STEAMBOAT SPRINGS — Steamboat Pilot & Today hosted a virtual town hall panel Dec. 17 with Routt County commissioners Tim Corrigan, Doug Monger and Beth Melton participating along with Routt County Public Health Director Roberta Smith and Dr. Brian Harrington, the county’s chief medical officer.
The panel answered questions from the community about COVID-19. Following the event, which lasted an hour and half, county leaders agreed to answer questions that were not posed due to time constraints. Their responses are included below in a Q&A.
Q: Studies show that taking vitamin D not only helps people’s immune system against COVID but also reduces spread. Also, getting outside has proven to be a good defender against COVID spread. Routt County is generally a healthy county. Why are our health officials not promoting vitamin D and getting outside as a good defense against COVID?
A: The case for vitamin D supplement benefits with COVID-19 infection is, as with all supplements, based more on theory and inference than on direct clinical proof. Vitamin D deficiency has long been associated with immune dysfunction and increased infection risk, and osteoporosis, among other conditions. Average vitamin D levels tend to be lower the farther someone lives from the equator, and during winters. Sun exposure is one way to achieve higher vitamin D levels, but significant skin exposure is needed, and too much sun exposure does carry the risk of increased skin cancer in the future. Getting adequate dietary vitamin D intake is the best way to achieve healthy levels. Fish and mushrooms are examples of foods with higher vitamin D levels. Several foods such as milk are also fortified with vitamin D. Among the supplements that a person can take, I believe that vitamin D has one of the strongest arguments. However, my general preventive health recommendations remain focused on eating a healthy and balanced diet, getting daily exercise, and getting enough sleep. Studies in previous cold and flu seasons have linked adequate sleep as one of the top factors for assuring healthy immune system markers and minimizing seasonal viral illnesses. And yes, being outside in open air reduces transmission of COVID-19 and other viral illness. The CDC and others have long recommended outside exercise in general as being party of a healthy lifestyle. I personally embrace the Blue Zones concepts as a model for health living which also emphasizes the importance of outside activity and exercise.
Q: How many Health Ambassadors have been hired? Do are they deployed? Do they wear uniforms?
Routt County launched its Health Ambassador program this week. Three health ambassadors were hired by the county to conduct inspections and public health education visits to local businesses; respond to questions from community members and visitors through [email protected] and the call line at 970-871-8444; and help disseminate public health information to the public. They will have identification, not uniforms. Many of the health ambassadors have served on the contact tracing team and have been long term members of the Routt County community. Like the contact tracers, names of the health ambassadors are not being shared with the public to protect their safety and privacy. In addition, the health ambassadors will have a critical role in implementing the state’s 5 Star Program for businesses in Routt County.
Q: If the state did not have a public health order and dial framework, what would the county’s public health order look like?
A: The county has had public health orders since the beginning of the pandemic focusing on site mitigation and event protocols for businesses as well as mask wearing. All the public health orders are listed on our website at covid19routtcounty.com/routt-county-public-health-orders. It is hypothetical to say what would have if the state did not have anything, but we would follow the science and the recommendation of our experts in the public health team, as we have done since the beginning of the pandemic.
Q: What are the current flu levels in Routt County?
A: The prevalence of influenza in Routt County is unusually low. Local clinics and the hospital have had almost no positive influenza tests so far. We have had no local hospitalizations related to influenza. We usually see significant numbers of influenza cases by November. Similarly, the state has very low numbers and so far, no long-term care facility outbreaks either, which is atypical. Influenza has been at low levels around the US and the world. Influenza is primary transmitted by sneezing, coughing and speaking, which is similar to COVID-19. Partial herd immunity and the use of influenza vaccines keep influenza somewhat in check most years. But it is no surprise that this year’s extra measures like wearing masks, social distancing, frequent hand washing, and staying home when sick have led to a dramatic drop from our usual rate of influenza cases.
Q: If many small businesses decided to hold off on paying some of their taxes and licensing fees during the lockdown in order to preserve cashflow and to support payroll needs, then why would the county require businesses to be current on these expenses to qualify for relief money? It appears that the relief money is simply a way for the state and county to get themselves paid?
A: The recent business COVID-19 relief grants were created to help businesses with their expenses. A small independent committee came up with a number of questions to score all the applicants who applied for the grants. Being up to date was one of many questions, including being a business established before March and are you locally owned and operated. The other questions can be found here. The business relief money of $773,000 was designed to help struggling businesses.
Q: Why is it that the county residents are asked to not travel and spend Christmas with their families, while we allow an influx of travelers?
