and safety of this vaccine.”

He said in recent weeks he has gained confidence by looking at the data himself, because the U.S. approved the vaccine, because another company has an independently created vaccine with similar effectiveness and that the United Kingdom had already approved the vaccine.

Harrington noted the vaccine did not skip steps on its way to usage, rather the process just moved really fast.

“I got my vaccine today,” Harrington said. “That’s because I have high confidence in the vaccine.”

Why doesn’t the public health board publish mental health, domestic abuse, child neglect, non-COVID morbidities and suicide data alongside the COVID case counts, hospitalizations and deaths?

“We do know that there have been some increases in some of these events,” said Smith. “We will be needing to work on our data sources for that.”

Smith said the public health department has been fully engaged in COVID data simply because of the amount of data that is coming in but said providing additional data as the question suggested was a good idea.

“I do think that is a good suggestion because that is important data,” Smith said.

You have claimed local restrictions have been maintained in order to secure state funding. On what basis and by what specific metrics have you determined that funding from the state provides a greater benefit to the community than relaxing restrictions and returning citizens to productive employment?

Commissioners denied saying state funding was contingent on restrictions being in place. In Corrigan’s understanding, the only state aid that would be in jeopardy if public health orders were not followed would be business relief recently passed by the state.

Of that money, Corrigan said he assumed it could be lost if the county stopped following state public health orders.

“There is an underlying assumption in the question about why Routt County has chosen not to operate like Weld County and to defy state public health orders. I don’t believe that I have ever stated that it is only due to funding, but I will state definitively that it is in the best interest of Routt County for us to be working in cooperation with the state rather than in opposition,” Melton said.

The state of Florida is now requiring that all labs release the cycle threshold values with COVID-19 test results. These CT values are important and many well-respected epidemiologist are on the record saying that a positive case with a CT value over 30-35 should not be counted as a positive case. Given that the positive case metrics are being used to justify shutdowns of many small businesses, shouldn’t our county be pressuring Gov. Jared Polis and the state to require the release of CT values with test results so that tests can be better interpreted?

“Somebody’s got a handful of who they claim are experts, we’ve got a lot of experts that say the other thing,” Harrington said. “Lets focus on the facts of things.”

Harrington, who has degrees from Harvard College at Harvard University, Dartmouth Medical School and the University of Washington and served 12 years in the U.S. Army, and said that in a PCR test the main test being used to detect COVID-19, a sample from an airway and amplifies the RNA to a point where it can be matched with DNA and identified as COVID-19 virus or not. This amplification takes place through chemical processes and depending on the test, a sample can be amplified a wide variety of different number of times.

He said PCR tests have been used to test for diseases for a long time and the technology is well understood. It is meant to give a dichotomous answer: do you have COVID-19?

“It was never set up to determine the degree of viral load or necessarily even infectivity. But it was set up to identify all cases,” Harrington said. “The idea that these are false positive tests is vocabularily probably an incorrect term.”

He said if anything the PCR tests are producing false negatives. It is dependent on many factors like the collection of the sample, how it is transported and when during the course of the disease the person is can all affect the outcome of a test.

“This is an ongoing issue for some people that we can somehow change the reality that we are facing. If we decrease the number of positive tests, that doesn’t allow me to discharge someone from the hospital that had COVID and say, ‘Well, you didn’t have COVID.’ It doesn’t remove a death from our death list,” Harrington said. “The cases are the cases and as much as we would like to imagine a different reality, this is the reality we are dealing with. Let’s have a debate about the policy, but we can’t wish away the reality that we face.”

Harrington said it is important to understand that the order in Florida came from the Governor and not health officials. It also does not outline what is to be done with the information and will not change how public health officials understand test results.

When most infected people younger than 65 have mild symptoms or are asymptomatic, why do public health officials use simple case counts as a primary metric to drive public health orders that shut down our community?

Harrington said health officials use cases because there is a clear, well-understood connection between them and deaths.

“The more cases you have, the more disease you have in the community. The more disease you have in the community, the more risk you have to everyone. The more risk there is to everyone, the more people you see getting critically ill. The more people you see getting critically ill, the more people you see getting hospitalized. The more people that get hospitalized, the more people that get intubated and so forth until you get to the point of more deaths,” Harrington said.

Still, he admitted it is frustrating to realize the large majority of people will not get seriously ill from COVID, but it is important to protect the more vulnerable in the population.

“It is wrong for us to believe that what healthy younger people do has no impact on the health of the other members of the community or that it has no impact on serious disease and death from COVID-19,” Harrington said.

An article in The Denver Post indicated that dial levels are negotiable. Why are Eagle and Grand counties still in level orange despite having similar metrics to Routt County and as Commissioners, did you have an opportunity to negotiate on our risk level and if you did, why didn’t you negotiate for us to stay at level orange?

“We now understand that they way the state has implemented the dial framework has been incredibly inconsistent. The conversations that occurred with counties were very different,” Melton said. “We were not given an opportunity to negotiate. We were moved to level red and we received the letter from (state officials) stating as such.”

Melton said they have been trying to resolve the issue and believe it is inequitable treatment of local businesses and they hope to have a remedy to the situation shortly.