A: There are no prohibitions against travel, only recommendations to decrease risk. Any interactions with those outside of your household carry some risk – whether they are in your family or not. For example, the county recommends that all residents continue to follow the Six Commitments to Containment even when they are not in Routt County and all travelers are asked to follow the Six Commitments when they visit Routt County. Routt County’s travel recommendations can be found here. Routt County is a tourist destination and many businesses and their employees depend on tourism to be viable. Colorado as a whole has not shut the borders to any travelers, the request is that anyone traveling to Colorado and counties like Routt County, follow the state and local public health orders.
Q: How long have the commissioners known about the 5-Star program?
A: When Mesa County was granted the ability to implement this program, the Routt County Commissioners immediately began outreach to understand the program and what local options may be available to restaurants. Once the state determined that they would not be allowing other counties to implement a similar program until the state framework was complete, Routt County staff began preparing so that 5 Star could launch in Routt County as soon as it was available. Many of the elements of the Five Star program are already in Routt County’s local public health order that requires businesses to have site mitigation protocols and events to self-certify. The Five Star Program has been reviewed by the state and they have outlined the parameters for how counties can apply. According the state’s press release: “Counties in Level Red are eligible only if a county has had a two-week sustained decline in incidence, percent positivity, and hospitalizations. If approved, certified businesses can operate at Orange capacity levels.” Routt County will continue to pursue the Five Star program which will have benefits for businesses at all levels of the state dial.
Q: Why can people fly sitting next to each other on an airplane but must distance at 6 feet elsewhere?
A: The Federal Aviation Administration makes the guidelines and rules for airports and airlines and has their own recommendations for safety that can be found at flyhealthy.gov/flyhealthy. There is no local or state authority to implement safety protocols on airplanes. Airlines require masks on airplanes and airlines have done an incredible job with air filtration systems to decrease the spread of COVID-19. The public health guidelines recommend masks and distancing in locations like restaurants of six feet because not everyone is wearing a mask. Keeping six feet distance and wearing a mask is the best practice but in some instances that is not possible and that is why other mitigation strategies are used, like air filtration.
Q: Roberta Smith made the comment, “Indoor dining with masks off for a prolonged period of time is a high-risk setting.” However, the statistics do not support this, either at a county level or a national level when compared to other allowable indoor activities. The CDC ranks indoor dining as ‘high-risk’ when compared to take-out and curbside pick-up, but it does not rank it as high-risk when compared to other allowable indoor activities as Ms. Smith’s comments suggested. Do you think that comments such as this have contributed to the perception that restaurants are not safe environments compared to all other businesses that allow patrons indoors?
A: No, Ms. Smith’s comments are based on the science of risk. When people from different households are together for more than 15 minutes with their masks off, risk increases. Public health understands that restaurants are following strict mitigation protocols against COVID-19 and also the food safety guidelines they are required to implement. Public health is trying to reduce risk and therefore prevent the spread of the virus. The CDC outlines the hierarchy of risk at restaurants on its website.
• Lowest Risk: Food service limited to drive-through, delivery, take-out, and curb-side pick up.
• More Risk: Drive-through, delivery, take-out, and curb-side pick up emphasized. On-site dining limited to outdoor seating. Seating capacity reduced to allow tables to be spaced at least 6 feet apart.
• Higher Risk: On-site dining with indoor seating capacity reduced to allow tables to be spaced at least 6 feet apart. And/or on-site dining with outdoor seating, but tables not spaced at least six feet apart.
• Highest Risk: On-site dining with indoor seating. Seating capacity not reduced and tables not spaced at least 6 feet apart.
Q: Dr. Harrington, can you share the discussion happening in your professional circle regarding the Covid early treatment protocol studied and shared by Dr. Paul Merrick and colleagues at Eastern VA Medical School for potentially drastically reducing our hospitalization, long hauler, and death rates?
A: The DuPage Medical Group is a private, large, multispecialty, for-profit, physician-led medical group in Illinois. Dr. Paul Merrick is President and Chairman of the Board. This group, as well as places like the Eastern Virginia Medical School, have promoted supplements such as vitamin D, zinc, vitamin C, and others for preventing and blunting the effects of COVID 19 infection. A key word in the question is “potentially.” There have not been any strong research trials published to prove a significant clinical benefit of supplements with COVID-19, but there are several published articles on commentaries, theoretical analyses, and evaluations of immune markers. Testing theories is one of the key ways we advance medicine, and I applaud groups like them especially if they apply their ideas to proper study and critical outside review. Just because we do not have “a good study” does not mean that a theory is not correct. However, modern medicine is predicated on evidence. As we have already seen in this pandemic, several early theories, such as the use of hydroxychloroquine, have been proven wrong and even harmful. I, and many of my colleagues, follow the evidence-based guidelines promulgated by COVID-19 experts and infectious disease specialists at places like the CDC, John’s Hopkins University, the Mayo Clinic, the University of Colorado Medical Center, and the UCHealth medical system with whom we often work. Most oral supplements are benign. If a person is willing to spend the money and it fits in their belief system to take supplements, that is okay. As I noted in my prior answer regarding vitamin D, I believe it is more important, adequate, and desired to eat a healthy diet that contains essential nutrients, get regular exercise, and get enough sleep.