Corrigan said he was glad for the question and that it is incredible frustrating that “that kind of misinformation,” referring to the idea that commissioners volunteered to move to level red, “is out there.”

“I suppose that someone may think that that is the case based on some newspaper article that they read, but we flatly did not have an opportunity to negotiate our position on the dial,” Corrigan said.

We’ve been wearing masks since May. If masks are working so well, why the increase in cases?

Smith said there are many different layers of what people should do to protect themselves from the virus and masks are just one of them.

“We do all of those things so that if one of those fails we’ve got that something else to fall back on to protect us. It is not just one thing; it is just not the masks. Sometimes if those things fail, then you might see disease transmission break through because of that failure,” Smith said.

Why do 3-year-olds have to wear masks in Routt County, against Centers for Disease Control and Prevention guidelines?

Currently, the only public health order in Routt County above what the state orders is a mask mandate for children between the ages of three and 11. The CDC does recommend mask wearing for children two years and older.

“Mask use among children age two and older is addressed in the American Academy of pediatrics and also in CDC, so those are those recommendations, and those are the sources that we cited to get that public health order in place,” Smith said. “Having our students in schools wearing masks at those younger ages has actually, I think contributed to the fact that we’ve had really good outcomes in our schools and have been able to have in person learning a lot longer than other school districts that we see statewide.”

Why does the county report case data by seven and 14 days and by collection day of the test, when the data is incomplete due to testing delays?

Harrington said part of it is because it is a standard used across the country. He also said they acknowledge their data on the previous week is not always compete right away but they should not ignore it.

Statistics are part of the reason they use the one- and two-week windows because it allows them to better compare weeks.

The county and the state differ about which day they record a positive test on. The state records a test on the day the new case result comes back, where the county reports it based on the day the test was taken. This does cause delays in getting testing data, but Harrington said it tells them more about the virus in the community.

In a recent New York City study, only 1.3% of COVID cases can be attributed to restaurants. That is New York City and not Routt County. How many cases in Steamboat can be attributed directly to restaurants?

“When we have a positive case, we do contact tracing and so we ask a series of questions of people. Where they have been, who they have hung out with and where they work to really assess where they’ve been in our community,” Smith said. “Some of those activities are easy to recall and some might not think potentially that it is information that we’re looking for.”

Smith said it is a respiratory virus so it can be tough to track exactly where cases are coming from. In instances of household spread, it is pretty clear where the virus came from, but there are cases that they cannot pin down.

“It is not to say they didn’t get it in a restaurant, they could have. They could have gotten it at a grocery store,” Smith said. “Now that this virus is so ubiquitous in our community, meaning we see a lot of community spread right now, that is even getting harder to say, ‘Oh, I went to this place and that is what caused my COVID,’ so it is a very difficult virus.”

Harrington said since the beginning of the pandemic they have focused on not placing blame on businesses for doing what they are supposed to do. He said they have had suspicions about various businesses spreading the virus including restaurants.

“Yes, we’ve had suspicions numerous times every week all along about the association of restaurants as well as other entities. We’ve continued to preach the idea that if you do the right thing no matter where you are, it is not so important about what is happening at which place,” Harrington said. “The absence of documentation of restaurant connections is not the same as the absence of it actually occurring. But I have good faith that the restaurants have been doing a good job. We had a summer here where we had the restaurants more open and we didn’t see what we are seeing now so clearly there are multiple factors involved.”

Overnight visitors to Aspen and the surrounding area, including its four ski mountains, are required to receive a negative COVID-19 result from a test administered within 72-hours of arrival and have been symptom free for 10 days prior to travel or quarantine for 10 days. Would additional public health orders such as this be beneficial for Routt’s overall health and economy?

Smith said tests are that information at that time and many places have put some sort of testing requirement in place to travel. One of the questions it poses to her is who would validate the information?

“Sometimes the burden of having to do some of those checks might be a little bit difficult for some people,” Smith said. “Sometimes a negative test, you could still be exposed after you take that test. It is not clearing you of being free from the virus.”

Melton said she has had conversations with other counties about putting a restriction like this in place. Melton said the question is if these measures work.

“It is easy enough to put these things in a public health order, to say we are doing these things, and the question we need to be asking is are we creating a false sense of security when we do that? Are we actually reducing disease transmission?” Melton said.

She said each county needs to assess what would work for them based on what their own winters look like and what makes sense for them. She said the consensus among the majority of counties she has talked to feel it likely wouldn’t have that much of an effect on transmission.

Commissioners have not discussed putting in place an order like in Pitkin County.

Routt County commissioners make $94,250 a year. When you tell restaurants they can be at 10% are you willing to take only 10% of your own salaries and donate the rest back to the county during this economic crisis?

“That sounds great, finding a way to make other people make sacrifices to level the playing field, but I don’t think that is an appropriate thing to ask of our public officials. We’re working really hard trying to do the best thing for our citizens, to somehow punish us for public health orders that are being implemented to protect the public at large does not make sense,” Corrigan said.

Monger said they have likely earned their salary more this year than any other year.

“We’re trying to have citizen government where people can live on the wages that we make,” Monger said. “That is why we don’t have zero salaries because people that are rich that can afford to be doing this would be the ones who are running.”


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