Q: Will the body’s natural build up of antibodies with the vaccine effect the current long/short COVID test results, since it has been stated that even with the vaccine you could be a carrier and we will need to keep current protocols in place?
A: A reduction is positive test results remains to be seen, but I think it is a fair expectation. I certainly hope so. The Pfizer and Moderna vaccine trials were designed to find out if their vaccines reduce COVID-19 illness, not necessarily infection/carrier status. The Moderna trial did involve some PCR testing after vaccination. Moderna published data demonstrating that fewer persons had positive PCR tests after vaccination in the vaccine arm as we would expect. A key goal of the vaccine ultimately, is to reduce transmission of COVID-19. If the vaccine is successful, we will see fewer cases of COVID-19 infection and illness. I expect that over the next few months we will see a downward trend in our cases and illnesses, and that will be attributed to the vaccine. I also expect, and hope, that as we learn more about the vaccine effects and as vaccination rates climb, we will see prevention protocols change and get easier.
Q: Since we know the new administration is going to ask for a 100-day mask mandate and the local guidelines on masks and gatherings have consistently met strong push back, what can be done to get more cooperation?
A: Our monitoring efforts have actually shown a very high level of participation with mask-wearing protocols. Because mask-wearing has been shown to be so effective, we hope that there will be even more cooperation in the future as more national, state and local leaders in the political, medical, academic, civic and youth sectors come together and lead by example. And it’s more than leaders, we all have a role to play in ending this pandemic. If we wear our masks, wash our hands, stay socially distanced, stay home when we are sick, get tested and limit personal gatherings, we can beat this virus. And when it becomes available to everyone, if we get all get vaccinated, we can achieve herd immunity. If we tell our family, friends and neighbors why we follow the prevention measures and why we will get vaccinated, we have the opportunity to influence others to do the same. So, think of your circle, if you can convince 5, 10, 20 people to follow the Six Commitments to Containment and to get vaccinated when it’s available we will get Routt County on the road to recovery and speed up our return to normal.
Q: What is the vaccination plan for Routt County?
A: What is important to remember is that vaccines are ordered by the federal government and that each state is given an allocation based on their population. Colorado makes up about 1.69% of the U.S. population, and each week the state expects to receive 1.69% of the available vaccines. Routt County gets an allocation from the state based on our population.
Vaccinations started Thursday, Dec. 17 in Routt County for individuals in the state’s Phase 1A group – highest-risk health care workers and individuals. The state’s definition for Phase 1A is people who have direct contact with COVID-19 patients for 15 minutes or more over a 24-hour period and long-term care facility staff and residents. UC Health Yampa Valley Medical Center (YVMC) and Walgreens are partners with Routt County Public Health in ensuring that people that fall in the 1A priority category are vaccinated first.
Colorado’s vaccine prioritization plan has three phases:
• Phase 1A (Winter): Highest-risk health care workers and individuals:
• People who have direct contact with COVID-19 patients for 15 minutes or more over a 24-hour period.
• Long-term care facility staff and residents.
• Phase 1B (Winter): Moderate-risk health care workers and responders:
• Health care workers with less direct contact with COVID-19 patients.
• Workers in home health/hospice, and dental settings.
• EMS, firefighters, police, correctional workers, dispatchers, funeral services, COVID-19 response personnel, and other first responders.
• Phase 2 (Spring): Higher-risk individuals and essential workers:
• People age 65 or older.
• People of any age with obesity, diabetes, chronic lung disease, significant heart disease, chronic kidney disease, cancer, or are immunocompromised.
• People who interact directly with the public at work, such as grocery store workers and school staff.
• People who work in high-density settings like farms and meat-packing plants.
• Workers serving people who live in high-density settings.
• Other health care workers not covered in Phase 1.
• Adults who received a placebo during a COVID-19 vaccine clinical trial.
• Phase 3 (Summer): The general public
There are two different COVID-19 vaccines that will be distributed by the state: the Pfizer vaccine and the Moderna vaccine:
• The Pfizer vaccine is two doses taken 21 days apart and is 95% effective.
• The Moderna vaccine is also two doses, but it is taken 28 days apart and 94.5% effective.
• Both vaccines are more effective than the flu vaccine and comparable to the efficacy rate of the measles component of the MMR vaccine.
To reach Bryce Martin, call 970-871-4206 or email [email protected]